Fatigue

Fatigue: Excerpt from In a Page: Signs and Symptoms

Fatigue is a very common, although nonspecific, presenting symptom that refers to the sensation of exhaustion during or after usual activities, or a feeling of inadequate energy to begin these activities. Fatigue is a difficult clinical complaint because there are many possible explanations. This difficulty is compounded by the subjective nature of the complaint and the potential seriousness of some of the etiologies. A thorough history and physical exam are crucial in narrowing down the differential and identifying serious causes.

Differential Diagnosis

• Infectious
  –Acute viral or bacterial infection
  –Chronic infection (e.g., subacute bacterial endocarditis, osteomyelitis, tuberculosis, HIV, viral hepatitis, mononucleosis)

Workup and Diagnosis

• Complete history and physical exam are essential, including screening for malignancy, chronic infection, chronic cardiopulmonary disease, and psychiatric disease
• Initial workup may include CBC, chemistries, glucose, calcium, urinalysis, liver function studies, TSH, stool guaiac, and age-appropriate cancer screening (e.g., PAP smear, mammography, flexible sigmoidoscopy, PSA)
• Further testing based on history and physical findings may include chest X-ray (for dyspnea, cough, abnormal lung exam), ECG (for chest pain, dyspnea), echocardiogram (heart murmur), appropriate cultures and/or serology if infection is suspected (e.g., PPD, HIV, hepatitis), malignancy workup, pregnancy test, ANA, ESR, RF, and Lyme titers
• Further testing based on abnormal initial labs may include anemia workup (reticulocyte count, iron studies, vitamin B₁₂ and folate levels, hemoglobin electrophoresis), hepatitis workup (GGTP, viral hepatitis serologies, ultrasound of the liver), renal ultrasound, bone marrow biopsy, colonoscopy, and thyroid function tests
• Appropriate imaging studies based on initial workup may include head CT/MRI, abdominal ultrasound or CT, cardiac stress testing, bone X-rays and/or bone scan

Treatment

• Treatment is targeted at specific underlying medical problems, if determined (e.g., thyroid disease, chronic infection, malignancy)
• Stop or change offending medications
• Consider trial of antidepressant therapy and/or cognitive behavioral psychiatric therapy
• Regularly scheduled physical activity
• Improve sleep hygiene
• Referral to support groups
• Discontinue offending medications
• Chronic fatigue syndrome and fibromyalgia are often treated with supportive care, healthy diet, moderate exercise, and low-dose antidepressants
• Weight loss for obesity

Book Source Details

• Book Title: In a Page: Signs and Symptoms
• Author(s): Scott Kahan, Ellen G. Smith
• Year of Publication: 2004
• Copyright Details: In a Page: Signs and Symptoms, Copyright © 2004 Lippincott Williams & Wilkins.

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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: In a Page: Signs and Symptoms Authors: Scott Kahan, Ellen G. Smith Publisher: Lippincott Williams & Wilkins Copyright: 2004 ISBN: 1-4051-0368-X

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