Fatigue and Associated Conditions

Fatigue with Hypothyroidism

• Symptoms:
  • Fatigue, decreased energy, dizziness
  • Hair loss, constipation, weight gain
  • Dry skin & brittle nails, pallor
  • Insomnia, depression, cold intolerance
  • Irregular menses, decreased exercise tolerance
  • Shortness of breath (SOB) on exertion, hoarseness
  • Sleep apnea due to macroglossia
  • Weakness, cramps, myalgias
  • Brain fog, thinning of lateral third of eyebrow
• General/Vitals: Bradycardia, hypertension (HTN), low temperature
• Labs:
  • CBC, CMP, Lipid Panel, TSH, free and total T3 and T4, Anti-TPO and/or Thyroglobulin Ab, rT3
• Imaging/Referrals:
  • Fine-needle aspiration biopsy if nodules suspected
• Lab Findings:
  • Refractory macrocytic or normocytic anemia, hypokalemia, increased LDH, elevated CPK, elevated cholesterol, LDL, and TG
  • Elevated TSH, low fT3/fT4, decreased rT3, elevated Anti-TPO/Thyroglobulin Ab

Fatigue with Adrenocortical Insufficiency

• Symptoms:
  • Fatigue, high stress, flat affect emotionally
  • Weight loss, salt cravings, GI symptoms (alternating constipation and diarrhea)
  • Decreased sex hormones (decreased libido, erectile dysfunction, cycle abnormalities in females)
• Vitals: Hypotension (especially orthostatic), hyperpigmentation
• Labs:
  • Fasting CMP (hyponatremia, hyperkalemia, hypoglycemia)
  • Fasting AM serum cortisol (low), Salivary cortisol X4 (low total daily)
  • ACTH stimulation test

Fatigue with Major Depressive Disorder

• Symptoms:
  • Decreased interest/apathy, fatigue, flat affect
  • Hyperinsomnia, weight gain, suicidal ideation, stress, decreased appetite
• Labs: CBC, TSH, Vit D, B12, CMP, Salivary cortisol, ACTH stimulation test
• Assessment: PHQ9 questionnaire

Fatigue with Mononucleosis

• Symptoms:
  • Fatigue/malaise, headache, sore throat, swelling around neck
  • Fever, temperature fluctuations
• Labs: CBC, CMP w/LFT, Rapid Strep, Monospot test, EBV titer
• Imaging/Referrals: Abdominal US if splenomegaly, possible hepatomegaly

Fatigue with Anemia

• Symptoms:
  • Fatigue, weakness, dizziness, dyspnea on exertion
  • Pallor, palpitations, brittle nails, pruritis (Fe Def)
• Labs: CBC w/differential, CMP, Ferritin, Serum Iron, TIBC, Serum B12, Serum folate, TSH
• Imaging/Referrals: Colonoscopy, Peripheral blood smear

Abdominal Pain and Associated Conditions

Abdominal Cancer

• Symptoms:
  • Abdominal pain, mass in abdomen, anorexia, weight loss, night sweats
  • Jaundice (possible Liver cancer)
• Labs: CBC, CMP w/ LFT, FOB, CEA
• Imaging/Referrals: EGD with biopsy, CT or MRI

Diverticulitis

• Symptoms:
  • Intermittent abdominal pain (LLQ), mass, rigidity, constipation
  • Fever, nausea/vomiting, loose bowel movement, blood in stool
• Labs: CBC, CMP, Lipase/Amylase, CRP, UA, FOB
• Imaging/Referrals: Abdominal CT, Colonoscopy

Appendicitis

• Symptoms:
  • RLQ pain, dull abdominal discomfort, fever, chills, anorexia
• Labs: CBC, UA
• Imaging/Referrals: Abdominal CT with contrast

Acute Pancreatitis

• Symptoms:
  • Intense epigastric pain, N/V, anorexia, fever
• Labs: CBC, CMP, Amylase, Lipase, Lipid Panel, CRP
• Imaging/Referrals: Abdominal US

Acute Gastritis

• Symptoms:
  • Epigastric pain, burning, gnawing pain
  • N/V, possible hematemesis, melena
• Labs: CBC, CMP, H. pylori, Serum MMA, Homocysteine, B12, FOB
• Imaging/Referrals: Upper Endoscopy & biopsy

Gastric Ulcer

• Symptoms:
  • Gnawing/burning epigastric pain, worse with food, better with antacids
  • N/V, early satiety, anorexia/weight loss
• Labs: CBC, CMP, H. pylori testing, FOB, Amylase
• Imaging/Referrals: Endoscopy

Duodenal Ulcer

• Symptoms:
  • Gnawing/burning epigastric pain, better initially with food
• Labs: CBC, CMP, H. pylori, FOB, Amylase
• Imaging/Referrals: Endoscopy

Hepatitis

• Symptoms:
  • RUQ pain, jaundice, nausea, vomiting, pruritis
• Labs: CBC w/ diff, CMP w/ LFT, Acute viral hepatitis panel
• Imaging/Referrals: Ultrasound (US)

Cholelithiasis w/ Cholangitis

• Symptoms:
  • RUQ pain, jaundice, nausea, reduced appetite
• Labs: CBC w/ diff, CMP w/ LFT, Amylase/lipase assay
• Imaging/Referrals: Transabdominal US

Cholelithiasis

• Symptoms:
  • Sharp RUQ pain, Anorexia, N/V
• Labs: CBC, CMP w/ LFT, Lipase/amylase, UA
• Imaging/Referrals: Abdominal US, HIDA scan

Acute Cholecystitis

• Symptoms:
  • Sharp or aching RUQ pain, nausea/vomiting, jaundice, fever
• Labs: CBC w/ diff, CMP w/ LFT, Amylase/lipase assay, U/A
• Imaging/Referrals: RUQ US

Cirrhosis

• Symptoms:
  • RUQ pain, nausea, jaundice, fatigue
• Labs: CBC w/ diff, CMP w/ LFT
• Imaging/Referrals: Transabdominal US