Physical Examination

General Appearance: Muscle wasting, cachexia. Signs of dehydration. Note whether the patient appears ill, well, or malnourished.

Vital Signs: Pulse (bradycardia), BP, respiratory rate, temperature (hypothermia).

Skin: Pallor, jaundice, hair changes, skin laxity, cheilosis, dermatitis (Pellagra).

HEENT: Dental erosions from vomiting, oropharyngeal lesions, thyromegaly, glossitis, temporal wasting, supraclavicular adenopathy (Virchow's node).

Chest: Rhonchi, barrel shaped chest.

Heart: Murmurs, displaced PMI.

Abdomen: Scars, decreased bowel sounds, tenderness, hepatomegaly splenomegaly. Periumbilical adenopathy, palpable masses.

Extremities: Edema, muscle wasting, lymphadenopathy, skin abrasions on fingers.

Neurologic: Decreased sensation, poor proprioception.

Rectal: Occult blood, masses.

Labs: CBC, electrolytes, protein, albumin, pre-albumin, transferrin, thyroid studies, LFTs, toxicology screen.

Differential Diagnosis: Inadequate caloric intake, peptic ulcer, depression, anorexia nervosa, dementia, hy-per/hypothyroidism, cardiopulmonary disease, narcotics, diminished taste, diminished olfaction, poor dental hygiene (loose dentures), cholelithiasis, malignancy (gastric carcinoma), gastritis, hepatic or renal failure, infection, alcohol abuse, AIDS.

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