What do you think before that you said: the patient has a psychiatric diagnosis: Part II
DOI:
https://doi.org/10.22517/25395203.25542Keywords:
diagnosis, dyspepsia, irritable bowel syndrome, xerostomia, bariatric surgery, syncope, deglutition disordersAbstract
Patients refer their symptoms in a variety of terms such as: “I am tired”, “my joints hurt”, “my body itches”, “my mouth is dry”, among others. Given these symptoms, the doctor automatically thinks in a limited number of pathologies that are familiar to him, but there are many other causes to these symptoms that are not considered. The lack of knowledge of the doctor causes the patient to be dissatisfied by not having a correct diagnosis and adequate treatment, this leads to multiple visits and the doctor comes to ask himself “will this patient have a psychiatric diagnosis?”. This article lists the frequent causes of these symptoms, describes causes that are rarely suspected and the clinical keys for the doctor to diagnose them. This second part will develop the symptoms: intolerance to food, xerostomia, syncope, dysphagia and manifestations in patients with bariatric surgery.
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Umaña Giraldo HJ, Marín-Medina DS, Arias-Jaramillo DR, López-Posada JA, RodríguezSuárez EL, Gámez-Cárdenas M, Álvarez-Vera T. Qué pensar antes de decir que el paciente tiene un diagnóstico psiquiátrico. Parte I. Rev. Médica Risaralda [Internet]. 27 de octubre de 2019 [citado 1 de agosto de 2024];25(1). Disponible en: https://revistas.utp.edu.co/index.php/revistamedica/article/view/18951
Duncanson KR, Talley NJ, Walker MM, Burrows TL. Food and functional dyspepsia: a systematic review. J Hum Nutr Diet. 2018;31(3):390 407.
Zopf Y, Hahn EG, Raithel M, Baenkler H-W, Silbermann A. The differential diagnosis of food intolerance. Dtsch Arztebl Int. 2009; 106(21):359.
Catassi C, Fasano A. Clinical practice: Celiac disease. N Engl J Med. 2012;367:2419–26.
Pavlovic M, Berenji K, Bukurov M. Screening of celiac disease in Down syndrome-Old and new dilemmas. World J Clin cases. 2017;5(7):264.
Atri D, Furfaro D, Dhaliwal G, Feingold KR, Manesh R. Going from A to Z. N Engl J Med. 2018;378(1):73–9.
Green PHR, Cellier C. Celiac disease. N Engl J Med. 2007;357(17):1731–43.
Bushara KO. Neurologic presentation of celiac disease. Gastroenterology. 2005;128(4):S92–7.
Jackson JR, Eaton WW, Cascella NG, Fasano A, Kelly DL. Neurologic and psychiatric manifestations of celiac disease and gluten sensitivity. Psychiatr Q. 2012;83(1):91–102.
Jung H, Locke III GR, Schleck CD, Zinsmeister AR, Szarka LA, Mullan B, et al. The incidence, prevalence, and outcomes of patients with gastroparesis in Olmsted County, Minnesota, from 1996 to 2006. Gastroenterology. 2009;136(4):1225–33.
McKenzie P, Bielefeldt K. Glass half empty? Lessons learned about gastroparesis. F1000Research. 2018;7:F1000.
Ali T, Hasan M, Hamadani M, Harty RF. Gastroparesis. South Med J. 2007 Mar;100(3):281-6.
Hasler WL. Gastroparesis: pathogenesis, diagnosis and management. Nat Rev Gastroenterol Hepatol. 2011;8(8):438–53.
Hasler WL. Gastroparesis–current concepts and considerations. Medscape J Med. 2008;10(1):16.
Oh JJ, Kim CH. Gastroparesis after a presumed viral illness: clinical and laboratory features and natural history. Mayo Clin Proc. 1990; 65(5):636-42.
Catassi C, Bai J, Bonaz B, Bouma G, Calabrò A, Carroccio A, et al. Non-celiac gluten sensitivity: the new frontier of gluten related disorders. Nutrients. 2013;5(10):3839–53.
Leonard MM, Sapone A, Catassi C, Fasano A. Celiac disease and nonceliac gluten sensitivity: a review. Jama. 2017;318(7):647–56.
Mansueto P, Seidita A, D’Alcamo A, Carroccio A. Non-celiac gluten sensitivity: literature review. J Am Coll Nutr. 2014;33(1):39–54.
Verdu EF, Armstrong D, Murray JA. Between celiac disease and irritable bowel syndrome: the “no man’s land” of gluten sensitivity. Am J Gastroenterol. 2009;104(6):1587.
Olson SH, Mignone L, Nakraseive C, Caputo TA, Barakat RR, Harlap S. Symptoms of ovarian cancer. Obstet Gynecol. 2001;98(2):212–7.
Vine MF, Ness RB, Calingaert B, Schildkraut JM, Berchuck A. Types and duration of symptoms prior to diagnosis of invasive or borderline ovarian tumor. Gynecol Oncol. 2001;83(3):466–71.
Goff B. Symptoms associated with ovarian cancer. Clin Obstet Gynecol. 2012;55(1):36–42.
Jayson GC, Kohn EC, Kitchener HC, Ledermann JA. Ovarian cancer. Lancet. 2014;384(9951):1376–88.
Okimoto K, Arai M, Ishigami H, Saito K, Minemura S, Maruoka D, et al. A prospective study of eosinophilic esophagitis and the expression of tight junction proteins in patients with gastroesophageal reflux disease symptoms. Gut Liver. 2018;12(1):30.
Furuta GT, Katzka DA. Eosinophilic esophagitis. N Engl J Med. 2015;373(17):1640–8.
Vitellas KM, Bennett WF, Bova JG, Johnston JC, Caldwell JH, Mayle JE. Idiopathic eosinophilic esophagitis. Radiology. 1993;186(3):789–93.
Richter JE, Falk GW, Vaezi MF. Helicobacter pylori and gastroesophageal reflux disease: the bug may not be all bad. Am J Gastroenterol. 1998;93(10):1800.
Rollán A, Giancaspero R, Fuster F. Efectos de la erradicación de Helicobacter pylori sobre el reflujo gastroesofágico patológico en pacientes con úlcera duodenal. Rev Med Chil. 2002;130(2):153–9.
Xie T, Cui X, Zheng H, Chen D, He L, Jiang B. Meta-analysis: eradication of Helicobacter pylori infection is associated with the development of endoscopic gastroesophageal reflux disease. Eur J Gastroenterol Hepatol. 2013;25(10):1195–205.
Iijima K, Koike T, Shimosegawa T. Reflux esophagitis triggered after Helicobacter pylori eradication: a noteworthy demerit of eradication therapy among the Japanese? Front Microbiol. 2015;6:566.
Halliez MCM, Buret AG. Extra-intestinal and long term consequences of Giardia duodenalis infections. World J Gastroenterol WJG. 2013; 19(47):8974.
Cantey PT, Roy S, Lee B, Cronquist A, Smith K, Liang J, et al. Study of nonoutbreak giardiasis: novel findings and implications for research. Am J Med. 2011;124(12):1175-e1.
Robertson LJ, Hanevik K, Escobedo AA, Mørch K, Langeland N. Giardiasis–why do the symptoms sometimes never stop? Trends Parasitol. 2010;26(2):75–82.
Rana S V, Bhasin DK, Vinayak VK. Lactose hydrogen breath test in Giardia lamblia-positive patients. Dig Dis Sci. 2005;50(2):259–61.
Sattianayagam P, Hawkins P, Gillmore J. Amyloid and the GI tract. Expert Rev Gastroenterol Hepatol. 2009;3(6):615–30.
Rowe K, Pankow J, Nehme F, Salyers W. Gastrointestinal amyloidosis: review of the literature. Cureus. 2017;9(5): e1228.
Ebert EC, Nagar M. Gastrointestinal manifestations of amyloidosis. Am J Gastroenterol. 2008;103(3):776.
Cowan AJ, Skinner M, Seldin DC, Berk JL, Lichtenstein DR, O’Hara CJ, et al. Amyloidosis of the gastrointestinal tract: a 13-year, single-center, referral experience. Haematologica. 2013;98(1):141–6.
Napthali K, Koloski N, Talley NJ. Abdominal migraine. Cephalalgia. 2016;36(10):980–6.
Bhattacharyya N. The Prevalence of Dysphagia among Adults in the United States. Otolaryngol Neck Surg. 2014;151(5):765–9.
Cho SY, Choung RS, Saito YA, Schleck CD, Zinsmeister AR, Locke III GR, et al. Prevalence and risk factors for dysphagia: a USA community study. Neurogastroenterol Motil. 2015;27(2):212–9.
Dresser L, Wlodarski R, Rezania K, Soliven B. Myasthenia Gravis: Epidemiology, Pathophysiology and Clinical Manifestations. J Clin Med. 2021;10(11):2235.
Ramalho S, Pereira S, Oliveira P, Morais H, Lima N, Condé A. Dysphagia as a presenting symptom of myasthenia gravis—case report. Int J Otolaryngol Head Neck Surg. 2014;3(01):23.
Llabrés M, Molina-Martinez FJ, Miralles F. Dysphagia as the sole manifestation of myasthenia gravis. J Neurol Neurosurg Psychiatry. 2005;76(9):1297–300.
Colton–Hudson A, Koopman WJ, Moosa T, Smith D, Bach D, Nicolle M. A prospective assessment of the characteristics of dysphagia in myasthenia gravis. Dysphagia. 2002;17(2):147–51.
Mugii N, Hasegawa M, Matsushita T, Hamaguchi Y, Oohata S, Okita H, et al. Oropharyngeal dysphagia in dermatomyositis: associations with clinical and laboratory features including autoantibodies. PLoS One. 2016;11(5):e0154746.
Joshi D, Mahmood R, Williams P, Kitchen P. Dysphagia secondary to dermatomyositis treated successfully with intravenous immunoglobulin: a case report. Int Arch Med. 2008;1(1):12.
Eyigor S. Dysphagia in rheumatological disorders. World J Rheumathology. 2013;3(3):45– 50.
Destek S, Gul VO, Ahioglu S, Tatar Z, Erbil Y. A rare cause of chronic dysphagia: eosinophilic esophagitis. J Surg case reports. 2014;2014(9): rju096.
Andrade C de M, Câmara ACJ da, Nunes DF, Guedes PM da M, Pereira WO, Chiari E, et al. Chagas disease: morbidity profile in an endemic area of Northeastern Brazil. Rev Soc Bras Med Trop. 2015;48(6):706–15.
Nascimento WV do, Cassiani R de A, Dantas RO. Disfagia em pacientes com doença de Chagas e divertículo de Zenker. Rev Soc Bras Fonoaudiol. 2010;15(2):277–81.
Bern C. Chagas’ disease. N Engl J Med. 2015;373(5):456–66.
Martinez EJ, Nord HJ, Cooper BG. Significance of solitary and multiple esophageal ulcers in patients with AIDS. South Med J 1995; 88: 626–629.
Tang H, Mao Y, Shi CX, Han J, Wang L, Xu J, et al. Baseline CD4 cell counts of newly diagnosed HIV cases in China: 2006–2012. PLoS One. 2014;9(6):e96098.
Bonacini M, Young T, Laine L. The causes of esophageal symptoms in human immunodeficiency virus infection: a prospective study of 110 patients. Arch Intern Med. 1991;151(8):1567–72.
Lee HH, Seo HG, Kim K, Lee SH, Lee WH, Oh B-M, et al. Characteristics of early oropharyngeal dysphagia in patients with multiple system atrophy. Neurodegener Dis. 2018;18(2–3):84–90.
Fanciulli A, Wenning GK. Multiple-system atrophy. N Engl J Med. 2015;372(3):249–63.
Burman KD, Wartofsky L. Thyroid nodules. N Engl J Med. 2015;373(24):2347–56.
Lawrence Jr W, Kaplan BJ. Diagnosis and management of patients with thyroid nodules. J Surg Oncol. 2002;80(3):157–70.
Popoveniuc G, Jonklaas J. Thyroid Nodules. Med Clin North Am [Internet]. 2012;96(2):329–49.
Novacek G. Plummer-vinson syndrome. Orphanet J Rare Dis. 2006;1(1):36.
Brown RH, Al-Chalabi A. Amyotrophic lateral sclerosis. N Engl J Med. 2017;377(2):162–72.
Onesti E, Schettino I, Gori MC, Frasca V, Ceccanti M, Cambieri C, et al. Dysphagia in amyotrophic lateral sclerosis: Impact on patient behavior, diet adaptation, and riluzole management. Front Neurol. 2017;8:94.
Marangoni RG, Rocha LF, Del Rio APT, Yoshinari NH, Marques-Neto JF, Sampaio-Barros PD. Systemic sclerosis sine scleroderma: distinct features in a large Brazilian cohort. Rheumatology. 2013;52(8):1520–4.
Shreiner AB, Murray C, Denton C, Khanna D. Gastrointestinal Manifestations of Systemic Sclerosis. J scleroderma Relat Disord. 2016/10/18. 2016;1(3):247–56.
Brandt N. Medications and dysphagia: how do they impact each other? Nutr Clin Pract. 1999;14:S27–30.
Schwemmle C, Jungheim M, Miller S, Kühn D, Ptok M. Medikamenteninduzierte Dysphagien : Ein Überblick [Medication-induced dysphagia : A review]. HNO. 2015;63(7):504-10.
Joanna NDY, Thomson WM. Dry mouth–an overview. Singapore Dent J. 2015;36:12–7.
Opriţă R, Opriţă B, Berceanu D, Diaconescu IB. Overview of IgG4–Related Disease. J Med Life. 2017;10(4):203.
Puxeddu I, Capecchi R, Carta F, Tavoni AG, Migliorini P, Puxeddu R. Salivary Gland Pathology in IgG4-Related Disease: A Comprehensive Review. J Immunol Res [Internet]. 2018 Apr 1;2018:6936727.
Hermet M, André M, Kémény JL, Le Guenno G, Déchelotte P, Guettrot-Imbert G, et al. Is IgG4-related disease a cause of xerostomia? A cohort study of 60 patients. Int J Rheumatol. 2012;2012.
Mortazavi H, Baharvand M, Movahhedian A, Mohammadi M, Khodadoustan A. Xerostomia due to systemic disease: a review of 20 conditions and mechanisms. Ann Med Health Sci Res. 2014;4(4):503–10.
Bargagli E, Prasse A. Sarcoidosis: a review for the internist. Intern Emerg Med. 2018;13(3):325–31.
Busato IMS, Thomaz M, Toda AI, Alanis DGP, França BHS, de Lima AAS, et al. Prevalence and impact of xerostomia on the quality of life of people living with HIV/AIDS from Brazil. Spec Care Dent. 2013;33(3):128–32.
Yrma S, Rita N, Alexis M, Neira C, Roberto G, Ivette S. Condiciones de saludenfremedad bucal en pacientes adultos VIH/SIDA. Acta odontológica Venez. 2008;46(2):1–7.
Ramos Casals M. El Virus de la hepatitis C como agente causal de enfermedades autoinmune. Med Integr Med Prev y Asist en atención primaria la salud. 2002;39(7):295–6.
García Ferrera WO, Nodarse Cuní H, Moredo Romo E. Manifestaciones Extrahepáticas de la Infección por el Virus de la Hepatitis C. Rev Gastroenterol del Perú. 2009;29(3):254–61.
Cabo OEBR, Acedo GT. Papel del otorrinolaringólogo en el diagnóstico y seguimiento de pacientes con vasculitis primarias. Reumatol Clínica. 2011;7:7–11.
Rice DH. Chronic inflammatory disorders of the salivary glands. Otolaryngol Clin North Am. 1999;32(5):813–8.
Montoya CL, Sierra M, Vidal A. enfermedad de injerto cutáneo contra huésped. Rev la Asoc Colomb Dermatología y Cirugía Dermatológica. 2016;24(2):90–102.
Mehanna H, McQueen A, Robinson M, Paleri V. Salivary gland swellings. Bmj. 2012;345.
Kessler AT, Bhatt AA. Review of the major and minor salivary glands, part 1: anatomy, infectious, and inflammatory processes. J Clin Imaging Sci. 2018;8.
Guevara C. Estado de la cirugía bariátrica en Colombia [Internet]. El Hospital. 2016 [citado el 25 Enero 2024]. p. 2. Available from: http://www.elhospital.com/temas/Estado-de-lacirugia-bariatrica-en-Colombia+114301
Chaves Y da S, Destefani AC. Pathophysiology, diagnosis and treatmentof dumping syndrome and its relation to bariatric surgery. ABCD Arq Bras Cir Dig (São Paulo). 2016;29:116–9.
Ukleja A. Dumping syndrome: pathophysiology and treatment. Nutr Clin Pract. 2005;20(5):517–25.
Cui Y, Elahi D, Andersen DK. Advances in the etiology and management of hyperinsulinemia hypoglycemia after Roux-en-Y gastric bypass. J Gastrointest Surg. 2011;15(10):1879–88.
Hu Y, Kim H-I, Hyung WJ, Song KJ, Lee JH, Kim YM, et al. Vitamin B12 deficiency after gastrectomy for gastric cancer: an analysis of clinical patterns and risk factors. Ann Surg. 2013;258(6):970–5.
Vargas-Ruiz AG, Hernández-Rivera G, Herrera MF. Prevalence of iron, folate, and vitamin B12 deficiency anemia after laparoscopic Roux en-Y gastric bypass. Obes Surg. 2008;18(3):288–93.
Bennett SE, Schmitt WP, Stanford FC, Baron JM. Case 22-2018: A 64-year-old man with progressive leg weakness, recurrent falls, and anemia. N Engl J Med. 2018;379(3):282–9.
Duncan A, Yacoubian C, Watson N, Morrison I. The risk of copper deficiency in patients prescribed zinc supplements. J Clin Pathol. 2015;68(9):723–5.
Urtiaga S, Terrero R, Malumbres M, Pinel A. Mielopatía por déficit de cobre: la gran simuladora. Neurol (Barc, Ed impr). 2018;278–81.
Amaya García M, Vilchez López FJ, Campos Martín C, Sánchez Vera P, Pereira Cunill JL. Micronutrientes en cirugía bariátrica. Nutr Hosp. 2012;27(2):349–61.
Batalla A, Gutiérrez-González E. Corkscrew-like hair and perifollicular purpura as a vitamin C deficiency sign. Med Clin (Barc). 2013;141(11):e21–e21.
Bloomberg RD, Fleishman A, Nalle JE, Herron DM, Kini S. Nutritional deficiencies following bariatric surgery: what have we learned? Obes Surg. 2005;15(2):145–54.
Saliba W, El Fakih R, Shaheen W. Heart failure secondary to selenium deficiency, reversible after supplementation. Int J Cardiol. 2010;141(2):e26–7.
Winters J, Niespodzany E, Kini TA, Al Othman B, Lee AG. Rapid same-day resolution of internuclear ophthalmoplegia in Wernicke encephalopathy following parenteral high dose thiamine. Can J Ophthalmol. 2020;55(2):e69–70.
Da Silva RMFL. Syncope: epidemiology, etiology, and prognosis. Front Physiol. 2014;5:471.
Cheshire WP Jr. Syncope. Continuum (Minneap Minn). 2017;23(2, Selected Topics in Outpatient Neurology):335-358.
Peinado Peinado R. Presíncope:¿ un síntoma con igual significado pronóstico que el síncope? Rev Española Cardiol. 2004;57(07):613–6.
Zanasi A, Tincani E, Evandri V, Giovanardi P, Bertolotti M, Rioli G. Meal-induced blood pressure variation and cardiovascular mortality in ambulatory hypertensive elderly patients: preliminary results. J Hypertens. 2012;30(11):2125–32.
Luciano GL, Brennan MJ, Rothberg MB. Postprandial hypotension. Am J Med. 2010;123(3):281-e1.
Onrot J, Goldberg MR, Biaggioni I, Hollister AS, Kincaid D, Robertson D. Hemodynamic and humoral effects of caffeine in autonomic failure: therapeutic implications for postprandial hypotension. N Engl J Med. 1985;313(9):549–54.
Jansen RW, Lipsitz LA. Postprandial hypotension: epidemiology, pathophysiology, and clinical management. Ann Intern Med. 1995 Feb 15;122(4):286-95.
Morrone D, Morrone V. Acute pulmonary embolism: focus on the clinical picture. Korean Circ J. 2018;48(5):365–81.
Keller K, Beule J, Balzer JO, Dippold W. Syncope and collapse in acute pulmonary embolism. Am J Emerg Med. 2016;34(7):1251– Dubrey SW, Hawkins PN, Falk RH. Amyloid diseases of the heart: assessment, diagnosis, and referral. Heart. 2011;97(1):75–84.
Shin SC, RobinsonPapp J. Amyloid neuropathies. Mt Sinai J Med A J Transl Pers Med. 2012;79(6):733–48.
Rodríguez Gómez F, Martínez Marcos FJ, Rodríguez Gómez E, Sobrino Márquez M, Conde García J, Pujol de la Llave E. Insuficiencia cardiaca con patrón de pseudoinfarto en el electrocardiograma como forma de presentación de amiloidosis. Emergencias (St Vicenç dels Horts). 2004;33–6.
Kitamura K, Kangawa K, Kawamoto M, Ichiki Y, Nakamura S, Matsuo H, et al. Adrenomedullin: a novel hypotensive peptide isolated from human pheochromocytoma. Biochem Biophys Res Commun. 1993;192(2):553–60.
Ionescu CN, Sakharova O V, Harwood MD, Caracciolo EA, Schoenfeld MH, Donohue TJ. Cyclic rapid fluctuation of hypertension and hypotension in pheochromocytoma. J Clin Hypertens. 2008;10(12):936–40.
Barbot M, Ceccato F, Zilio M, Albiger N, Sigon R, Rolma G, et al. Cardiovascular autonomic dysfunction in patients with idiopathic diabetes insipidus. Pituitary. 2018;21(1):50–5. 112. Bancos I, Hahner S, Tomlinson J, Arlt W. Diagnosis and management of adrenal insufficiency. lancet Diabetes Endocrinol. 2015;3(3):216–26.
Kutlubaev MA, Xu Y, Manchaiah V, Zou J, Pyykkö I. Vestibular drop attacks in Ménière’s disease: A systematic review and meta analysis of frequency, correlates and consequences. J Vestib Res. 2022;32(2):171-182.
Ramirez JAC, Hernandez JPPO, Medina DSM. Polifarmacia y prescripción de medicamentos potencialmente no apropiados en ancianos. Rev médica Risaralda. 2015;21(2):52-57.
Zalewski P, Słomko J, Zawadka-Kunikowska M. Autonomic dysfunction and chronic disease. Br Med Bull. 2018; 128(1):61-74.
Allan LM. Diagnosis and management of autonomic dysfunction in dementia syndromes. Curr Treat Options Neurol. 2019;21(8):1–11.
Idiáquez J, Idiáquez JF, Benarroch E. Evaluación clínica de las Disautonomías. Rev Chil Neuropsiquiatr. 2020;58(4):324–36.
Fich F, Chahuán M, Farías M, Cárdenas C, Abarzúa Á, Araya G, et al. Manifestaciones cutáneas de amiloidosis sistémica como clave diagnóstica: Caso clínico. Rev Med Chil. 2012;140(4):499–502.
Gertz MA, Dispenzieri A. Systemic amyloidosis recognition, prognosis, and therapy: a systematic review. Jama. 2020;324(1):79–89.
García-Pavía P, Tomé-Esteban MT, Rapezzi C. Amiloidosis. También una enfermedad del corazón. Rev Española Cardiol. 2011;64(9):797–808.
Turiño Sarduy MI, Colomé González T, Fuentes Guirola E, Palmas Mora S. Síntomas y enfermedades asociadas al climaterio y la menopausia. Medicentro Electrónica. 2019;23(2):116–24.
Davis SR, Lambrinoudaki I, Lumsden M, Mishra GD, Pal L, Rees M, et al. Menopause. Nat Rev Dis Prim [Internet]. 2015;1(1):15004.
Arroyo C, Nadia P, Elena S. Hipogonadismo asociado a edad avanzada. Rev Mex Urol. 2011;71(6):331–7.
Raj SR. The postural tachycardia syndrome (POTS): pathophysiology, diagnosis & management. Indian Pacing Electrophysiol J. 2006;6(2):84.
Wells R, Spurrier AJ, Linz D, Gallagher C, Mahajan R, Sanders P, et al. Postural tachycardia syndrome: current perspectives. Vasc Health Risk Manag. 2018;14:1.
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