Anorexia Nervosa
Definition
Specific Type
Epidemiology
Aetiology
Clinical Features
Triad: Fasting, amenorrhoea, hyperacitivity
Symptoms
SCOFF tool:
S ick: Do you make yourself sick because you feel uncomfortably full?
C ontrol: Do you worry you have lost control over how much you eat?
O ne stone/6.5kg: Have you recently lost more than one stone (6.5kg) in a 3 month period?
F at: Do you believe yourself to be fat when other people say you are thin?
F ood: Would you say that food dominates your life?
Signs
Management
Source
Toronto Notes 2012
Dr Megan Corp 2014
- For Paediatric AN, click here
- Refusal to maintain body weight at or above a minimally normal weight for age and height
- Intense fear of gaining weight or becoming fat, even though underweight
- Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight
- In postmenarcheal females, amenorrhoea, i.e. the absence of at least three consecutive menstrual cycles
Specific Type
- Restricting (no binge-eating/ purging)
- Binge-eating/purging
Epidemiology
- F>M; 10:1
- Most common 14-18y
Aetiology
- Genetics
- Prenatal complications
- Social/ cultural stressors
Clinical Features
Triad: Fasting, amenorrhoea, hyperacitivity
Symptoms
- Deteriorating mood
- Isolation
- Trouble concentrating due to thoughts about food and weight
- Poor sleep
SCOFF tool:
S ick: Do you make yourself sick because you feel uncomfortably full?
C ontrol: Do you worry you have lost control over how much you eat?
O ne stone/6.5kg: Have you recently lost more than one stone (6.5kg) in a 3 month period?
F at: Do you believe yourself to be fat when other people say you are thin?
F ood: Would you say that food dominates your life?
Signs
- Lanugo (baby like hair) on face and limbs. NOTE: not hirsutism
- Malnutrition
- Bradycardic (50-60)
- Hypotensive (90/60)
- Knuckle calluses
- Erosion of teeth
Management
- Admit to hospital if: <65% of standard body weight ( <85% of standard body weight for adolescents), hypovolemia requiring intravenous fluid, heart rate <40 bpm, abnormal serum chemistry or if actively suicidal
- Aim to gain 200-300g/day
- Psychotherapy (individual/group/family)
- Monitor for complications of AN
- Monitor for refeeding syndrome (↓ serum K, PO4, Mg)
Source
Toronto Notes 2012
Dr Megan Corp 2014