Anorexia Nervosa
Diagnosis (DSM V)
A person must display:
1) Persistent restriction of energy intake leading to significantly low body weight (in context of what is minimally expected for age, sex, developmental trajectory, and physical health) .
2) Either an intense fear of gaining weight or of becoming fat, or persistent behaviour that interferes with weight gain (even though significantly low weight).
3) Disturbance in the way one's body weight or shape is experienced, undue influence of body shape and weight on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.
4) Subtypes:
a) Restricting type
b) Binge-eating/purging type
Note: AN is different from BN in terms of drive. AN is restrictive, BN is overeating.
Clinical Features
1) Post-void weight (minimal clothing)
a. Do urinalysis on specific gravity
b. Post-void because sometimes patients will water-load prior to weighing
2) Height, BMI on percentile chart (depending on age)
3) Lying and standing HR (≠ BP in this case)
a. >30bpm ↑ need to discuss with paeds – ADMIT
b. Normally <10bpm difference
c. ∵ Ability to ↑ stroke volume is impaired with eating disorder ∵ of myocardial atrophy
4) Lying and standing BP
a. >20mmHg ↓ need discuss with paeds – ADMIT
b. Patient to lie flat for 10 minutes, take BP and HR. Then stand up, take pulse manually for a full minute, while BP take on opposite arm
5) If baseline HR<50, need ECG and discuss with paeds team
Poor perfusion, lanugo, pressure areas, s/c fat stores, muscle bulk, cognitive blunting
Investigations
1) Urinalysis (H20 loading or dehydration)
2) Bloods:
a. FBC, UEC, CMP, LFT
b. TSH, T4
c. Iron, B12, Folate, Vit A,D,E (fat soluble vitamins[1])
3) ECG
[1] Fat soluble vitamins are vitamins A,D,E,K
Complications:
o CVS: Myocardial atrophy, mitral valve prolapse, pericardial effusion
o GUT: amenorrhoea, fertility
o Bone: Osteoporosis, growth disturbance, falls risk
o GI: gastroparesis, constipation
o Suicide*
Source
Toronto Notes 2012
Dr Megan Corp 2014
A person must display:
1) Persistent restriction of energy intake leading to significantly low body weight (in context of what is minimally expected for age, sex, developmental trajectory, and physical health) .
2) Either an intense fear of gaining weight or of becoming fat, or persistent behaviour that interferes with weight gain (even though significantly low weight).
3) Disturbance in the way one's body weight or shape is experienced, undue influence of body shape and weight on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.
4) Subtypes:
a) Restricting type
b) Binge-eating/purging type
Note: AN is different from BN in terms of drive. AN is restrictive, BN is overeating.
Clinical Features
1) Post-void weight (minimal clothing)
a. Do urinalysis on specific gravity
b. Post-void because sometimes patients will water-load prior to weighing
2) Height, BMI on percentile chart (depending on age)
3) Lying and standing HR (≠ BP in this case)
a. >30bpm ↑ need to discuss with paeds – ADMIT
b. Normally <10bpm difference
c. ∵ Ability to ↑ stroke volume is impaired with eating disorder ∵ of myocardial atrophy
4) Lying and standing BP
a. >20mmHg ↓ need discuss with paeds – ADMIT
b. Patient to lie flat for 10 minutes, take BP and HR. Then stand up, take pulse manually for a full minute, while BP take on opposite arm
5) If baseline HR<50, need ECG and discuss with paeds team
Poor perfusion, lanugo, pressure areas, s/c fat stores, muscle bulk, cognitive blunting
Investigations
1) Urinalysis (H20 loading or dehydration)
2) Bloods:
a. FBC, UEC, CMP, LFT
b. TSH, T4
c. Iron, B12, Folate, Vit A,D,E (fat soluble vitamins[1])
3) ECG
[1] Fat soluble vitamins are vitamins A,D,E,K
Complications:
o CVS: Myocardial atrophy, mitral valve prolapse, pericardial effusion
o GUT: amenorrhoea, fertility
o Bone: Osteoporosis, growth disturbance, falls risk
o GI: gastroparesis, constipation
o Suicide*
Source
Toronto Notes 2012
Dr Megan Corp 2014