| ID | 22 |
|---|---|
| Name | ANOREXIA |
| Cause | Causes: 1. Psychic- viz. anorexia nervosa, bulimia nervosa, emotional disturbances. 2. Organic- carcinoma of stomach & pancreas; pituitary insufficiency etc. 3. Viral hepatitis and other form of chronic liver diseases. 4. Infection diseases and fever. 5. As a side effect of many drugs. 6. Alcoholic excess; drug addiction e.g. cocaine. 7. Faulty feeding etc. |
| Signs Symptoms | Physical signs and symptoms of anorexia may include: Extreme weight loss or not making expected developmental weight gains Thin appearance Abnormal blood counts Fatigue Insomnia Dizziness or fainting Bluish discoloration of the fingers Hair that thins, breaks or falls out Soft, downy hair covering the body Absence of menstruation Constipation and abdominal pain Dry or yellowish skin Intolerance of cold Irregular heart rhythms Low blood pressure Dehydration Swelling of arms or legs Eroded teeth and calluses on the knuckles from induced vomiting Emotional and behavioral signs and symptoms may include: Preoccupation with food, which sometimes includes cooking elaborate meals for others but not eating them Frequently skipping meals or refusing to eat Denial of hunger or making excuses for not eating Eating only a few certain "safe" foods, usually those low in fat and calories Adopting rigid meal or eating rituals, such as spitting food out after chewing Not wanting to eat in public Lying about how much food has been eaten Fear of gaining weight that may include repeated weighing or measuring the body Frequent checking in the mirror for perceived flaws Complaining about being fat or having parts of the body that are fat Covering up in layers of clothing Flat mood (lack of emotion) Social withdrawal Irritability Insomnia Reduced interest in sex |
| Diagnosis | Physical exam. This may include measuring your height and weight; checking your vital signs, such as heart rate, blood pressure and temperature; checking skin and nails for problems; listening to your heart and lungs; and examining your abdomen. Lab tests. These may include a complete blood count (CBC) and more-specialized blood tests to check electrolytes and protein as well as functioning of your liver, kidney and thyroid. A urinalysis also may be done. Psychological evaluation. Thoughts, feelings and eating habits. Complete psychological self-assessment questionnaires. Other studies. X-rays may be taken to check bone density, check for stress fractures or broken bones, or check for pneumonia or heart problems. Electrocardiograms may be done to look for heart irregularities. |
| Investigations | Clinically evaluation |
| Management | Treatment for anorexia is generally done using a team approach, which includes doctors, mental health professionals and dietitians, all with experience in eating disorders. Ongoing therapy and nutrition education are highly important to continued recovery. Hospitalization and other programs If life is in immediate danger, may need treatment in a hospital emergency room for such issues as a heart rhythm disturbance, dehydration, electrolyte imbalances or a psychiatric emergency. Hospitalization may be required for medical complications, severe psychiatric problems, severe malnutrition or continued refusal to eat. Medical care Because of the host of complications anorexia causes, may need frequent monitoring of vital signs, hydration level and electrolytes, as well as related physical conditions. In severe cases, people with anorexia may initially require feeding through a tube that's placed in their nose and goes to the stomach (nasogastric tube). Restoring a healthy weight Medical care and supervise your calorie needs and weight gain A psychologist or other mental health professional, who can work with development of behavioral strategies to help patient return to a healthy weight A dietitian, who can offer guidance getting back to regular patterns of eating, including providing specific meal plans and calorie requirements Psychotherapy |
| Introduction | Anorexia, an eating disorder with loss of appetite. It is mostly a problem of adolescence and young adulthood, patients are predominantly females (about 90%). Generally two types of eating disorders are well-defined-anorexia nervosa and bulimia nervosa. These present some overlapping features, but, in anorexia nervosa weight loss is marked about 15% below expected, with distorted body image, fear of weight gain or of loss of control over food intake. In bulimia nervosa, weight loss is not marked, but shows a morbid fear of fatness associated with disturbed eating behaviour. Anorexia, many times a common symptom of different diseases, drug side-effects and drug abuses. |
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| Treatment | Treatment: 1. Anorexia nervosa should be treated by persuation, psychotherapy and family therapy. 2. Antidepressant drugs- tricyclic antidepressants, SSRIs or lithium carbonate may be helpful in some cases. 3. Patients with malnutrition may require enteral or parenteral feeding with i.v infusion of nutrition and sometimes insulin therapy. 4. Treatment of underlying organic or infection disease (if any) should be treated after diagnostic confirmation. |
| Complications | Heart Complications A healthy heart requires a balance of minerals such as potassium, calcium, magnesium and phosphate. These electrolytes are normally dissolved in bodily fluids; however, due to the dehydration that is often attendant to anorexia binge-purge subtype (AN-BP), the reduction of fluids and minerals can result in an electrolyte imbalance. Some of these electrolytes are essential to maintaining a normal heart rate and without them, an individual may develop irregular or slowed heart rhythms and be at risk for sudden cardiac death. As weight drops further and the flow of blood is reduced, the heart can become weakened and shrink in size. Brain Complications Patients with anorexia may suffer neurological damage that can result in seizures and cognitive impairment marked by the inability to concentrate or engage in sustained reasoning. Brain scans can demonstrate that the brain endures structural changes; while most changes normalize with weight restoration, in severe cases, structural changes and cognitive disabilities may be permanent. Bone Complications Individuals with anorexia often have reduced bone mineral density. Mild loss is termed osteopenia and severe loss of bone mineral density is termed osteoporosis. Patients who develop anorexia during adolescence are particularly at risk for these complications because bone accrual occurs through the early-20’s. As a result, young patients may never reach peak bone mass, bringing an increased lifetime risk of bone fractures and, particularly in male adolescents, stunted growth. Stomach Complications Patients often develop a digestive disorder that affects the stomach muscles and impedes the stomach from emptying properly. This is referred to as gastroparesis. Symptoms generally include bloating, early satiety and pain. Constipation is also a common gastrointestinal complication of anorexia nervosa. Skin Complications As the body attempts to maintain core temperature and prevent the heat loss that results from drastic weight loss, multiple dermatological changes can occur. Patients may develop dry skin, which can crack and bleed, or they may develop painful and itchy skin lesions on the lower legs, hands, toes, feet, ears and face. In addition, the body may grow fine downy hair on the sides of the face and along the spine called lanugo hair. There may also be bluish or purple coloring of the hands and feet caused by slow blood circulation. |
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