Diagnosis of Binge eating disorder
Binge eating disorder Diagnosis: Book Excerpts
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ANOREXIA:
Ask the following questions:
(Algorithmic Diagnosis of Symptoms and Signs)
- Is it acute or chronic? Acute anorexia would most likely be due to an acute febrile disease or acute psychiatric disturbance.
- Is there a history of drug or alcohol ingestion? Alcoholics frequently have a loss of appetite. Patients on aspirin and digitalis and many other drugs may lose their appetite.
- Is there an abdominal mass? The abdominal mass may be either an enlarged liver or other mass. The most likely abdominal mass to produce anorexia as the only symptom would be an early pancreatic neoplasm. When the neoplasm advances, jaundice should be present. Other neoplasms may be felt and/or metastasize to the liver and cause hepatomegaly.
- Is there a cough? If there is a chronic cough, one should consider tuberculosis or carcinoma of the lung.
- Is there hepatomegaly? Hepatomegaly without any other masses present in the abdomen would certainly bring to mind a cirrhosis. This could be of cardiac origin, so congestive heart failure should be ruled out. Also, the hepatomegaly may be related to a collagen disease or metastatic carcinoma.
DIAGNOSTIC WORKUP
If the general physical examination is normal, it may be wise to obtain a psychiatric consult at the outset. All patients with anorexia as the major sign should have a CBC, sedimentation rate, chemistry panel, thyroid profile [free thyroxine index (FT
4
I) and thyroid-stimulating hormone-sensitive assay (
S-TSH)]
, and a chest x-ray. A referral to a gastroenterologist may be wise if these are negative. However, if the clinician wishes to proceed on his own, then a search for a neoplasm should be conducted and should include an upper GI series, barium enema, abdominal CT scan, and bone scan. If these are negative, a gastroscopy or colonoscopy may be required.
A complete endocrinologic workup by an endocrinologist may be indicated if all the above studies are negative. Patients with a normal physical examination and normal diagnostic studies should be referred to a psychiatrist.
» READ BOOK EXCERPT ONLINE »
Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
POLYPHAGIA:
Ask the Following Questions:
(Algorithmic Diagnosis of Symptoms and Signs)
- Is there associated polydipsia, polyuria, and weight loss? The presence of these symptoms would suggest diabetes mellitus or hyperthyroidism.
- Is there associated weight gain? This symptom would indicate that the patient has an insulinoma, Cushing's disease, or idiopathic obesity.
- Is there associated anxiety, depression, or other emotional problems? These symptoms would signal that the polyphagia is related to bulimia, hysteria, or other psychic disorder.
- Is there associated diarrhea? This would suggest the disorder is related to a malabsorption syndrome, intestinal bypass, or GI fistula.
DIAGNOSTIC WORKUP
The basic workup of polyphagia should include a CBC, sedimentation rate, chemistry panel, thyroid profile, and stool for ovum and parasites.
If diabetes mellitus is suspected, a glucose tolerance test may be done. If Cushing's disease is suspected, a serum free cortisol should be done. If an insulinoma is suspected, plasma insulin or C-peptide levels may be done, or the patient may be hospitalized for a 72-hr fast with frequent blood sugar determinations. If hyperthyroidism, diabetes mellitus, insulinoma, and intestinal disorders have been ruled out, a referral to a psychiatrist would be indicated.
» READ BOOK EXCERPT ONLINE »
Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
Anorexia:
Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)
- Psychosocial/psychiatric
–Unrealistic parental expectations of what child should eat leads to pressure and causes food refusal
–Anorexia nervosa: Common among
adolescents, particularly females
–Depression
- Infectious
–Gastroenteritis: Salmonella, Shigella, E. coli,
Norwalk agent
–HIV
–Hepatitis A, B, C
–Pyelonephritis
–Mycobacterium tuberculosis
-
GI disorders
–Gastroesophageal reflux disease
–Constipation
–Appendicitis
–Celiac disease
–Pancreatitis
–Crohn disease
–Achalasia
–Esophageal foreign body
–Liver failure
-
Metabolic/endocrine disorders
–Hypothyroidism
–Hypercalcemia
–Panhypopituitarism
–Addison disease
–Diabetes insipidus
–Lead poisoning
-
Nutritional disorders
–Zinc deficiency
–B12 deficiency
–Iron deficiency
–Dietary chloride deficiency
–Hypervitaminosis A
-
Cardiopulmonary disease
–Congestive heart failure
–Cystic fibrosis
-
Drug toxicity
–Illicit drugs
–Antihistamines
–Methylphenidate
–Ephedrine
–Digitalis
-
Rheumatic disorders
–Systemic lupus erythematosus
–Juvenile rheumatoid arthritis
-
Pregnancy
Workup and Diagnosis
- History
–Nausea, vomiting, weight loss, diarrhea, hematochezia, melena, abdominal pain, pica
–Fever, sick contacts, recent travel, headache, rashes, diaphoresis, dysuria, cough, rashes, joint complaints, insomnia, activity level
–Medications: Prescription and over-the-counter
–Dietary history: Quantity and types of food
–Social history: Changes in home environment, abuse,
drug use, alcohol use, tobacco use, changes in grades in school, changes in activities/interests
- Physical exam
–Height and weight, pulse, blood pressure
–Scleral icteris, jaundice, abdominal pain/distension, hepatosplenomegaly
–Dentition, mucous membranes, murmurs, lung sounds, joint tenderness, skin turgor, rashes, neurology exam including funduscopy
-
Labs/studies
–Electrolytes and CBC with differential
–Consider LFTs, amylase and lipase, thyroid tests
–Stool for blood, stool culture, urinalysis with culture
–Vitamin levels, lead level, HIV test, hepatitis panels
–Pregnancy testing
-
Consider upper endoscopy/colonoscopy
-
Consider chest X-ray
-
Consider upper GI with small bowel follow through
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Polyphagia:
Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)
-
Exogenous obesity
-
Bulimia
-
Depression
-
Anxiety
-
Diabetes mellitus
-
Hypoglycemia
-
Diabetes insipidus in infants
–On breast milk or formula diet, excessive drinking is misinterpreted as excessive eating
-
Hyperthyroidism or Graves disease
–Increased metabolic rate, increased appetite, and increased oral intake as well as increased stool output
-
Medications
–Corticosteroids
–Cyproheptadine
–Tricyclic antidepressants
–Valproic acid
–Tetrahydrocannabinol
–Neuroleptics
-
Hypothalamic lesions (hypothalamic –Tumors (e.g., craniopharyngioma)
–Inflammation/autoimmune
–Central nervous system infection
–Head trauma
-
Genetic syndromes
–Prader-Willi syndrome
–Laurence-Moon-Bardet-Biedl syndrome
–Kleine-Levin syndrome
-
Cystic fibrosis
–Malabsorption results in chronic
malnutrition, especially of fat
Workup and Diagnosis
- History
–Nutritional history/diet recall for 24–72 hour
–Onset (age, life events) of change in eating behaviors
–Symptoms of depression, anxiety, eating disorders, or other psychiatric illness
–Symptoms of diabetes: Polyuria, polydipsia, wt loss
–Symptoms of hyperthyroidism or Graves disease: Palpitations, proximal muscle weakness, heat intolerance, ocular symptoms, difficulty concentrating, tremulousness
–Past medical history, medications
–Symptoms of brain tumor or infection/injury to CNS: Headaches, visual changes, fever, trauma, mental status changes
–A history of poor feeding and hypotonia at birth, developmental delay, hypogonadism, and hyperphagia with subsequent obesity suggests Prader-Willi syndrome
-
Physical exam: Height and weight, visual fields, optic disks, visual acuity (brain tumor), proptosis, goiter, lid lag (Graves), syndromic features
-
Labs/studies: Blood glucose; TSH, T4, T3, thyroid stimulating immunoglobulin; genetic testing for Prader-Willi or Laurence-Moon-Bardet-Biedl syndrome; simultaneous serum and urine osmolalities may indicate DI; often requires formal water deprivation test
-
MRI of the brain and pituitary
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
ANOREXIA:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
Loss of appetite usually is related to one of four things: a psychiatric disorder, an endocrine disorder, a malignancy, or a chronic disease. If the general physical examination is normal, it is wise to get a psychiatric consult at the onset. Alternatively, one may order a psychometric test such as the MMPI (Minnesota Multiphasic Personality Inventory).
The organic causes of anorexia are usually associated with significant weight loss. The combination with anorexia of other symptoms and signs will help make the diagnosis. Anorexia with jaundice points to hepatitis or liver neoplasm as the cause. Anorexia with nonpitting edema would suggest hypothyroidism. Anorexia with dysphagia would suggest an esophageal neoplasm. Anorexia with tanning of the skin would suggest adrenal insufficiency.
The initial workup of anorexia includes a CBC; sedimentation rate; urinalysis; chemistry panel; stool for occult blood, ovum, and parasites; chest x-ray; and flat plate of the abdomen. If hypothyroidism is suspected, a free thyroxine index (FT4) and thyroid-stimulating hormone–sensitive assay (S-TSH) text is ordered. If liver disease is suspected, a liver profile or hepatitis profile may be ordered. If malabsorption syndrome is suspected, one can order a d-xylose absorption test or quantitative stool fat analysis. If CHF is suspected, a circulation time is a good screening test. If pancreatic carcinoma or other GI malignancy is suspected, a CT scan of the abdomen may be ordered. It is best to consult a gastroenterologist before ordering these expensive tests. He or she can decide if endoscopic procedures or other studies would be more useful before ordering a CT scan.
» READ BOOK EXCERPT ONLINE »
Source: Differential Diagnosis in Primary Care, 2007
POLYPHAGIA:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
Association with other symptoms is the key to a definitive diagnosis of polyphagia. Thus, polyphagia and obesity suggest an islet cell adenoma. Polyphagia with polyuria, polydipsia, weakness, and weight loss suggest hyperthyroidism or diabetes mellitus.
The laboratory workup should include thyroid function studies, a skull x-ray for pituitary size, glucose tolerance tests, and, possibly, a 48-hour fast with frequent blood sugar determinations. An MRI of the pituitary is the best way to reveal microadenomas.
» READ BOOK EXCERPT ONLINE »
Source: Differential Diagnosis in Primary Care, 2007
Anorexia:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
Take the patient’s vital signs and weight. Find out previous minimum and maximum weights. Ask about involuntary weight loss greater than 10 lb (4.5 kg) in the past month. Explore dietary habits such as when and what the patient eats. Ask what foods he likes and dislikes and why. The patient may identify tastes and smells that nauseate him and cause loss of appetite. Ask about dental problems that interfere with chewing, including poor-fitting dentures. Ask if he has difficulty or pain when swallowing or if he vomits or has diarrhea after meals. Ask the patient how frequently and intensely he exercises.
Check for a history of stomach or bowel disorders, which can interfere with the ability to digest, absorb, or metabolize nutrients. Find out about changes in bowel habits. Ask about alcohol use and drug use and dosage.
If the medical history doesn’t reveal an organic basis for anorexia, consider psychological factors. Ask the patient if he knows what’s causing his decreased appetite. Situational factors — such as a death in the family or problems at school or at work — can lead to depression and a subsequent loss of appetite. Be alert for signs of malnutrition, consistent refusal of food, and a 7% to 10% loss of body weight in the preceding month. (See Is your patient malnourished? )
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Polyphagia [Hyperphagia]:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
Begin your evaluation by asking the patient what he has eaten and drunk within the past 24 hours. (If he easily recalls this information, ask about his intake for the 2 previous days, for a broader view of his dietary habits.) Note the frequency of meals and the amount and types of food eaten. Find out if the patient’s eating habits have changed recently. Has he always had a large appetite? Does his overeating alternate with periods of anorexia? Ask about conditions that may trigger overeating, such as stress, depression, or menstruation. Does the patient actually feel hungry, or does he eat simply because food is available? Does he ever vomit or have a headache after overeating?
Explore related signs and symptoms. Has the patient recently gained or lost weight? Does he feel tired, nervous, or excitable? Has he experienced heat intolerance, dizziness, palpitations, diarrhea, or increased thirst or urination? Obtain a complete drug history, including the use of laxatives or enemas.
During the physical examination, weigh the patient. Tell him his current weight, and watch for an expression of disbelief or anger. Inspect the skin to detect dryness or poor turgor. Palpate the thyroid for enlargement.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Anorexia nervosa:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
For characteristic findings in patients with this condition, see Diagnosing anorexia nervosa.
Laboratory tests help to identify various disorders and deficiencies and help to rule out endocrine, metabolic, and central nervous system abnormalities; cancer; malabsorption syndrome; and other disorders that cause physical wasting.
Abnormal findings that may accompany a weight loss exceeding 30% of normal body weight include:
❑ low hemoglobin level, platelet count, and white blood cell count
❑ prolonged bleeding time due to thrombocytopenia
❑ decreased erythrocyte sedimentation rate
❑ decreased levels of serum creatinine, blood urea nitrogen, uric acid, cholesterol, total protein, albumin, sodium, potassium, chloride, calcium, and fasting blood glucose (resulting from malnutrition)
❑ elevated levels of alanine aminotransferase and aspartate aminotransferase in severe starvation states
❑ elevated serum amylase levels when pancreatitis isn’t present
❑ in females, decreased levels of serum luteinizing hormone and follicle-
stimulating hormone
❑ decreased triiodothyronine levels resulting from a lower basal metabolic rate
❑ dilute urine caused by the kidneys’ impaired ability to concentrate urine
❑ nonspecific ST interval, prolonged PR interval, and T-wave changes on the electrocardiogram. Ventricular arrhythmias may also be present.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Anorexia:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
Take the patient’s vital signs and weight. Find out previous minimum and maximum weights. Ask about involuntary weight loss greater than 10 lb (4.5 kg) in the last month. Explore dietary habits, including what the patient eats and when. Ask what foods he likes and dislikes and why. The patient may identify tastes and smells that nauseate him and cause loss of appetite. Ask about dental problems that interfere with chewing, including poor-fitting dentures. Ask if he has difficulty or pain when swallowing or if he vomits or has diarrhea after meals. Ask the patient how frequently and intensely he exercises.
Check for a history of stomach or bowel disorders, which can interfere with the ability to digest, absorb, or metabolize nutrients. Find out about changes in bowel habits. Ask about alcohol use and drug use and dosage.
If the medical history doesn’t reveal an organic basis for anorexia, consider psychological factors. Ask the patient if he knows what’s causing his decreased appetite. Situational factors—such as a death in the family or problems at school or at work—can lead to depression and subsequent loss of appetite. Be alert for signs of malnutrition, consistent refusal of food, and a 7% to 10% loss of body weight in the preceding month. (See Is your patient malnourished? page 54.)
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Polyphagia [Hyperphagia]:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
Begin your evaluation by asking the patient what he has eaten and drunk within the last 24 hours. (If he easily recalls this information, ask about his intake for the 2 previous days, for a broader view of his dietary habits.) Note the frequency of meals and the amount and types of food eaten. Find out if the patient’s eating habits have changed recently. Has he always had a large appetite? Does his overeating alternate with periods of anorexia? Ask about conditions thatmay trigger overeating, suchas stress, depression, or menstruation. Does the patient actually feel hungry, or does he eat simply because food is available? Does he ever vomit or have a headache after overeating?
Explore related signs and symptoms. Has the patient recently gained or lost weight? Does he feel tired, nervous, or excitable? Has he experienced heat intolerance, dizziness, palpitations, diarrhea, or increased thirst or urination? Obtain a complete drug history, including the use of laxatives or enemas.
During the physical examination, weigh the patient. Tell him his current weight, and watch for any expression of disbelief or anger. Inspect the skin to detect dryness or poor turgor. Palpate the thyroid for enlargement.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Anorexia:
History
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
A. History of present illness. The patient must provide a careful explanation of the problem: How is it affecting daily life? What does the patient think is responsible for the problem? Is the patient describing early satiety, dysphagia, or social dissatisfaction associated with eating? Do symptoms fluctuate? How are symptoms associated with meals? What has been tried to increase appetite and what does the patient think is responsible for the problem? Is there weight loss, or other associated symptoms?
B. Past medical history. Is there any history of eating disorders, chronic medical conditions, or history of psychiatric diagnosis?
C. Medications. Prescription and nonprescription medications as well as recreational drugs, herbal medications, and dietary supplements need to be listed. Over-the-counter medications are often overlooked by physicians, as well as by patients. Ask if any medications have recently been discontinued and why. Antidepressants, for example, can have anorexia as a withdrawal symptom.
D. Social history. The major focus is on recent life stressors that may play a pertinent role. Stressors can be positively perceived and still be constitutionally disabling. Take a brief life satisfaction survey of the patient. Anniversary dates of lost loved ones or marked changes in lifestyle can also be important.
E. Review of systems. A careful review of systems beginning with weight loss is necessary. An accurate diet history, either retrospective or prospective (with a dietary log), can prove helpful. Include signs and symptoms of depression and a brief psychiatric inventory. Consider a mental status examination. Are there any negative rewards for eating or any pain or difficulty swallowing? The patient may have painful dentition, nausea, vomiting, bloating, diarrhea, constipation, or bleeding associated with food ingestion. Finally, ask about recent head injury, or general neurologic changes suggestive of postconcussion syndrome, a central lesion, or cerebral vascular accident (5).
Physical examination
A. General appearance. Any level of anxiety behavior consistent with a personality disorder should be noted. Signs of systemic disease should be evaluated with vital signs, orthostatic blood pressure assessment, and temperature. Accurate weight documentation is critical in the evaluation for loss of appetite complaints. Serial measurements over time are required.
B. Head, eyes, ears, nose, and throat (HEENT). Dentition and neck examination, including observation of swallowing and thyroid examination, are important.
C. Cardiovascular and respiratory systems. Examine for cardiac arrhythmia and heart failure, including jugular venous distention, rales, peripheral edema, and hepatic congestion. Lungs should be examined for chronic obstructive pulmonary disease.
D. Gastrointestinal. Pain or rigidity of an acute abdomen, absent or hyperactive bowel sounds, ascites, and hepatomegaly should be evaluated. Rectal examination and stool guaiac testing should be done.
E. Skin. Look for the possible presence of skin tracks, cyanosis, or lanugo (fine, white, downy hairs sometimes seen in patients with anorexia nervosa). Jaundice or hyperpigmentation should be noted. Changes in hair pattern may be a clue to peripheral vascular disease.
F. Neurologic examination. Cranial nerve examination, including olfactory sensation and taste, should be performed. Deficits in these basic sensations can affect appetite significantly. Motor weakness, focal or asymmetric proprioception, and gait disturbance may show evidence of cerebral pathology. Most chronic neurologic disease and acute cerebral vascular events will include loss of appetite. Mental status needs to be assessed, if indicated. Organic brain syndrome, dementia, delirium, and psychosis can all play a role in loss of appetite.
» READ BOOK EXCERPT ONLINE »
Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Anorexia nervosa:
Diagnosis
(Handbook of Diseases)
For characteristic findings in patients with this condition, see Diagnosing anorexia nervosa.
In addition, laboratory tests help to identify various disorders and deficiencies and help to rule out endocrine, metabolic, and central nervous system abnormalities; cancer; malabsorption syndrome; and other disorders that cause physical wasting.
Abnormal findings that may accompany a weight loss of more than 30% of normal body weight include:
low hemoglobin level, platelet count, and white blood cell count
prolonged bleeding time due to thrombocytopenia
decreased erythrocyte sedimentation rate
decreased levels of serum creatinine, blood urea nitrogen, uric acid, cholesterol, total protein, albumin, sodium, potassium, chloride, calcium, and fasting blood glucose (resulting from malnutrition)
elevated levels of alanine aminotransferase and aspartate aminotransferase in severe starvation states
elevated serum amylase levels when pancreatitis isn’t present
in females, decreased levels of serum luteinizing hormone and follicle-stimulating hormone
decreased triiodothyronine levels resulting from a lower basal metabolic rate
dilute urine caused by the kidneys’ impaired ability to concentrate urine
nonspecific ST interval, prolonged PR interval, and T-wave changes on the electrocardiogram. Ventricular arrhythmias also may be present.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Anorexia:
History
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Find out previous minimum and maximum weights. Ask about involuntary weight loss greater than 10 lb (4.5 kg) in the last month. Explore dietary habits, such as when and what the patient eats. Ask what foods he likes and dislikes and why. The patient may identify tastes and smells that nauseate him and cause loss of appetite. Ask about dental problems that interfere with chewing, including poor-fitting dentures. Ask if he has difficulty or pain when swallowing or if he vomits or has diarrhea after meals. Ask the patient how frequently and intensely he exercises.
Check for a history of stomach or bowel disorders, which can interfere with the ability to digest, absorb, or metabolize nutrients. Find out about changes in bowel habits. Ask about alcohol use and drug use and dosage.
If the medical history doesn’t reveal an organic basis for anorexia, consider psychological factors. Ask the patient if he knows what’s causing his decreased appetite. Situational factors — such as a death in the family or problems at school or at work — can lead to depression and subsequent loss of appetite. Be alert for signs of malnutrition, consistent refusal of food, and a 7% to 10% loss of body weight in the preceding month.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Polyphagia:
History
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Begin your evaluation by asking the patient what he has eaten and drunk within the last 24 hours. (If he easily recalls this information, ask about his intake for the 2 previous days, for a broader view of his dietary habits.) Note the frequency of meals and the amount and types of food eaten. Find out if the patient’s eating habits have changed recently. Has he always had a large appetite? Does his overeating alternate with periods of anorexia? Ask about conditions thatmay trigger overeating, suchas stress, depression, or menstruation. Does the patient actually feel hungry, or does he eat simply because food is available? Does he ever vomit or have a headache after overeating?
Explore related signs and symptoms. Has the patient recently gained or lost weight? Does he feel tired, nervous, or excitable? Has he experienced heat intolerance, dizziness, palpitations, diarrhea, or increased thirst or urination? Obtain a complete drug history, including the use of laxatives or enemas.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Anorexia:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
Take the patient's vital signs and weight. Find out previous minimum and maximum weights. Ask about involuntary weight loss greater than 10 lb (4.5 kg) in the past month. Explore dietary habits such as when and what the patient eats. Ask what foods he likes and dislikes and why. The patient may identify tastes and smells that nauseate him and cause loss of appetite. Ask about dental problems that interfere with chewing, including poor-fitting dentures. Ask if he has difficulty or pain when swallowing or if he vomits or has diarrhea after meals. Ask the patient how frequently and intensely he exercises.
Check for a history of stomach or bowel disorders, which can interfere with the ability to digest, absorb, or metabolize nutrients. Find out about changes in bowel habits. Ask about alcohol use and drug use and dosage.
If the medical history doesn't reveal an organic basis for anorexia, consider psychological factors. Ask the patient if he knows what's causing his decreased appetite. Situational factors—such as a death in the family or problems at school or at work—can lead to depression and a subsequent loss of appetite. Be alert for signs of malnutrition, consistent refusal of food, and a 7% to 10% loss of body weight in the preceding month. (See Is your patient malnourished?)
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Polyphagia [Hyperphagia]:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
Begin your evaluation by asking the patient about his oral intake within the past 24 hours. (If he easily recalls this information, ask about his intake for the 2previous days, for a broader view of his dietary habits.) Note the frequency of meals and the amount and types of food eaten. Find out if the patient's eating habits have changed recently. Has he always had a large appetite? Does his overeating alternate with periods of anorexia? Ask about conditions that may trigger overeating, such as stress, depression, or menstruation. Does the patient actually feel hungry, or does he eat simply because food is available? Does he ever vomit or have a headache after overeating?
Explore related signs and symptoms. Has the patient recently gained or lost weight? Does he feel tired, nervous, or excitable? Has he experienced heat intolerance, dizziness, palpitations, diarrhea, or increased thirst or urination? Obtain a complete drug history, including the use of laxatives or enemas.
During the physical examination, weigh the patient. Tell him his current weight, and watch for his reaction. Inspect the skin to detect dryness or poor turgor. Palpate the thyroid for enlargement.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
ANOREXIA:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
Loss of appetite usually is related to one of four things: (i) a
psychiatric disorder, (ii) an endocrine disorder, (iii) a malignancy, or
(iv) a chronic disease. If the general physical examination is normal, it is
wise to get a psychiatric consult at the onset. Alternatively, one may order
a psychometric test such as the MMPI (Minnesota Multiphasic Personality
Inventory).
The organic causes of anorexia are usually associated with significant
weight loss. The combination with anorexia of other symptoms and signs will
help make the diagnosis. Anorexia with jaundice points to hepatitis or liver
neoplasm as the cause. Anorexia with nonpitting edema would suggest
hypothyroidism. Anorexia with dysphagia would suggest an esophageal
neoplasm. Anorexia with tanning of the skin would suggest adrenal
insufficiency.
The initial workup of anorexia includes a CBC; sedimentation rate;
urinalysis; chemistry panel; stool for occult blood, ovum, and parasites;
chest x-ray; and flat plate of the abdomen. If hypothyroidism is suspected,
a free thyroxine index (FT4) and thyroid-stimulating hormone–sensitive
(S-TSH) assay is ordered. If liver
disease is suspected, a liver profile or hepatitis profile may be ordered.
If malabsorption syndrome is suspected, one can order a D-xylose
absorption test or quantitative stool fat analysis. If CHF is suspected, a
circulation time is a good screening test. If pancreatic carcinoma or other
GI malignancy is suspected, a CT scan of the abdomen may be ordered. It is
best to consult a gastroenterologist before ordering these expensive tests.
He or she can decide if endoscopic procedures or other studies would be more
useful before ordering a CT scan.
» READ BOOK EXCERPT ONLINE »
Source: Differential Diagnosis in Primary Care, 2007
POLYPHAGIA:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
Association with other symptoms is the key to a definitive diagnosis of
polyphagia. Thus, polyphagia and obesity suggest an islet cell adenoma.
Polyphagia with polyuria, polydipsia, weakness, and weight loss suggest
hyperthyroidism or diabetes mellitus.
The laboratory workup should include thyroid function studies, a skull x-ray
for pituitary size, glucose tolerance tests, and, possibly, a 48-hour fast
with frequent blood sugar determinations. An MRI of the pituitary is the
best way to reveal microadenomas.
» READ BOOK EXCERPT ONLINE »
Source: Differential Diagnosis in Primary Care, 2007
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