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Diagnostic Tests for Bulimia nervosa

Contents
  1. Bulimia nervosa: Introduction
  2. Symptoms of Bulimia nervosa
  3. Diagnosis
  4. Home Diagnostic Testing
  5. Alternative Diagnoses
  6. Misdiagnosis
  7. Complications

Bulimia nervosa Tests: Book Excerpts

Home Diagnostic Testing

These home medical tests may be relevant to Bulimia nervosa:

Bulimia nervosa Diagnosis: Book Excerpts

Diagnostic Tests for Bulimia nervosa: Online Medical Books

16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about the diagnostic tests for Bulimia nervosa.

WEIGHT LOSS: DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)

Routine diagnostic studies include a CBC, sedimentation rate, urinalysis, chemistry panel, thyroid panel, serum amylase and lipase, febrile agglutinins, tuberculin test, ANA titer, serum protein electrophoresis, serum B 12 and folic acid, chest x-ray, EKG, and a flat plate of the abdomen. An HIV antibody titer needs to be done in selected clinical circumstances.

A stool for fat, trypsin, occult blood, and ovum and parasites should be done. Further tests for steatorrhea are listed on page 446 . If these tests are within normal limits or are unrevealing, it is best to refer the patient to a gastroenterologist or oncologist for further evaluation. Sometimes, clinical clues suggest the need for an endocrinologist or psychiatrist as well. However, if the primary care physician wishes to proceed further, he may order an upper GI series and esophagogram, a small bowel series, barium enema, and a sigmoidoscopic examination. A CT scan of the abdomen and pelvis may be useful, but it is an expensive procedure.

Twenty-four-hr urine collection for 17-ketosteroids and 17-hydroxysteroids or rapid ACTH stimulation test will diagnose Addison's disease. Quantitative stool fat and d -xylose absorption or a simple glucose tolerance test will diagnose some cases of malabsorption syndrome. Endoscopic procedures, including laparoscopy and even an exploratory laparotomy, have their place in the diagnostic workup. However, it is always best to enlist the help of specialists before considering these procedures, even if one is located in an isolated community.

 

» READ BOOK EXCERPT ONLINE »

Source: Algorithmic Diagnosis of Symptoms and Signs, 2003

Weight gain, excessive: History and physical examination
(Handbook of Signs & Symptoms (Third Edition))

Determine your patient’s previous patterns of weight gain and loss. Does he have a family history of obesity, thyroid disease, or diabetes mellitus? Assess his eating and activity patterns. Has his appetite increased? Does he exercise regularly or at all? Next, ask about associated symptoms. Has he experienced visual disturbances, hoarseness, paresthesia, or increased urination and thirst? Has he become impotent? If the patient is female, has she had menstrual irregularities or experienced weight gain during menstruation?

Form an impression of the patient’s mental status. Is he anxious or depressed? Does he respond slowly? Is his memory poor? What medications is he using?

During your physical examination, measure skin-fold thickness to estimate fat reserves. (See Evaluating nutritional status, pages 644 and 645.) Note fat distribution and the presence of localized or generalized edema and overall nutritional status. Inspect for other abnormalities, such as abnormal body hair distribution or hair loss and dry skin. Take and record the patient’s vital signs.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Signs & Symptoms (Third Edition), 2006

Low birth weight: History and physical examination
(Handbook of Signs & Symptoms (Third Edition))

As soon as possible, evaluate the neonate’s neuromuscular and physical maturity to determine gestational age. (See Ballard Scale for calculating gestational age, pages 382 and 383.) Follow with a routine neonatal examination.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Signs & Symptoms (Third Edition), 2006

Weight loss, excessive: History and physical examination
(Handbook of Signs & Symptoms (Third Edition))

Begin with a thorough diet history because weight loss almost always is caused by inadequate caloric intake. If the patient hasn’t been eating properly, try to determine why. Ask him about previous weight and if the recent loss was intentional. Be alert to lifestyle or occupational changes that may be a source of anxiety or depression. For example, has he gotten separated or divorced? Has a family member or friend died recently? Has he recently changed jobs?

Inquire about recent changes in bowel habits, such as diarrhea or bulky, floating stools. Has the patient had nausea, vomiting, or abdominal pain, which may indicate a GI disorder? Has he had excessive thirst, excessive urination, or heat intolerance, which may signal an endocrine disorder? Take a careful drug history, noting especially any use of diet pills and laxatives.

Carefully check the patient’s height and weight, and ask about his previous weight. Take his vital signs and note his general appearance: Is he well nourished? Do his clothes fit? Is muscle wasting evident? Ask about exact weight changes (with approximate dates).

Next, examine the patient’s skin for turgor and abnormal pigmentation, especially around the joints. Does he have pallor or jaundice? Examine his mouth, including the condition of his teeth or dentures. Look for signs of infection or irritation on the roof of the mouth, and note any hyperpigmentation of the buccal mucosa. Also, check the patient’s eyes for exophthalmos and his neck for swelling; evaluate his lungs for adventitious sounds. Inspect his abdomen for signs of wasting, and palpate for masses, tenderness, and an enlarged liver.

Conventional laboratory and radiologic investigations such as complete blood count, serum albumin levels, urinalysis, chest X-ray, and upper GI series usually reveal the cause. Almost all physical causes are clinically evident during the initial evaluation. Cancer, GI disorders, and depression are the most common pathologic causes.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Signs & Symptoms (Third Edition), 2006

Weight gain, excessive: History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))

Determine your patient’s previous patterns of weight gain and loss. Does he have a family history of obesity, thyroid disease, or diabetes mellitus? Assess his eating and activity patterns. Has his appetite increased? Does he exercise regularly or at all? Next, ask about associated symptoms. Has he experienced visual disturbances, hoarseness, paresthesia, or increased urination and thirst? Has he become impotent? If the patient is female, has she had menstrual irregularities or experienced weight gain during menstruation?

Form an impression of the patient’s mental status. Is he anxious or depressed? Does he respond slowly? Is his memory poor? What medications is he using?

During your physical examination, measure skin-fold thickness to estimate fat reserves. (See Evaluating nutritional status.) Note fat distribution, the presence of localized or generalized edema, and overall nutritional status. Examine the patient for other abnormalities, such as abnormal body hair distribution or hair loss and dry skin. Take and record the patient’s vital signs.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Low birth weight: History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))

As soon as possible, evaluate the neonate’s neuromuscular and physical maturity to determine gestational age. (See Ballard Scale for calculating gestational age, pages 488 and 489.) Follow with a routine neonatal examination.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Weight loss, excessive: History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))

Begin with a thorough diet history because weight loss is almost always caused by inadequate caloric intake. If the patient hasn’t been eating properly, try to determine why. Ask about his previous weight and whether the recent loss was intentional. Be alert for lifestyle or occupational changes that may be causing anxiety or depression. For example, has he gotten separated or divorced? Has he recently changed jobs?

Inquire about recent changes in bowel habits, such as diarrhea or bulky, floating stools. Has the patient had nausea, vomiting, or abdominal pain, which may indicate a GI disorder? Has he had excessive thirst, excessive urination, or heat intolerance, which may signal an endocrine disorder? Take a careful drug history, noting especially the use of diet pills or laxatives.

Carefully check the patient’s height and weight, and ask about exact weight changes with approximate dates. Take his vital signs and note his general appearance: Is he well nourished? Do his clothes fit? Is muscle wasting evident?

Next, examine the patient’s skin for turgor and abnormal pigmentation, especially around the joints. Does he have pallor or jaundice? Examine his mouth, including the condition of his teeth or dentures. Look for signs of infection or irritation on the roof of the mouth, and note any hyperpigmentation of the buccal mucosa. Also, check the patient’s eyes for exophthalmos and his neck for swelling; auscultate his lungs for adventitious sounds. Inspect his abdomen for signs of wasting, and palpate for masses, tenderness, and an enlarged liver.

Conventional laboratory and radiologic tests, such as complete blood count, serum albumin levels, urinalysis, chest
X-rays, and upper GI series, usually reveal the cause. Almost all physical causes are clinically evident during the initial evaluation. Cancer, GI disorders, and depression are the most common pathologic causes.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Weight Loss: Basic physical examination
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)

A. Relevant physical findings will be present in 66% of cases (1,2,5).

B. Quantify loss by serial weight measurements.

C. Check the vital signs: temperature, blood pressure, and respiratory and heart rates. Consider determining oxygen saturation.

D. Perform a physical examination, with emphasis on areas suggested by clues from the history.

Testing

A. Basic laboratory tests. Debate continues regarding the most useful and cost-effective laboratory testing for involuntary weight loss. A structured approach is best (1–5). Useful tests include:

1. Complete blood count, thyrotropin assay, urinalysis, and fecal occult blood testing.

 2. Comprehensive chemistry panel including albumin, transaminases, blood urea nitrogen, creatinine, and electrolytes—calcium, magnesium, phosphorus, sodium, and potassium.

 3. Chest radiograph is often useful but not required (1).

B. Comprehensive analysis. Further testing should be done only as directed by the initial findings. Careful observation and follow-up are superior management strategies to undirected diagnostic testing (1–5).

1. When indicated, upper gastrointestinal radiographs, endoscopy, and colonoscopy are the most useful second-line tests (3).

 2. National Cancer Institute or United States Preventive Services Task Force age-specific screening guidelines should be considered and brought up to date for the patient. These can be accessed on the internet through the National Library of Medicine (http://www.nlm.nih.gov).

 3. Computed tomography and other expensive investigations are seldom beneficial in the absence of a specific (often guideline-based) indication (3,4).

Diagnostic assessment.

 The integration of history, examination, and laboratory data usually reveals the cause for involuntary weight loss.

 A. Cancer, including gastrointestinal malignancies, accounts for 16% to 36% of cases, and other gastrointestinal diseases account for another 14% to 23% (1,3).

 B. If the initial steps are not conclusive, the best approach is careful observation. Follow-up examinations and testing should be done monthly for 6 months. If a physical cause exists, it will almost always be found within this time (1).

 C. If an organic cause is present, this simple approach will find it more than 75% of the time (1–3).

D. If an organic cause is not identified in 6 months, one is unlikely to be found (1–3). These undifferentiated patients, however, do well and have an excellent prognosis, assuming they do not have continued and progressive weight loss (1).

E. Malignancy is a significant cause of weight loss; however, a truly occult malignancy is rare and an exhaustive search for one is not supported by the literature (1–5).


References

1. Marton KI, Sox Jr HC, Krupp JR. Involuntary weight loss: diagnostic and prognostic significance. Ann Intern Med 1981;95:568–574.

2. Rabinovitz M, Pitlik SD, Leifer M, et al. Unintentional weight loss. A retrospective analysis of 154 cases. Arch Intern Med 1986;146:186–187.

3. Thompson MP, Morris LK. Unexplained weight loss in the ambulatory elderly. J Am Geriatr Soc 1991;39:497–500.

4. Wise GR, Craig D. Evaluation of involuntary weight loss. Where do you start? Postgrad Med 1994;95:143–146, 149–150.

5. Reife CM. Involuntary weight loss. Med Clin  North Am 1995;79(2):299–313.

» READ BOOK EXCERPT ONLINE »

Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000

Involuntary Weight Loss: Diagnostic Approach
(Field Guide to Bedside Diagnosis)

Cachexia is accelerated loss of lean body mass in the context of a chronic inflammatory response, caused by a combination of decreased intake (with decreased appetite) and increased metabolic rate. The cause of the weight loss will usually be evident, based on concurrent symptoms. If not, first document that weight loss has occurred by using prior records of measured weights or the discovery of loose-fitting clothes (tightening belt notches) or dentures. If the cause is not found on the first pass, document the weight and re-examine several weeks later.

Weight loss in patients with congestive heart failure, cirrhosis, and
uremia may be masked by fluid retention, but temporalis and limb wasting will be prominent. Weight loss in malignancy of more than 5% of body mass prior to treatment portends a poor prognosis.

» READ BOOK EXCERPT ONLINE »

Source: Field Guide to Bedside Diagnosis, 2007

Weight gain, excessive: Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

During your physical assessment, measure skin-fold thickness to estimate fat reserves. (See Evaluating nutritional status, pages 710 and 711.) Note fat distribution and the presence of localized or generalized edema and overall nutritional status. Inspect for other abnormalities, such as abnormal body hair distribution or hair loss and dry skin. Take and record the patient’s vital signs.

» READ BOOK EXCERPT ONLINE »

Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

Weight loss, excessive: Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

Carefully check the patient’s height and weight. Ask about his previous weight. Take his vital signs and note his general appearance: Is he well nourished? Do his clothes fit? Is muscle wasting evident? Ask about exact weight changes (with approximate dates).

Next, examine the patient’s skin for turgor and abnormal pigmentation, especially around the joints. Does he have pallor or jaundice? Examine his mouth, including the condition of his teeth or dentures. Look for signs of infection or irritation on the roof of the mouth, and note any hyperpigmentation of the buccal mucosa. Also check the patient’s eyes for exophthalmos and his neck for swelling; evaluate his lungs for adventitious sounds. Inspect his abdomen for signs of wasting, and palpate for masses, tenderness, and an enlarged liver.

Conventional laboratory and radiologic investigations, such as complete blood count, serum albumin levels, urinalysis, chest X-ray, and upper GI series usually reveal the cause of weight loss.

» READ BOOK EXCERPT ONLINE »

Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

Growth Deficiency: Weight and Height: Diagnostic Approach
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)

  • Determinewhether problem is primarily one of impaired weight gain, lineargrowth, or combination.
  • Complete history and physical examshould be performed.
  • Growth parameters (weight, height,head circumference) should be plotted on growth charts publishedby CDC (2001). All past measurements should also be plotted on thesegrowth curves.

    • Impaired Weight Gain or Weight Loss

  • Diagnosisof intrauterine growth disturbance can be made at birth or evensometimes before birth.
  • History and physical exam provide theclues for further investigation.
  • Presence of dysmorphic features andabnormal physical findings suggests chromosomal disorders, dysmorphicsyndromes, or multiple malformation syndromes of unknown cause.
  • Chromosomal karyotype with bandingtechniques should be performed with suspected chromosomal disorder,with unknown constellation of dysmorphic features, or with majorand minor malformations.
  • Presence of specific major malformation(e.g., hydrocephalus) determines which further diagnostic testsneed to be performed.
  • If problem is primarily weight gain,history can estimate daily caloric intake. This and other historicinformation along with physical exam is diagnostic in many casesincluding psychologic disturbances.
  • Inadequate caloric intake is most commoncause of failure to gain weight in otherwise normal child. Withproper counseling and follow-up, mild cases may be treated successfullywithout hospitalization. If child is ill or lack of weight gainis more than mild or psychosocial problems are serious, he or shecan be admitted to the hospital to monitor caloric intake and weightgain, gain more insight and understanding about parents and family,and educate parents about proper nutrition.
  • Excessive caloric wasting from persistentdiarrhea, polyuria, or vomiting can impair adequate weight gainand also cause weight loss. See Chap.14, Diarrhea; Chap.47, Polyuria and Polydipsia; and Chap. 55, Regurgitation and Vomiting,respectively.
  • Best screening tests for chronic diseaseare history and physical exam. Tests that can help pinpoint theinvolved organ system include CBC with differential; stool guaiac;serum electrolytes, glucose, creatinine, calcium, and phosphorus;blood urea nitrogen; UA; urine culture; erythrocyte sedimentationrate; liver function tests; chest radiography; sweat test; and endomesial antibodies.

    • Impaired Skeletal Growth (Height)

  • Same generaldiagnostic approach described for impaired weight gain should befollowed in cases of impaired linear growth.
  • Weight, height, and head circumferencemeasurements should be recorded on standard growth charts. Lengthis usually measured from birth until 18 mos of age, whereas heightis commonly measured after this age.
  • Height velocity charts of Tanner andDavies (1985) can be used to calculate height velocity in cm/yr.
  • Most common causes of short statureinclude genetic (familial) short stature, constitutional delay,chronic disease of any organ system, and psychosocial deprivation.
  • In general, diagnostic studies arelimited to short children who are growing at subnormal rate. Ifgrowth rate is normal, significant problem is unlikely.
  • If history and physical exam do notidentify cause of abnormal growth, certain tests should be considered:CBC with differential; UA including pH and specific gravity; urineculture; erythrocyte sedimentation rate; serum electrolytes, glucose,and creatinine; blood urea nitrogen; T4 andTSH; insulin-like growth factor-binding protein 3 and insulin-likegrowth factor I; and bone age.
  • Bone age measurement provides assessmentof skeletal maturation as index of biologic age. Can be determinedby using knee radiograph in infants <3 mos of age and lefthand and wrist in those >3 mos of age and should be performedwith suspected growth hormone deficiency.
  • Other tests depend on results of theabove findings and suspected diagnosis.
  • When disproportionate growth is clinicallyobserved, ratio of upper to lower segment may be useful. Lower segmentis measured from pubis to bottom of feet, and this measurement issubtracted from height to give upper segment length. Normal uppersegment:lower segment ratio is 1.7:1 at birth and decreases untilabout age 10 yrs, when it is 1, which approximates normal adultvalue. Disproportionate short limbs or trunk are noted with manyof the osteochondrodysplasias.
  • Genetic growth potential can be estimatedby the following procedure as noted by Rudolph (1996). Based ongenetic factors alone, predicted adult height should fall within5 cm above or below calculated midparental height. Midparental heightfor girls is calculated as follows: [(father'sheight - 13 cm) + (mother's height)] dividedby 2. Midparental height for boys is calculated as follows: [(mother'sheight + 13 cm) + (father's height)] dividedby 2.
    • >

    » READ BOOK EXCERPT ONLINE »

    Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006

    Weight gain, excessive: History and physical examination
    (Nursing: Interpreting Signs and Symptoms)

    Determine your patient's previous patterns of weight gain and loss. Does he have a family history of obesity, thyroid disease, or diabetes mellitus? Assess his eating and activity patterns. Has his appetite increased? Does he exercise regularly or at all? Ask about associated symptoms. Has the patient experienced vision disturbances, hoarseness, paresthesia, or increased urination and thirst? Has he become impotent? If the patient is female, has she had menstrual irregularities or experienced weight gain during menstruation? Is she menopausal or postmenopausal?

    Form an impression of the patient's mental status. Is he anxious or depressed? Does he respond slowly? Is his memory poor? What medications is he taking?

    During your physical examination, measure skin-fold thickness to estimate fat reserves. (See Evaluating nutritional status, pages 644 and 645.) Note fat distribution and the presence of localized or generalized edema and overall nutritional status. Inspect for other abnormalities, such as abnormal body hair distribution or hair loss and dry skin. Take and record the patient's vital signs.

    » READ BOOK EXCERPT ONLINE »

    Source: Nursing: Interpreting Signs and Symptoms, 2007

    Low birth weight: History and physical examination
    (Nursing: Interpreting Signs and Symptoms)

    As soon as possible, evaluate the neonate's neuromuscular and physical maturity to determine gestational age. (See Ballard Scale for calculating gestational age.) Follow with a routine neonatal examination.

    » READ BOOK EXCERPT ONLINE »

    Source: Nursing: Interpreting Signs and Symptoms, 2007

    Weight loss, excessive: History and physical examination
    (Nursing: Interpreting Signs and Symptoms)

    Begin with a thorough diet history because weight loss is almost always caused by inadequate caloric intake. If the patient hasn't been eating properly, try to determine why. Ask him about previous weight and whether the recent loss was intentional. Determine how long the weight loss has been taking place. Be alert to lifestyle or occupational changes that may be a source of anxiety or depression. Has the patient recently experienced a loss?

    Inquire about recent changes in bowel habits, such as diarrhea or bulky, floating stools. Has the patient had nausea, vomiting, or abdominal pain, which may indicate a GI disorder? Has he had excessive thirst, excessive urination, or heat intolerance, which may signal an endocrine disorder? Has he been experiencing other pain? If so, ask about the location of the pain and how long he has had it. Take a careful drug history, noting especially use of diet pills and laxatives.

    Carefully check the patient's height and weight and ask about his previous weight. Take his vital signs and note his general appearance: Is he well nourished? Do his clothes fit? Is muscle wasting evident? Ask about exact weight changes (with approximate dates).

    Examine the patient's skin for turgor and abnormal pigmentation, especially around the joints. Does he have pallor or jaundice? Examine his mouth, including the condition of his teeth or dentures. Look for signs of infection or irritation on the roof of the mouth and note hyperpigmentation of the buccal mucosa. Check the patient's eyes for exophthalmos and his neck for swelling; evaluate his lungs for adventitious sounds. Inspect his abdomen for signs of wasting, and palpate for masses, tenderness, and an enlarged liver.

    Conventional laboratory and radiologic investigations such as complete blood count, serum albumin levels, urinalysis, chest X-ray, and upper GI series usually reveal the cause. Almost all physical causes are clinically evident during the initial evaluation. Cancer, GI disorders, and depression are the most common pathologic causes.

    » READ BOOK EXCERPT ONLINE »

    Source: Nursing: Interpreting Signs and Symptoms, 2007


     » Next page: Diagnosis of Bulimia nervosa

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