Anorexia

Anorexia: Excerpt from In A Page: Pediatric Signs and Symptoms

Anorexia refers to a loss of appetite. The hypothalamus is thought to be the center of appetite control, but the stimuli that influence this control are poorly understood. Prolonged anorexia accompanied by weight loss or poor weight gain usually denotes a serious underlying organic or psychological disorder.

Differential Diagnosis

• 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

Treatment

• Treatment geared toward specific causes
• Maintain hydration status and correct any electrolyte and vitamin imbalances
• Treat infectious causes if indicated
• Counseling for psychiatric causes
• May require NG feeds to maintain nutrition
• Remove toxic agents
• Lower esophageal dilation or myomectomy for achalasia
• Parental education regarding expectations
• Treat depression

Book Source Details

• Book Title: In A Page: Pediatric Signs and Symptoms
• Author(s): Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
• Year of Publication: 2007
• Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.

More About Eating Disorder not Otherwise Specified (ENDOS)

• Back to disease: Eating Disorder not Otherwise Specified (ENDOS): Introduction
• Next Book Extract About Eating Disorder not Otherwise Specified (ENDOS): Polyphagia (In A Page: Pediatric Signs and Symptoms)
• More Book Extracts: All Online Books for Eating Disorder not Otherwise Specified (ENDOS)

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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: In A Page: Pediatric Signs and Symptoms Authors: Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-4051-0427-9

 » Next page: Polyphagia (In A Page: Pediatric Signs and Symptoms)

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