Causes of Eating Disorder not Otherwise Specified (ENDOS)
Eating Disorder not Otherwise Specified (ENDOS) Causes: Book Excerpts
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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
» 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
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Anorexia:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
❑ Acquired immunodeficiency syndrome.An infection or Kaposi’s sarcoma affecting the GI or respiratory tract may lead to anorexia. Other findings include fatigue, afternoon fevers, night sweats, diarrhea, cough, lymphadenopathy, bleeding, oral thrush, gingivitis, and skin disorders, including persistent herpes zoster and recurrent herpes simplex, herpes labialis, or herpes genitalis.
❑ Adrenocortical hypofunction. With adrenocortical hypofunction, anorexia may begin slowly and subtly, causing gradual weight loss. Other common signs and symptoms include nausea and vomiting, abdominal pain, diarrhea, weakness, fatigue, malaise, vitiligo, bronze-colored skin, and purple striae on the breasts, abdomen, shoulders, and hips.
❑ Alcoholism. Chronic anorexia commonly accompanies alcoholism, eventually leading to malnutrition. Other findings include signs of liver damage (jaundice, spider angiomas, ascites, edema), paresthesia, tremors, increased blood pressure, bruising, GI bleeding, and abdominal pain.
❑ Anorexia nervosa. Chronic anorexia begins insidiously and eventually leads to life-threatening malnutrition, as evidenced by skeletal muscle atrophy, loss of fatty tissue, constipation, amenorrhea, dry and blotchy or sallow skin, alopecia, sleep disturbances, distorted self-image, anhedonia, and decreased libido. Paradoxically, the patient typically exhibits extreme restlessness and vigor and may exercise avidly. He also may have complicated food preparation and eating rituals.
❑ Appendicitis. Anorexia closely follows the abrupt onset of generalized or localized epigastric pain, nausea, and vomiting. It can continue as pain localizes in the right lower quadrant (McBurney’s point), and other signs and symptoms appear: abdominal rigidity, rebound tenderness, constipation (or diarrhea), a slight fever, and tachycardia.
❑ Cancer. Chronic anorexia occurs along with possible weight loss, weakness, apathy, and cachexia.
❑ Chronic renal failure. Chronic anorexia is common and insidious. It’s accompanied by changes in all body systems, such as nausea, vomiting, mouth ulcers, ammonia breath odor, metallic taste in the mouth, GI bleeding, constipation or diarrhea, drowsiness, confusion, tremors, pallor, dry and scaly skin, pruritus, alopecia, purpuric lesions, and edema.
❑ Cirrhosis. Anorexia occurs early in cirrhosis and may be accompanied by weakness, nausea, vomiting, constipation or diarrhea, and dull abdominal pain. It continues after these early signs and symptoms subside and is accompanied by lethargy, slurred speech, bleeding tendencies, ascites, severe pruritus, dry skin, poor skin turgor, hepatomegaly, fetor hepaticus, jaundice, leg edema, gynecomastia, and right upper quadrant pain.
❑ Crohn’s disease. Chronic anorexia causes marked weight loss. Associated signs vary according to the site and extent of the lesion, but may include diarrhea, abdominal pain, fever, an abdominal mass, weakness, perianal or vaginal fistulas and, rarely, clubbing of the fingers. Acute inflammatory signs and symptoms — right lower quadrant pain, cramping, tenderness, flatulence, fever, nausea, diarrhea (including nocturnal), and bloody stools — mimic those of appendicitis.
❑ Gastritis. With acute gastritis, the onset of anorexia may be sudden. The patient may experience postprandial epigastric distress after a meal, accompanied by nausea, vomiting (commonly with hematemesis), fever, belching, hiccups, and malaise.
❑ Hepatitis. With viral hepatitis (hepatitis A, B, C, or D), anorexia begins in the preicteric phase, accompanied by fatigue, malaise, headache, arthralgia, myalgia, photophobia, nausea and vomiting, a mild fever, hepatomegaly, and lymphadenopathy. It may continue throughout the icteric phase, along with mild weight loss, dark urine, clay-colored stools, jaundice, right upper quadrant pain and, possibly, irritability and severe pruritus.
Signs and symptoms of nonviral hepatitis usually resemble those of viral hepatitis but may vary, depending on the cause and extent of liver damage.
❑ Hypothyroidism. Anorexia is common and usually insidious in patients with a thyroid hormone deficiency. Typically, vague early findings include fatigue, forgetfulness, cold intolerance, unexplained weight gain, and constipation. Subsequent findings include decreased mental stability; dry, flaky, and inelastic skin; edema of the face, hands, and feet; ptosis; hoarseness; thick, brittle nails; coarse, broken hair; and signs of decreased cardiac output such as bradycardia. Other common findings include abdominal distention, menstrual irregularities, decreased libido, ataxia, intention tremor, nystagmus, a dull facial expression, and slow reflex relaxation time.
❑ Ketoacidosis. Anorexia usually arises gradually and is accompanied by dry, flushed skin; a fruity breath odor; polydipsia; polyuria and nocturia; hypotension; a weak, rapid pulse; a dry mouth; abdominal pain; and vomiting.
❑ Pernicious anemia. With pernicious anemia, insidious anorexia may cause considerable weight loss. Related findings include the classic triad of a burning tongue, general weakness, and numbness and tingling in the extremities; alternating constipation and diarrhea; abdominal pain; nausea and vomiting; bleeding gums; ataxia; positive Babinski’s and Romberg’s signs; diplopia and blurred vision; irritability; head-ache; malaise; and fatigue.
Other causes
❑ Drugs. Anorexia results from the use of amphetamines; chemotherapeutic agents; sympathomimetics, such as ephedrine; and some antibiotics. It also signals digoxin toxicity.
❑ Radiation therapy. Radiation treatments can cause anorexia, possibly as a result of metabolic disturbances.
❑ Total parenteral nutrition (TPN). Maintenance of blood glucose levels by I.V. therapy may cause anorexia.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Polyphagia [Hyperphagia]:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
Anxiety
Polyphagia may result from mild to moderate anxiety or emotional stress. Mild anxiety typically produces restlessness, sleeplessness, irritability, repetitive questioning, and constant seeking of attention and reassurance. With moderate anxiety, selective inattention and difficulty concentrating may also occur. Other effects of anxiety may include muscle tension, diaphoresis, GI distress, palpitations, tachycardia, and urinary and sexual dysfunction.
Bulimia
Most common in women ages 18 to 29, bulimia causes polyphagia that alternates with self-induced vomiting, fasting, or diarrhea. The patient typically weighs less than normal, but has a morbid fear of obesity. She appears depressed, has low self-esteem, and conceals her overeating.
Diabetes mellitus
With diabetes mellitus, polyphagia occurs with weight loss, polydipsia, and polyuria. It’s accompanied by nocturia, weakness, fatigue, and signs of dehydration, such as dry mucous membranes and poor skin turgor.
Premenstrual syndrome (PMS)
Appetite changes, typified by food cravings and binges, are common with PMS. Abdominal bloating, the most common associated finding, may occur with behavioral changes, such as depression and insomnia. A headache, paresthesia, and other neurologic symptoms may also occur. Related findings include diarrhea or constipation, edema and temporary weight gain, palpitations, back pain, breast swelling and tenderness, oliguria, and easy bruising.
Other causes
Drugs
Corticosteroids, cyproheptadine, and some hormone supplements may increase appetite, causing weight gain.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Anorexia nervosa:
Causes and incidence
(Professional Guide to Diseases (Eighth Edition))
No causes of anorexia nervosa have been identified; however, genetic, social, and psychological factors have been implicated. Researchers in neuroendocrinology are seeking a physiologic cause, but have found nothing definite. Clearly, social attitudes that equate slimness with beauty play some role in provoking this disorder; family factors are also implicated. Most theorists believe that refusing to eat is a subconscious effort to exert personal control over one’s life. Anorexia nervosa has been associated with other psychiatric disorders, such as obsessive-compulsive disorder, depression, and anxiety.
Anorexia occurs in 5% to 10% of the population; about 95% of those affected are women. This disorder occurs primarily in adolescents and young adults but may also affect older women. The occurrence among males is rising. The prognosis varies but improves if the patient is diagnosed early or if she wants to overcome the disorder and seeks help voluntarily. Mortality ranges from 5% to 15% — the highest mortality associated with a psychiatric disturbance. One-third of these deaths can be attributed to suicide.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Anorexia:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Acquired immunodeficiency syndrome (AIDS)
An infection or Kaposi’s sarcoma affecting the GI or respiratory tract may lead to anorexia in a patient with AIDS. Other findings include fatigue, afternoon fevers, night sweats, diarrhea, cough, bleeding, lymphadenopathy, oral thrush, gingivitis, and skin disorders, including persistent herpes zoster and recurrent herpes simplex, herpes labialis, or herpes genitalis.
Adrenocortical hypofunction
In adrenocortical hypofunction, anorexia may begin slowly and subtly, causing gradual weight loss. Other common signs and symptoms include nausea and vomiting, abdominal pain, diarrhea, weakness, fatigue, malaise, vitiligo, bronze-colored skin, and purple striae on the breasts, abdomen, shoulders, and hips.
Alcoholism
Chronic anorexia commonly accompanies alcoholism, eventually leading to malnutrition. Other findings include signs of liver damage (jaundice, spider angiomas, ascites, edema), paresthesia, tremors, increased blood pressure, bruising, GI bleeding, and abdominal pain.
Anorexia nervosa
Chronic anorexia nervosa is an eating disorder that begins insidiously and eventually leads to life-threatening malnutrition, as evidenced by skeletal muscle atrophy, loss of fatty tissue, constipation, amenorrhea, dry and blotchy or sallow skin, alopecia, sleep disturbances, distorted self-image, anhedonia, and decreased libido. Paradoxically, many patients exhibit extreme restlessness and vigor and may exercise avidly; many also have complicated food preparation and eating rituals.
Appendicitis
Anorexia closely follows the abrupt onset of generalized or localized epigastric pain, nausea, and vomiting. It can continue as pain localizes in the right lower quadrant (McBurney’s point) and other signs and symptoms—abdominal rigidity, rebound tenderness, constipation or diarrhea, slight fever, and tachycardia—appear.
Cancer
Chronic anorexia may be accompanied by weight loss, weakness, apathy, and cachexia.
Chronic renal failure
Chronic anorexia is common and develops insidiously in chronic renal failure. It’s accompanied by changes in all body systems, such as nausea, vomiting, mouth ulcers, ammonia breath odor, metallic taste, GI bleeding, constipation or diarrhea, drowsiness, confusion, tremors, pallor, dry and scaly skin, pruritus, alopecia, purpuric lesions, and edema.
Cirrhosis
Anorexia occurs early in cirrhosis and may be accompanied by weakness, nausea, vomiting, constipation or diarrhea, and dull abdominal pain. It continues after these early signs and symptoms subside and is accompanied by lethargy, slurred speech, bleeding tendencies, ascites, severe pruritus, dry skin, poor skin turgor, hepatomegaly, fetor hepaticus, jaundice, edema of the legs, gynecomastia, and right-upper-quadrant pain.
Crohn’s disease
Chronic anorexia causes marked weight loss in Crohn’s disease. Associated signs vary according to the site and extent of the lesion but may include diarrhea, abdominal pain, fever, abdominal mass, weakness, perianal or vaginal fistulas and, rarely, clubbing of the fingers. Acute inflammatory signs and symptoms—right-lower-quadrant pain, cramping, tenderness, flatulence, fever, nausea, diarrhea (including nocturnal), and bloody stools—mimic those of appendicitis.
Depressive syndrome
Anorexia reflects anhedonia in depressive syndrome. Accompanying signs and symptoms include poor concentration, indecisiveness, delusions, menstrual irregularities, decreased libido, insomnia or hypersomnia, fatigue, mood swings, poor self-image, and gradual social withdrawal.
Gastritis
In acute gastritis, anorexia may have a sudden onset. The patient may experience postprandial epigastric distress accompanied by nausea, vomiting (often with hematemesis), fever, belching, hiccups, and malaise.
Hepatitis
In viral hepatitis (hepatitis A, B, C, or D), anorexia begins in the preicteric phase and is accompanied by fatigue, malaise, headache, arthralgia, myalgia, photophobia, nausea and vomiting, mild fever, hepatomegaly, and lymphadenopathy. It may continue throughout the icteric phase along with mild weight loss, dark urine, clay-colored stools, jaundice, right-upper-quadrant pain and, possibly, irritability and severe pruritus.
Signs and symptoms of nonviral hepatitis usually resemble those of viral hepatitis but may vary, depending on the cause and the extent of liver damage.
Hypopituitarism
Anorexia usually develops slowly in hypopituitarism, which usually begins with hypergonadism. Accompanying signs and symptoms vary with the disorder’s severity and the number and type of deficient hormones. They may include amenorrhea; decreased libido; lethargy; cold intolerance; pale, thin, and dry skin; dry, brittle hair; and decreased temperature, blood pressure, and pulse rate.
Hypothyroidism
Anorexia is common and usually insidious in patients with thyroid hormone deficiency. Vague early findings typically include fatigue, forgetfulness, cold intolerance, unexplained weight gain, and constipation. Subsequent findings include decreased mental stability; dry, flaky, and inelastic skin; edema of the face, hands, and feet; ptosis; hoarseness; thick, brittle nails; coarse, broken hair; and signs of decreased cardiac output such as bradycardia. Other common findings include abdominal distention, menstrual
irregularities, decreased libido, ataxia, intention tremor, nystagmus, dull facial expression, and slow reflex relaxation time.
Ketoacidosis
Anorexia usually arises gradually in ketoacidosis and is accompanied by dry, flushed skin; fruity breath odor; polydipsia; polyuria and nocturia; hypotension; weak, rapid pulse; dry mouth; abdominal pain; and vomiting.
Pernicious anemia
In pernicious anemia, insidious anorexia may cause considerable weight loss. Related findings include the classic triad of burning tongue, general weakness, and numbness and tingling in the extremities; alternating constipation and diarrhea; abdominal pain; nausea and vomiting; bleeding gums; ataxia; positive Babinski’s and Romberg’s signs; diplopia and blurred vision; irritability, headache, malaise, and fatigue.
Other causes
Drugs
Anorexia may result from the use of amphetamines, chemotherapeutic agents, sympathomimetics such as ephedrine, and some antibiotics. It also may signal digoxin toxicity.
Radiation therapy
Radiation treatments can cause anorexia, possibly as the result of metabolic disturbances.
Total parenteral nutrition
Maintenance of blood glucose levels by I.V. therapy may cause anorexia.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Polyphagia [Hyperphagia]:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Anxiety
Polyphagia may result from mild to moderate anxiety or emotional stress. Mild anxiety typically produces restlessness, sleeplessness, irritability, repetitive questioning, and constant seeking of attention and reassurance. With moderate anxiety, selective inattention and difficulty concentrating may also occur. Other effects of anxiety may include muscle tension, diaphoresis, GI distress, palpitations, tachycardia, and urinary and sexual dysfunction.
Bulimia
Most common in women ages 18 to 29, bulimia causes polyphagia that alternates with self-induced vomiting, fasting, or diarrhea. The patient typically weighs less than normal but has a morbid fear of obesity. She appears depressed, has low self-esteem, and conceals her overeating.
Diabetes mellitus
With this disorder, polyphagia occurs with weight loss, polydipsia, and polyuria. It’s accompanied by nocturia, weakness, fatigue, and signs of dehydration, such as dry mucous membranes and poor skin turgor.
Migraine headache
Polyphagia sometimes precedes a migraine headache. The individual may experience changes in appetite or food cravings. Other prodromal signs and symptoms include fatigue, nausea, vomiting, and a visual aura. Light and noise sensitivity may also occur.
Premenstrual syndrome
Appetite changes, typified by food cravings and binges, are common with this syndrome. Abdominal bloating, the most common associated finding, may occur with behavioral changes, such as depression and insomnia. Headache, paresthesia, and other neurologic symptoms may also occur. Related findings include diarrhea or constipation, edema and temporary weight gain, palpitations, back pain, breast swelling and tenderness, oliguria, and easy bruising.
Thyrotoxicosis
This disorder can produce weight loss, despite constant polyphagia. Other characteristics include weakness, nervousness, diarrhea, tremors, diaphoresis, and dyspnea. The patient’s hair and nails are thin and brittle, and his thyroid is enlarged. He may also exhibit palpitations, tachycardia, heat intolerance, exophthalmos, and an atrial or ventricular gallop.
Other causes
Drugs
Corticosteroids and cyproheptadine may increase appetite, causing weight gain.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Anorexia nervosa:
Causes
(Handbook of Diseases)
No one knows what causes anorexia nervosa. Researchers in neuroendocrinology are seeking a physiologic cause but have found nothing definite. Clearly, social attitudes that equate slimness with beauty play some role in provoking this disorder; family factors also are implicated. Most theorists believe that refusing to eat is a subconscious effort to exert personal control over one’s life.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Anorexia:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Acquired immunodeficiency syndrome
With acquired immunodeficiency syndrome (AIDS), an infection or Kaposi’s sarcoma affecting the GI or respiratory tract may lead to anorexia. Other findings include fatigue, afternoon fevers, night sweats, diarrhea, cough, bleeding, lymphadenopathy, oral thrush, gingivitis, and skin disorders, including persistent herpes zoster and recurrent herpes simplex, herpes labialis, or herpes genitalis.
Adrenocortical hypofunction
With adrenocortical hypofunction, anorexia may begin slowly and subtly, causing gradual weight loss. Other common signs and symptoms include nausea and vomiting, abdominal pain, diarrhea, weakness, fatigue, malaise, vitiligo, bronze-colored skin, and purple striae on the breasts, abdomen, shoulders, and hips.
Alcoholism
Chronic anorexia commonly accompanies alcoholism, eventually leading to malnutrition. Other findings include signs of liver damage (jaundice, spider angiomas, ascites, edema), paresthesia, tremors, increased blood pressure, bruising, GI bleeding, and abdominal pain.
Anorexia nervosa
With anorexia nervosa, chronic anorexia begins insidiously and eventually leads to life-threatening malnutrition, as evidenced by skeletal muscle atrophy, loss of fatty tissue, constipation, amenorrhea, dry and blotchy or sallow skin, alopecia, sleep disturbances, distorted self-image, anhedonia, and decreased libido. Paradoxically, the patient commonly exhibits extreme restlessness and vigor and may exercise avidly. Many patients also have complicated food preparation and eating rituals.
Appendicitis
With appendicitis, anorexia closely follows the abrupt onset of generalized or localized epigastric pain, nausea, and vomiting. It can continue as pain localizes in the right lower quadrant (McBurney’s point) and other signs and symptoms appear: abdominal rigidity, rebound tenderness, constipation (or diarrhea), slight fever, and tachycardia.
Cancer
With cancer, chronic anorexia occurs along with possible weight loss, weakness, apathy, and cachexia. Other findings may include nausea, vomiting, oral lesions, and changes in bowel habits.
Chronic renal failure
Chronic anorexia is common and insidious in chronic renal failure. It’s accompanied by changes in all body systems, such as nausea, vomiting, mouth ulcers, ammonia breath odor, metallic taste in the mouth, GI bleeding, constipation or diarrhea, drowsiness, confusion, tremors, pallor, dry and scaly skin, pruritus, alopecia, purpuric lesions, and edema.
Cirrhosis
With cirrhosis, anorexia occurs early and may be accompanied by weakness, nausea, vomiting, constipation or diarrhea, and dull abdominal pain. It continues after these early signs and symptoms subside and is accompanied by lethargy, slurred speech, bleeding tendencies, ascites, severe pruritus, dry skin, poor skin turgor, hepatomegaly, fetor hepaticus, jaundice, edema of the legs, gynecomastia, and right-upper-quadrant pain.
Crohn’s disease
With Crohn’s disease, chronic anorexia causes marked weight loss. Associated signs vary according to the site and extent of the lesion but may include diarrhea, abdominal pain, fever, abdominal mass, weakness, perianal or vaginal fistulas and, rarely, clubbing of the fingers. Acute inflammatory signs and symptoms — right-lower-quadrant pain, cramping, tenderness, flatulence, fever, nausea, diarrhea (including nocturnal), and bloody stools — mimic those of appendicitis.
Depressive syndrome
Anorexia reflects anhedonia in depressive syndrome. Accompanying signs and symptoms include poor concentration, indecisiveness, delusions, menstrual irregularities, decreased libido, insomnia or hypersomnia, fatigue, mood swings, poor self-image, and gradual social withdrawal.
Gastritis
With acute gastritis, the onset of anorexia may be sudden. The patient may experience postprandial epigastric distress, accompanied by nausea, vomiting (commonly hematemesis), fever, belching, hiccups, and malaise.
Hepatitis
With viral hepatitis (hepatitis A, B, C, or D), anorexia begins in the preicteric phase, accompanied by fatigue, malaise, headache, arthralgia, myalgia, photophobia, nausea and vomiting, mild fever, hepatomegaly, and lymphadenopathy. It may continue through the icteric phase, along with mild weight loss, dark urine, clay-colored stools, jaundice, right-upper-quadrant pain and, possibly, irritability and severe pruritus.
Signs and symptoms of nonviral hepatitis usually resemble those of viral hepatitis but may vary, depending on the cause and extent of liver damage.
Hypopituitarism
Anorexia usually develops slowly in hypopituitarism, which usually begins with hypergonadism. Accompanying signs and symptoms vary with the disorder’s severity and the number and type of deficient hormones. Such signs and symptoms include amenorrhea; decreased libido; lethargy; cold intolerance; pale, thin, and dry skin; dry, brittle hair; and decreased temperature, blood pressure, and pulse rate.
Hypothyroidism
Anorexia is common and usually insidious in patients with hypothyroidism (thyroid hormone deficiency). Typically, vague early findings include fatigue, forgetfulness, cold intolerance, unexplained weight gain, and constipation. Subsequent findings include decreased mental stability; dry, flaky, and inelastic skin; edema of the face, hands, and feet; ptosis; hoarseness; thick, brittle nails; coarse, broken hair; and signs of decreased cardiac output such as bradycardia. Other common findings include abdominal distention, menstrual irregularities, decreased libido, ataxia, intention tremor, nystagmus, dull facial expression, and slow reflex relaxation time.
Pernicious anemia
With pernicious anemia, insidious anorexia may cause considerable weight loss. Related findings include the classic triad of burning tongue, general weakness, and numbness and tingling in the extremities; alternating constipation and diarrhea; abdominal pain; nausea and vomiting; bleeding gums; ataxia; positive Babinski’s and Romberg’s signs; diplopia and blurred vision; irritability, headache, malaise, and fatigue.
Other causes
Drugs
Anorexia results from the use of amphetamines, chemotherapeutic agents, sympathomimetics such as ephedrine, and some antibiotics. It also signals digoxin toxicity.
Radiation therapy
Radiation treatments can cause anorexia, possibly as the result of metabolic disturbances.
Total parenteral nutrition
Maintenance of blood glucose levels by I.V. therapy may cause anorexia.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Polyphagia:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Anxiety
Polyphagia may result from mild to moderate anxiety or emotional stress. Mild anxiety typically produces restlessness, sleeplessness, irritability, repetitive questioning, and constant seeking of attention and reassurance. With moderate anxiety, selective inattention and difficulty concentrating may also occur. Other effects of anxiety may include muscle tension, diaphoresis, GI distress, palpitations, tachycardia, and urinary and sexual dysfunction.
Bulimia
Most common in women ages 18 to 29, bulimia causes polyphagia that alternates with self-induced vomiting, fasting, or diarrhea. The patient typically weighs less than normal but has a morbid fear of obesity. She appears depressed, has low self-esteem, and conceals her overeating.
Diabetes mellitus
With diabetes mellitus, polyphagia occurs with weight loss, polydipsia, and polyuria. It’s accompanied by nocturia, weakness, fatigue, and such signs of dehydration as dry mucous membranes and poor skin turgor.
Migraine headache
Polyphagia sometimes precedes a migraine headache. The individual may experience changes in appetite or food cravings. Other prodromal signs and symptoms include fatigue, nausea, vomiting, and a visual aura. Light and noise sensitivity may also occur.
Premenstrual syndrome
Appetite changes, typified by food cravings and binges, are common with premenstrual syndrome. Abdominal bloating, the most common associated finding, may occur with behavioral changes, such as depression and insomnia. Headache, paresthesia, and other neurologic symptoms may also occur. Related findings include diarrhea or constipation, edema and temporary weight gain, palpitations, back pain, breast swelling and tenderness, oliguria, and easy bruising.
Thyrotoxicosis
Thyrotoxicosis can produce weight loss despite constant polyphagia. Other characteristics include weakness, nervousness, diarrhea, tremors, diaphoresis, and dyspnea. The patient’s hair and nails are thin and brittle, and his thyroid is enlarged. He may also exhibit palpitations, tachycardia, heat intolerance, exophthalmos, and an atrial or ventricular gallop.
Other causes
Drugs
Corticosteroids and cyproheptadine may increase appetite, causing weight gain.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Anorexia:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Acquired immunodeficiency syndrome.An infection or Kaposi's sarcoma affecting the GI or respiratory tract may lead to anorexia. Other findings include fatigue, afternoon fevers, night sweats, diarrhea, cough, lymphadenopathy, bleeding, oral thrush, gingivitis, and skin disorders, including persistent herpes zoster and recurrent herpes simplex, herpes labialis, or herpes genitalis.
Adrenocortical hypofunction.With adrenocortical hypofunction, anorexia may begin slowly and subtly, causing gradual weight loss. Other common signs and symptoms include nausea and vomiting, abdominal pain, diarrhea, weakness, fatigue, malaise, vitiligo, bronze-colored skin, and purple striae on the breasts, abdomen, shoulders, and hips.
Alcoholism.Chronic anorexia commonly accompanies alcoholism, eventually leading to malnutrition. Other findings include signs of liver damage (jaundice, spider angiomas, ascites, edema), paresthesia, tremors, increased blood pressure, bruising, GI bleeding, and abdominal pain.
Anorexia nervosa.Chronic anorexia begins insidiously and eventually leads to life-threatening malnutrition and electrolyte disorders, as evidenced by skeletal muscle atrophy, loss of fatty tissue, constipation, amenorrhea, dry and blotchy or sallow skin, alopecia, sleep disturbances, distorted self-image, anhedonia, decreased libido, and cardiac arrhythmias. Paradoxically, the patient typically exhibits extreme restlessness and vigor and may exercise compulsively. He may have complicated food preparation and eating rituals.
Appendicitis.Anorexia closely follows the abrupt onset of generalized or localized epigastric pain, nausea, and vomiting cause by appendicitis. It can continue as pain localizes in the right lower quadrant (McBurney's point), and other signs and symptoms appear, such as abdominal rigidity, rebound tenderness, constipation (or diarrhea), a slight fever, and tachycardia.
Cancer.Chronic anorexia occurs along with possible weight loss, weakness, apathy, and cachexia.
Chronic renal failure.With chronic rental failure,chronic anorexia is common and insidious. It's accompanied by changes in all body systems, such as nausea, vomiting, mouth ulcers, ammonia breath odor, metallic taste in the mouth, GI bleeding, constipation or diarrhea, drowsiness, confusion, tremors, pallor, dry and scaly skin, pruritus, alopecia, purpuric lesions, and edema.
Cirrhosis.Anorexia occurs early in cirrhosis and may be accompanied by weakness, nausea, vomiting, constipation or diarrhea, and dull abdominal pain. It continues after these early signs and symptoms subside and is accompanied by lethargy, slurred speech, bleeding tendencies, ascites, severe pruritus, dry skin, poor skin turgor, hepatomegaly, fetor hepaticus, jaundice, leg edema, gynecomastia, and right upper quadrant pain.
Crohn's disease.With Crohn's disease, chronic anorexia causes marked weight loss. Associated signs vary according to the site and extent of the lesion, but may include diarrhea, abdominal pain, fever, an abdominal mass, weakness, perianal or vaginal fistulas and, rarely, clubbing of the fingers. Acute inflammatory signs and symptoms—right lower quadrant pain, cramping, tenderness, flatulence, fever, nausea, diarrhea (including nocturnal), and bloody stools—mimic those of appendicitis.
Gastritis.With acute gastritis, the onset of anorexia may be sudden. The patient may experience postprandial epigastric distress after a meal, accompanied by nausea, vomiting (commonly with hematemesis), fever, belching, hiccups, and malaise.
Hepatitis.With viral hepatitis (hepatitis A, B, C, or D), anorexia begins in the preicteric phase, accompanied by fatigue, malaise, headache, arthralgia, myalgia, photophobia, nausea and vomiting, a mild fever, hepatomegaly, and lymphadenopathy. It may continue throughout the icteric phase, along with mild weight loss, dark urine, clay-colored stools, jaundice, right upper quadrant pain and, possibly, irritability and severe pruritus.
Signs and symptoms of nonviral hepatitis usually resemble those of viral hepatitis but may vary, depending on the cause and extent of liver damage.
Hypothyroidism.Anorexia is common and usually insidious in patients with a thyroid hormone deficiency. Typically, vague early findings include fatigue, forgetfulness, cold intolerance, unexplained weight gain, and constipation. Subsequent findings include decreased mental stability; dry, flaky, and inelastic skin; edema of the face, hands, and feet; ptosis; hoarseness; thick, brittle nails; coarse, broken hair; and signs of decreased cardiac output such as bradycardia. Other common findings include abdominal distention, menstrual irregularities, decreased libido, ataxia, intention tremor, nystagmus, a dull facial expression, and slow reflex relaxation time.
Ketoacidosis.Anorexia usually arises gradually and is accompanied by dry, flushed skin; a fruity breath odor; polydipsia; polyuria and nocturia; hypotension; a weak, rapid pulse; a dry mouth; abdominal pain; vomiting, and altered level of consciousness.
Pernicious anemia.With pernicious anemia, insidious anorexia may cause considerable weight loss. Related findings include the classic triad of a burning tongue, general weakness, and numbness and tingling in the extremities; alternating constipation and diarrhea; abdominal pain; nausea and vomiting; bleeding gums; ataxia; positive Babinski's and Romberg's signs; diplopia and blurred vision; irritability; head-ache; malaise; and fatigue.
Other causes
Drugs.Anorexia results from the use of amphetamines, chemotherapeutic agents, sympathomimetics such as ephedrine, and some antibiotics. It also signals digoxin toxicity.
Radiation therapy.Radiationtreatments can cause anorexia, possibly as a result of metabolic disturbances.
Total parenteral nutrition (TPN).Maintenance of blood glucose levels by I.V. therapy may cause anorexia.
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Source: Nursing: Interpreting Signs and Symptoms, 2007
Polyphagia [Hyperphagia]:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Anxiety.Polyphagia may result from mild to moderate anxiety or emotional stress. Mild anxiety typically produces restlessness, sleeplessness, irritability, repetitive questioning, and constant seeking of attention and reassurance. With moderate anxiety, selective inattention and difficulty concentrating may also occur. Other effects of anxiety may include muscle tension, diaphoresis, GI distress, palpitations, tachycardia, and urinary and sexual dysfunction.
Bulimia.Bulimia causes polyphagia that alternates with self-induced vomiting, fasting, or diarrhea. The patient typically weighs less than normal, but has a morbid fear of obesity. She appears depressed, has low self-esteem, and conceals her overeating.
Diabetes mellitus.With diabetes mellitus, polyphagia occurs with weight loss, polydipsia, and polyuria. It's accompanied by nocturia, weakness, fatigue, and signs of dehydration, such as dry mucous membranes and poor skin turgor.
Premenstrual syndrome (PMS).Appetite changes, typified by food cravings and binges, are common with PMS. Abdominal bloating, the most common associated finding, may occur with behavioral changes, such as depression and insomnia. Headache, paresthesia, and other neurologic symptoms may also occur. Related findings include diarrhea or constipation, edema and temporary weight gain, palpitations, back pain, breast swelling and tenderness, oliguria, and easy bruising.
Other causes
Drugs.Corticosteroids, cyproheptadine, and some hormone supplements may increase appetite, causing weight gain.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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