Diagnostic Tests for Eating Disorder not Otherwise Specified (ENDOS)
Eating Disorder not Otherwise Specified (ENDOS) Tests: Book Excerpts
Home Diagnostic Testing
These home medical tests may be relevant to Eating Disorder not Otherwise Specified (ENDOS):
- Child Behavior: Home Testing
- Mental Health (Adults): Home Testing
- Mental Health: Home Testing:
- Brain & Neurological Disorders: Related Home Testing:
Eating Disorder not Otherwise Specified (ENDOS) Diagnosis: Book Excerpts
Diagnostic Tests for Eating Disorder not Otherwise Specified (ENDOS): Online Medical Books
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ANOREXIA:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
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:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
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:
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:
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:
Physical examination
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
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.
Testing
A. History and physical examination should guide clinical laboratory testing. A general evaluation should include a complete blood count and a metabolic panel to assess electrolyte balance and hepatorenal function. Other specific laboratory studies to consider include HIV serology, viral hepatitis panel, calcium, thyroid-stimulating hormone, and albumin levels. Also, low levels of prealbumin can indicate malnutrition or impaired protein metabolism. Suspicion may direct the physician toward a urine drug screen, in addition to a urine dipstick test to screen for glucose, protein, and pH.
B. Special studies may include a chest radiograph, esophagoduodenoscopy (EGD), abdominal ultrasound, abdominal angiogram, or computed tomography (CT) scan. A tuberculosis skin test may be useful.
C. Psychological testing can include a formal depression scale, psychiatric consultation, or pharmaceutical trial with an (orexigenic) antidepressant, such as tricyclics.
Diagnostic assessment
Loss of appetite as a chief complaint rarely stands alone as the only problem when an effective history and physical examination are performed. The acuity of onset and the physical well-being of the patient may direct the urgency of the evaluation. The spectrum of additional constitutional symptoms in a complete review of systems will assist the examiner. The plan of action should be predicated by the assessment. Focus is then on treating the underlying condition: consider a trial of orexigenic therapy and nutritional supplementation to alleviate both the cause and the symptom of loss of appetite.
References
1. Morton KI, Sox HC, Krupp JR. Involuntary weight loss: diagnostic and prognostic significance. Ann Intern Med 1981;95(5):568–567.
2. Summerbell CD, Perrett JP, Gazzard BG. Causes of weight loss in human immunodeficiency virus infection. Int J STD AIDS 1993;4:234–236.
3. Garfinkel PE, Garner DM, Kaplan AS, Rodin G, Kennedy S. Differential diagnosis of emotional disorders that cause weight loss. CMAJ 1983;129(9):939–945.
4. Morley JE. Anorexia in older persons: epidemiology and optimal treatment. Drugs Aging 1996;8(2):134–135.
5. Evans RW. The post concussion syndrome and the sequelae of mild head injury. Neurol Clin 1992;10(4):815–847.
» READ BOOK EXCERPT ONLINE »
Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Anorexia:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Perform a complete physical examination. Take the patient’s vital signs and weight. (See Is your patient malnourished? page 44. )
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Polyphagia:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
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: 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
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