STUDY - Technical - New Dacian's Medicine
Anorexia
(Classical / Allopathic Medicine)
Anorexia is a lack
of appetite in the presence of a physiologic need for food.
This symptom is common with GI and endocrine disorders and is
characteristic of certain severe psychological disturbances
such as anorexia nervosa. It can also result from such factors
as anxiety, chronic pain, poor oral hygiene, increased blood
temperature due to hot weather or fever, and changes in taste
or smell that normally accompany aging. Anorexia can also
result from drug therapy or abuse. Short-term anorexia rarely
jeopardizes health, but chronic anorexia can lead to
life-threatening malnutrition. (See Common signs and symptoms
of malnutrition.)
HISTORY:
Ask the patient
about previous minimum and maximum weights.
Ask the patient about his dietary habits, such as when and what he eats, what foods he likes and dislikes, and why.
Ask the patient about dental problems that interfere with chewing, including poorly fitting dentures.
Ask the patient about swallowing problems and about GI disturbances after eating.
Ask the patient how frequently and intensely he exercises.
Review the patient's medical history, noting especially stomach or bowel disorders and changes in bowel habits.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
Explore psychological factors that may affect appetite, including recent loss or life change and depression.
Ask the patient about his dietary habits, such as when and what he eats, what foods he likes and dislikes, and why.
Ask the patient about dental problems that interfere with chewing, including poorly fitting dentures.
Ask the patient about swallowing problems and about GI disturbances after eating.
Ask the patient how frequently and intensely he exercises.
Review the patient's medical history, noting especially stomach or bowel disorders and changes in bowel habits.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
Explore psychological factors that may affect appetite, including recent loss or life change and depression.
Common signs and
symptoms of malnutrition
When assessing a patient with anorexia, check for these common signs of malnutrition:
- abdomen - enlarged liver and spleen
- cardiovascular system - heart rate greater than 100 beats/minute, arrhythmias, elevated blood pressure
- eyes - dull appearance; dry and pale or red membranes; triangular, shiny gray spots on the conjunctivae; red, fissured eyelid corners; bloodshot ring around the cornea
- face - generalized swelling, dark areas on the cheeks and under the eyes, lumpy or flaky skin around the nose and mouth, enlarged parotid glands
- hair - dull, dry, thin, fine, and straight; easily plucked; areas of lighter or darker spots; hair loss
- lips - red and swollen, especially at the corners
musculoskeletal system - muscle wasting, knock-kneed or bowlegged, bumps on the ribs, swollen joints, musculoskeletal hemorrhages
- nails - spoon shaped, brittle, and ridged
- neck - swollen thyroid gland
- nervous system - irritability, confusion, paresthesia in the hands and feet, loss of proprioception, decreased ankle and knee reflexes
- reproductive system - decreased libido, amenorrhea
- skin - dry, flaky, and swollen; dark with lighter or darker spots, some resembling bruises; tight and drawn with poor turgor
- teeth - missing or emerging abnormally; visible cavities or dark spots; spongy, bleeding gums
- tongue - swollen, purple, and raw looking; sores or abnormal papillae.
When assessing a patient with anorexia, check for these common signs of malnutrition:
- abdomen - enlarged liver and spleen
- cardiovascular system - heart rate greater than 100 beats/minute, arrhythmias, elevated blood pressure
- eyes - dull appearance; dry and pale or red membranes; triangular, shiny gray spots on the conjunctivae; red, fissured eyelid corners; bloodshot ring around the cornea
- face - generalized swelling, dark areas on the cheeks and under the eyes, lumpy or flaky skin around the nose and mouth, enlarged parotid glands
- hair - dull, dry, thin, fine, and straight; easily plucked; areas of lighter or darker spots; hair loss
- lips - red and swollen, especially at the corners
musculoskeletal system - muscle wasting, knock-kneed or bowlegged, bumps on the ribs, swollen joints, musculoskeletal hemorrhages
- nails - spoon shaped, brittle, and ridged
- neck - swollen thyroid gland
- nervous system - irritability, confusion, paresthesia in the hands and feet, loss of proprioception, decreased ankle and knee reflexes
- reproductive system - decreased libido, amenorrhea
- skin - dry, flaky, and swollen; dark with lighter or darker spots, some resembling bruises; tight and drawn with poor turgor
- teeth - missing or emerging abnormally; visible cavities or dark spots; spongy, bleeding gums
- tongue - swollen, purple, and raw looking; sores or abnormal papillae.
PHYSICAL
ASSESSMENT:
Take the patient's vital signs.
Weigh the patient, and evaluate him for signs of malnutrition.
Palpate the abdomen, noting complaints of tenderness or palpable masses.
Take the patient's vital signs.
Weigh the patient, and evaluate him for signs of malnutrition.
Palpate the abdomen, noting complaints of tenderness or palpable masses.
SPECIAL
CONSIDERATIONS:
Because anorexia and poor nutrition increase susceptibility to infection, monitor the patient's vital signs and white blood cell count, and closely observe wounds.
Because anorexia and poor nutrition increase susceptibility to infection, monitor the patient's vital signs and white blood cell count, and closely observe wounds.
PEDIATRIC
POINTERS:
In children, anorexia commonly accompanies many illnesses but usually resolves promptly. However, in preadolescent and adolescent girls, be alert for the commonly subtle signs of anorexia nervosa.
In children, anorexia commonly accompanies many illnesses but usually resolves promptly. However, in preadolescent and adolescent girls, be alert for the commonly subtle signs of anorexia nervosa.
PATIENT
COUNSELING:
Promote protein and calorie intake. Encourage supplemental nutritional support. Advise the patient to eat high-calorie snacks or frequent small meals. Refer the patient to a nutritionist for additional dietary information and for psychological counseling, if appropriate.
Promote protein and calorie intake. Encourage supplemental nutritional support. Advise the patient to eat high-calorie snacks or frequent small meals. Refer the patient to a nutritionist for additional dietary information and for psychological counseling, if appropriate.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common
symptoms, Edition V, McGraw - Hill, 2002.
Dorin,
Merticaru (2010)