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Anorexia Nervosa - Comment

Description: Complex eating disorder characterized by obsessive pursuit of thinness through dieting with extreme weight loss and disturbance of body image
Anorexia nervosa is typically characterized by
voluntary restriction of food intake ,distorted body image and fear of gaining weight.

1. ANOREXIA NERVOSA Prepared by: Anish Dhakal (Aryan)
2. OBJECTIVES • To discuss about anorexia nervosa • Differences with bulimia nervosa • Management of anorexia nervosa
3. EATING DISORDERS IN ADOLESCENT • Concerns about body image and dieting are very common in modern society females • Among these dieters, 5-10% become abnormally preoccupied with dieting and slimness • Low self esteem, tend to be perfectionists with obsessive compulsive traits • Genetic vulnerability, temperament, psychological and environmental factors also mediate the illness • ‘Genes load the gun, environment pulls the trigger’
4. ANOREXIA NERVOSA • Complex eating disorder characterized by obsessive pursuit of thinness through dieting with extreme weight loss and disturbance of body image • Characterized by • voluntary restriction of food intake • distorted body image • fear of gaining weight
5. EPIDEMIOLOGY • Among women, lifetime prevalence is approximately 1%. • Less common in males (1:10) • Prevalent where food is plentiful and thinness viewed as attractive • Incidence increasing
6. ETIOLOGY • Probably genetic and environmental factors including social pressure to be thin and attractive • ↑ Incidence in families with an affected member
7. CLINICAL FEATURES • Begins in early puberty, before menarche, but seldom begins after age 40 • Severe weight loss • Fear of gaining weight • Use of diuretics, laxatives • Excessive exercise
8. PHYSICAL FEATURES • Cardiac and skeletal systems are most affected • Constipation • Amenorrhea • Vital signs: bradycardia, hypotension, and mild hypothermia • Lanugo hair in back, forearm and cheeks • Salivary gland enlargement • Acrocyanosis of the digits • Peripheral edema
9. DIAGNOSIS • Diagnosis based on • pronounced fear of fatness despite being thin • absence of alternative causes of weight loss
10. EXAMINATION & INVESTIGATIONS • Physical exam • Laboratory tests • complete blood count (CBC) • electrolytes • protein • LFT, RFT, TFT • urinalysis • Psychological evaluation • thoughts, feelings and eating habits • Other studies • X-rays (broken bones, pneumonia) • Electrocardiograms (heart irregularities) • Bone density testing
11. MANAGEMENT • Aim • Ensure patient’s well-being by helping them gain weight through addressing beliefs and behaviors that maintain low weight • Usually done on OPD basis • Inpatient treatment • if weight < 75% of normal • if chances of death due to complications • if risk of suicide • if outpatient treatment fails
12. TREATMENT GOALS • Establish good and caring relationship with patient • Resolve underlying psychological difficulties • Restore weight between ideal and the patient concept of optimal weight • Provide a balanced diet of at least 3000 kcal/day
13. OUTPATIENT TREATMENT • Aim • Cognitive behavioral or interpersonal psychotherapies • Family therapy is more effective than individual psychotherapy in adolescents
14. INPATIENT TREATMENT • Aim • Establishing a therapeutic relationship with both the patient and her family • Restoring the weight to a level between the ideal body weight and the patient’s ideal weight • The provision of a balanced diet, aimed at gaining 0.5–1 kg weight per week • The elimination of purgative and/or laxative use and vomiting • If fails, insertion of NG tube and feeding
15. DIET • Calories • Start calorie intake by approximately 1200-1800 kcal/day and increase intake (3000 kcal/day at least) • Ideal weight gain 0.5 - 1 kg/week • Micronutrients • Zinc • Calcium (1500 md/day) • Vitamin D (400 IU/day) • Essential fatty acids • omega-3 fatty acids docosahexaenoic acid (DHA) • eicosapentaenoic acid (EPA)
16. PSYCHOTHERAPY • Counseling • Cognitive Behavioral Therapy • Family-based treatment • Medications • Antidepressants (SSRIs) • Olanzapine
18. PROGNOSIS • About 20% of patient have good outcomes • Further 20% develop chronic intractable disorder • Remaining have intermediate outcomes • Mortality rate is 10-20% (complication of starvation or from suicide) • Suicide has been reported in 2-5% • Highest mortality and suicide rate of any psychiatry disorder
19. INDICATORS OF A POOR OUTCOME • A long initial illness • Severe weight loss • Older age at onset • Bingeing and purging • Personality difficulties • Difficulties in relationships
20. COMPLICATION • Anorexia nervosa starvation malnutrition protein deficiency and disruption of multiple organ systems. Cardiovascular Renal Gastrointestinal Neurological Endocrine, metabolic and reproductive Integumentary, skeletal and hematologic
21. EMR 1.Delayed puberty 2.Amenorrhoea 3.Anovulation 4.Low estrogen states 5.Increased growth hormones 6.Decreased ADH 7.Hypothermia 8.Hypokalemia, hyponatremia 9.Hyper cortisolism 10.Arrested growth and osteoporosis 11.Decreased gonadotropin levels
22. CVS 1.Cardiomyopathy 2.Mitral valve prolapse 3.Supraventricular and ventricular dysrhythmias 4.Long QT syndrome 5.Bradycardia 6.Orthostatic hypotension 7.Shock due to congestive heart failure
23. RENAL 1.Decreased glomerular filtration rate (GFR) 2.Elevated BUN 3.Edema 4.Acidosis with dehydration 5.Hypokalemia 6.Hypochloremic alkalosis with vomiting 7.Hyperaldosteronism 8.Renal calculi
24. GI 1.Constipation 2.Decreased intestinal mobility 3.Delayed gastric emptying 4.Gastric dilation and rupture(from binge eating and purging) can lead to pneumothorax and pneumoperitoneum
25. NEUROLOGIC 1.Peripheral neuropathy 2.Wernicke’s encephalopathy 3.Korsakkoff syndrome 4.Ventricular enlargement
26. INTEGUMENTARY 1.Dry skin and hair 2.Hair loss 3.Lanugo hair/hypertrichosis
27. HEMATOLOGY 1.Anemia 2.Leukopenia 3.Thrombocytopenia
28. REPRODUCTION 1.Infertility 2.Low-birth-weight
29. REFERENCES • Harrison’s Principles of Internal Medicine, 19th ed. • Murtagh’s General Practice, 5th edition, Mc Graw Hill • Davidson’s Principles and Practice of Medicine, 22nd edition • Kumar and Clark Clinical Medicine, 8th ed.

Posted by :  peter88 Post date :  2020-10-19 22:32
Category :  Health & Medicine Views :  91

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