Updated: 10/9/2020

Anorexia Nervosa

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Evidence
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Snapshot
  • A 17-year-old girl presents to your office for an annual sports physical. She is an accomplished varsity athlete on her high school cross-country team and feels significant pressure to set a school record during her final season. She does not bring up any health issues that are of concern to her, but upon questioning, she admits that she has not menstruated for 5 months. Her BMI is 15 kg/m2.
Introduction
  • Overview
    • anorexia nervosa is an eating disorder characterized by an extreme fear of weight gain, behavioral and dietary habits that prevent weight gain, and an altered perception of one's body weight
  • Epidemiology
    • prevalence
      • 0.3-1% overall in the US
        • as high as 4% among women
    • demographics
      • female:male ratio 10-20:1
      • most prevalent in pubertal and adolescent girls
        • majority have onset between ages 13-18 years
    • risk factors
      • female
      • family history of eating disorders
      • low self-esteem
  • Pathophysiology
    • result of a complex of psychosocial factors
  • Prognosis
    • mobidity 10-20%
    • about 50% of patients make a complete recovery
    • worse prognosis for patients who are older (> 18 years of age) at age of onset of the disorder as well as patients with an onset before 11 years of age
Presentation
  • Symptoms
    • anxiety
    • depression
    • negative self image
    • amenorrhea
    • irritability
    • constipation
    • dry skin
    • hair loss
    • fainting or dizziness
    • lethargy
  • Physical exam
    • low BMI (< 18.5 kg/m2
    • hypotension
    • bradycardia
    • hypothermia
    • dry skin
    • lanugo
    • peripheral edema
    • loss of muscle mass
Studies
  • Serum labs
    • complete blood count
      • may show leukopenia and thrombocytopenia
    • basic metabolic panel
      • may show electrolyte abnormalities in severe disease
  • EKG
    • may show evidence of sinus bradycardia
    • QT-interval prolongation indicates serious risk for cardiac arrhythmias
Tested Differential
  • Hyperthyroidism  
    • key distinguishing factor
      • abnormal thyroid hormone levels
  • Celiac disease  
    • key distinguishing factor
      • intolerance to gluten-containing foods
Treatment
  • Lifestyle
    • psychological/behavioral therapy & nutritional rehabilitation
      • indications
        • BMI > 14.5 kg/mm2
        • mild electrolyte imbalances
      • technique
        • vitamin supplementation with calcium
        • monitor for refeeding syndrome, a possible complication that leads to electrolyte and fluid imbalances
          • labs: hypophosphatemia, hypokalemia, hypomagnesemia 
  • Medical
    • estrogen replacement (e.g. oral contraceptives)
      • indications
        • treatment of osteopenia associated with anorexia
    • hospital admission with inpatient treatment
      • indications
        • BMI < 14.5 kg/mm2
        • severe electrolyte imbalances
Complications
  • Malnutrition
  • Delayed puberty
  • Amenorrhea
  • Arrested growth
  • Osteoporosis 
  • Electrolyte imbalances
  • Cardiovascular effects
    • cardiomyopathy
    • long QT sndrome
    • bradycardia

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Questions (2)
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(M2.PY.17.107) An 18-year-old female visits your obstetrics clinic for her first prenatal check up. It's her first month of pregnancy and other than morning sickness, she is feeling well. Upon inquiring about her past medical history, the patient admits that she used to be very fearful of weight gain and often used laxatives to lose weight. After getting therapy for this condition, she regained her normal body weight but continues to struggle with the disease occasionally. Given this history, how could her past condition affect the pregnancy? Tested Concept

QID: 105777
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Down syndrome in newborn

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Postpartum depression for mother

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Bradycardia in newborn

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Anemia in newborn

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5

Seizure for mother

33%

(1/3)

M 8 C

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Evidence (8)
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