Anorexia Nervosa  Infertility

 Breast atrophy
A Restriction of energy intake relative to
MSK  Cramps
requirements, leading to a significant low body
 Tetany
weight in the context of age, sex, development
trajectory and physical health  Muscle weakness
 Osteopenia
Significant low body weight:  Stress fracture
→ weight is less than minimally normal (for PNS  Peripheral neuropathy
children & adolescent less than minimally  Impaired autonomic function
expected) Dermatology  Dry skin
B Intense fear of gaining weight/ becoming fat, or  Brittle nail
persistent behaviour that interferes with weight  Loss of head hair
gain, even though at a significantly low weight  ↑ Body hair (Lanugo hair)
C Disturbance in the way in which one’s body  Pallor
weight/ shape is experienced, undue influence  Hypothermia
of body weight/ shape on self-evaluation or Others  Suicidal ideation
persistent lack of recognition of the seriousness  Substance use
of the current low body weight
Laboratory Findings
Specify: FBC  Anaemia
- Partial remission: Criteria A not met, only B/ C  Leukopenia
- Full remission: None Criteria is met  ↓LSR
- Mild :BMI ≥ 17  Thrombocytopenia
- Moderate: 16- 16.99  Weakened complement system
- Severe: 15- 15.99 Electrolyte  ↓ K, CA2+, NA, PO4, MG2+
- Extreme: < 15  Liver & renal failure
 ↑ Amylase isoenzyme
ICD-10 Subtypes  ↓ Albumin
Restricting type – during the last 3 months, the  ↓ Glucose
individual has NOT engaged in recurrent episodes of  ↓ Insulin
binge eating/ purging behaviour  ↑ Lipid (d/t ↓ estrogen)
→ presentations in which weight loss accomplished  Metabolic acidosis (d/t diarrhea)
primarily through dieting, fasting and excessive exercise.  Metabolic alkalosis (d/t induced
vomiting)
Binge-eating/ Purging type – during the last 3 months, HPA Axis  ↑ CRG
the individual HAS engaged in recurrent episodes of  Normal ACTH
binge eating or purging behaviour  ↑ Cortisol
Hormones  ↓ FSH and LH
Physical Examination Finding  ↓ Estogen/ Testosterone
CNS  Impaired cognition  ↓ T4/T3
 Poor concentration  ↑ Growth hormones
 Seizures  Brain pseudoatrophy
 Syncope  ↓ Bone mineral density
 Depression  Abnormal ECG
 Anxiety
 Obsessive & Compulsive behaviour Treatment
CVS  Bradycardia ( 30-40 bpm) Hospitalization  BMI < 13
 Hypotension (systolic < 70mmHg)  Heart rate < 40 bpm
 Arrthymia (Prolonged QT)  Failure of OPD
 Mitral Valve prolapse  Suicidal risk
 Pericardial effusion Pharmacology  No drug proven effective
 Cardiomyopathy Non  CBT
GIT  Delayed gastric emptying Pharmacology  Interpersonal psychotherapy
 Severe constipation  Family therapy
 Painful/ distended abdomen
 Nutritional hepatitis
Renal  Nocturia
 Renal stones
Reproductive Prepubertal state: Prognosis
 Amenorrhea Poor Factors Good factors
 Small ovaries and uterus
 Late age onset Early onset MSK  Tetany
Very severe vomiting & No severe weight loss &  Muscle weakness
weight loss serious medical  Russell’s Sign: abrasions (callus/ scarring) over
complication dorsal part pf the hand because fingers are used
Dysfunctional family Supportive family to induced vomiting
Extreme treatment Good motivation to
avoidance change Laboratory Findings
Long duration of illness FBC  Leukopenia
(esp untreated)  Lymphocytosis
Personality disorder BUS  ↓ K, Na+, Cl-
Male E
Very low BMI  ↑ serum amylase
 Metabolic acidosis (d/t laxative misuse)
 Metabolic alkalosis (d/t induced vomiting)
Bulimia Nervosa
A Recurrent episodes of binge eating. Treatment
An episodes of binge eating is characterised by Locus OPD
both of the following: Pharmacology - SSRI (Fluoxetine, Fluvoxamine) - ↓
1. Eating in a discrete period of time (within any binge eating & associated impulse
2 hrs period), an amount of food that is behaviours
definitely larger than what most individuals - Mood stabilizers – lack evidence
would eat in a similar period of time under Non - CBT
similar circumstances Pharmacology - Interpersonal psychotherapy
2. A sense of lack of control overeating during
the episodes (feeling that one cant stop Prognosis
eating/ control what or how much one is - Chronic & relapsing
eating) - Better prognosis than Anorexia Nervosa
B Recurrent inappropriate compensatory - Symptoms ↑ with stressful conditions
behaviours in order to prevent weight gain (self- - ↑ suicidal risk
induced vomiting, misuse of laxatives, diuretics,
excessive exercise)
C Binge eating and inappropriate compensatory
behaviours BOTH OCCUR, ≥ 3 months
D Self-evaluation is unduly (excessive) influenced
by body shape and weight
E Not exclusively occur during episodes of anorexia
nervosa

Specify:
- Partial remission: some, but not all criteria
met
- Full remission: non criteria met
Severity based on frequency of inappropriate
compensatory behaviours per week
- Mild: 1-3 episodes
- Moderate: 4-7 episodes
- Severe: 8-13 episodes
- Extreme ≥ 14 episodes

Physical Examination Findings

CNS  Epilepsy
Oral &  Parotid gland swelling
Esophagus  Dental erosions/ caries
 Esophageal erosion
 Mallory-Weiss tear
CVS  Arrythmias
 Cardiac failure → sudden death
GIT  Gastric perforation
 Gastric/ duodenal ulcers
 Constipation
 Pancreatitis