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ULY CLINIC

ULY CLINIC

18 Mei 2025, 19:02:37

Anorexia

Anorexia
Anorexia
Anorexia

Anorexia is the loss of appetite despite the body’s need for food. It commonly occurs in gastrointestinal (GI) and endocrine disorders and is a hallmark of serious psychological conditions like anorexia nervosa. Other causes include anxiety, chronic pain, poor oral hygiene, fever or hot weather, and changes in taste or smell often seen with aging. Certain medications or substance abuse can also lead to anorexia. While short-term anorexia usually does not threaten health, chronic anorexia can result in severe malnutrition and serious health complications.


History and physical examination

  • Vital signs & weight: Record current weight, as well as the patient’s usual minimum and maximum weights.

  • Weight changes: Ask about any involuntary weight loss over 10 pounds (4.5 kg) in the last month.

  • Dietary habits: Understand what, when, and how much the patient eats. Identify foods or smells that cause nausea or loss of appetite.

  • Oral health: Check for dental issues, including poorly fitting dentures, that may interfere with chewing.

  • GI symptoms: Inquire about difficulty swallowing, vomiting, diarrhea, or changes in bowel habits.

  • Physical activity: Ask about exercise frequency and intensity.

  • Medical history: Screen for stomach or bowel disorders and substance use (alcohol, drugs).

  • Psychological factors: If no organic cause is found, consider emotional or situational stress such as grief, work, or school problems that might lead to depression and appetite loss.

  • Signs of malnutrition: Look for weight loss of 7–10% over the past month and refusal to eat.


Common medical causes of anorexia

Here's the information organized into a clear table format for easier reading:

Cause

Signs and Symptoms

Acquired Immunodeficiency Syndrome (AIDS)

Anorexia due to GI/respiratory infections or Kaposi’s sarcoma; fatigue, afternoon fevers, night sweats, diarrhea, cough, lymphadenopathy, bleeding, oral thrush, gingivitis, persistent herpes infections.

Adrenocortical Hypofunction

Gradual anorexia, weight loss, nausea, vomiting, abdominal pain, diarrhea, fatigue, malaise, vitiligo, bronze skin, purple striae.

Alcoholism

Chronic anorexia, malnutrition, liver damage (jaundice, ascites), paresthesia, tremors, GI bleeding, bruising.

Anorexia Nervosa

Chronic anorexia, extreme weight loss, muscle atrophy, amenorrhea, constipation, dry skin, alopecia, distorted self-image, anhedonia, excessive exercise.

Appendicitis

Sudden anorexia, epigastric pain migrating to RLQ (McBurney’s point), nausea, vomiting, fever, abdominal rigidity, rebound tenderness.

Cancer

Chronic anorexia with weight loss, weakness, apathy, cachexia.

Chronic Renal Failure

Chronic anorexia, nausea, vomiting, mouth ulcers, ammonia breath, GI bleeding, confusion, dry/scaly skin, pruritus, edema.

Cirrhosis

Early anorexia, nausea, vomiting, later signs include lethargy, ascites, jaundice, hepatomegaly, leg edema, pruritus.

Crohn’s Disease

Chronic anorexia, weight loss, diarrhea, abdominal pain, fever, fistulas, bloody stools, mimics appendicitis.

Gastritis

Sudden anorexia, postprandial distress, nausea, vomiting (±hematemesis), fever, belching, hiccups.

Hepatitis (Viral & Nonviral)

Preicteric anorexia, fatigue, malaise, jaundice, dark urine, RUQ pain, photophobia, lymphadenopathy.

Hypothyroidism

Gradual anorexia, fatigue, cold intolerance, weight gain, constipation, flaky skin, edema, bradycardia, menstrual irregularities.

Ketoacidosis

Gradual anorexia, dry skin, fruity breath, polyuria, polydipsia, hypotension, abdominal pain, vomiting.

Pernicious Anemia

Insidious anorexia, burning tongue, weakness, numbness, GI upset, visual issues, irritability, ataxia.

Drugs

Anorexia caused by amphetamines, chemo, sympathomimetics, some antibiotics; digoxin toxicity.

Radiation Therapy

Anorexia due to metabolic disturbances from treatment.

Total Parenteral Nutrition (TPN)

Anorexia caused by maintained glucose levels via IV therapy.


Signs of malnutrition to check during exam

  • Hair: Dry, thin, brittle, easily plucked

  • Skin: Dry, flaky, swollen, pigmented spots

  • Eyes: Dull, pale or red conjunctiva, cracked eyelids

  • Lips and Tongue: Swollen, cracked, raw-looking tongue

  • Teeth and Gums: Missing teeth, cavities, bleeding gums

  • Nails: Spoon-shaped, brittle

  • Muscles and Joints: Wasting, swelling, deformities

  • Cardiovascular: Tachycardia, arrhythmias, hypotension

  • Neurological: Irritability, confusion, numbness, decreased reflexes


Diagnostic workup

Due to the variety of causes, diagnosis may include:

  • Thyroid function tests

  • Endoscopy and imaging (e.g., abdominal ultrasound, CT scans)

  • Blood tests (CBC, liver and kidney function, nutritional markers)

  • Hormone assays


Management

  • Identify and treat the underlying cause.

  • Nutritional support: Encourage high-calorie, protein-rich meals and frequent small snacks.

  • Family involvement: Provide favorite foods to stimulate appetite.

  • Monitor intake: Keep a daily diet history and calorie count, especially in anorexia nervosa.

  • Supplemental nutrition: Use oral supplements or TPN in severe cases.

  • Infection prevention: Monitor vital signs, WBC count, and wound healing closely.

  • Psychological support: Refer for counseling when appropriate.


Patient counseling

  • Educate about the importance of nutrition and maintaining a healthy weight.

  • Encourage daily weight tracking and maintaining a weight log.

  • Discuss coping strategies and encourage seeking psychological and nutritional counseling.


Pediatric notes

  • Anorexia in children is common during illnesses and usually resolves.

  • In preadolescent or adolescent girls, watch for early signs of anorexia nervosa.


References

  1. Smeltzer SC, Bare BG, Hinkle JL, Cheever KH. Brunner & Suddarth’s Textbook of Medical-Surgical Nursing. 12th ed. Philadelphia: Lippincott Williams & Wilkins; 2010.

  2. Ignatavicius DD, Workman ML. Medical-Surgical Nursing: Patient-Centered Collaborative Care. 7th ed. St. Louis: Saunders Elsevier; 2013.

  3. Gropper SS, Smith JL, Carr TP. Advanced Nutrition and Human Metabolism. 7th ed. Boston: Cengage Learning; 2018.

  4. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. 5th ed. Arlington: American Psychiatric Publishing; 2013.

  5. Goldman L, Schafer AI. Goldman-Cecil Medicine. 26th ed. Philadelphia: Elsevier Saunders; 2020.

  6. Kumar V, Abbas AK, Aster JC. Robbins and Cotran Pathologic Basis of Disease. 10th ed. Philadelphia: Elsevier; 2020.

  7. National Institute for Health and Care Excellence (NICE). Eating Disorders: Recognition and Treatment. NICE guideline [NG69]; 2017 [cited 2025 May 18]. Available from: https://www.nice.org.uk/guidance/ng69

  8. World Health Organization. Management of severe malnutrition: a manual for physicians and other senior health workers. Geneva: WHO; 1999.

  9. Mahan LK, Raymond JL. Krause’s Food & the Nutrition Care Process. 14th ed. St. Louis: Elsevier Saunders; 2017.

  10. Ferraro C, Grant M, Koczywas M, Dorr-Uyemura L. Management of anorexia-cachexia in late-stage lung cancer patients. J Hosp Palliat Nurs. 2012;14(6):397-402.

  11. Black JM, Hawks JH. Medical-Surgical Nursing: Clinical Management for Positive Outcomes. 8th ed. Elsevier; 2009.

  12. Ignatavicius DD, Workman ML. Medical-Surgical Nursing: Patient-Centered Collaborative Care. 7th ed. Saunders; 2013.

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