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307.1 Anorexia Nervosa -Associated physical examination findings and general medical conditions

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Many of the physical signs and symptoms of Anorexia Nervosa are attributable to starvation. In addition to amenorrhea, there may be complaints of constipation, abdominal pain, cold intolerance, lethargy, and excess energy. The most obvious finding on physical examination is emaciation. There may also be significant hypotension, hypothermia, and dryness of skin. Some individuals develop lanugo, a fine downy body hair, on their trunks. Most individuals with Anorexia Nervosa exhibit bradycardia. Some develop peripheral edema, especially during weight restoration or on cessation of laxative and diuretic abuse. Rarely, petechiae, usually on the extremities, may indicate a bleeding diathesis. Some individuals evidence a yellowing of the skin associated with hypercarotenemia. Hypertrophy of the salivary glands, particularly the parotid glands, may be present. Individuals who induce vomiting may have dental enamel erosion and some may have scars or calluses on the dorsum of the hand from contact with the teeth when using the hand to induce vomiting.

The semistarvation of Anorexia Nervosa, and the purging behaviors sometimes associated with it, can result in significant associated general medical conditions. These include the development of normochromic normocytic anemia, impaired renal function (associated with chronic dehydration and hypokalemia), cardiovascular problems (severe hypotension, arrhythmias), dental problems, and osteoporosis (resulting from low calcium intake and absorption, reduced estrogen secretion, and increased cortisol secretion).

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