Diagnosis

Diagnosis and clinical features:

Diagnosis of this problem can prove to be quite difficult and the concerned doctor needs to consult the patient and also his/hers immediate family to obtain as much knowledge about the patient as possible. Information about a patient's weight, eating habits, menstrual periods, physical activity and behavior is a must for a proper diagnosis. The diagnosis for anorexia nervosa is primarily based on the following criteria:

• The patient maintains a weight that is 15% less than what the normal body weight should be depending on the height, age and sex.
• There is a constant fear of gaining weight accompanied by a deliberate self imposed tendency to avoid food.
• A continuous dissatisfaction about one's own body shape and weight that makes the patient feel very low at all times.
  
• When women miss three consecutive menstrual periods (amenorrhoea) and need a hormone for their periods to occur. Men may lose interest in sex and may also suffer from impotency.
• Onset of puberty in boys and girls is either delayed or arrested.

• Dental cavities and enamel erosion.
• Dermatologic examination reveals dry scaly skin.
• Lanugo (covering of fine "baby" hair).
• Irregular or low heart beat.
• Swelling in legs due to fluid retention.
• Enlargement of parotid glands.
• In rare cases patients may suffer from seizures due to electrolyte disturbances.

There are no definitive tests for the diagnosis of anorexia nervosa and a complete medical evaluation is required before the diagnosis is confirmed. Laboratory tests that prove helpful in the diagnosis of anorexia nervosa include:

• Chem-20: A chemistry panel used for assessing hypokalemic and hypochloremic metabolic alkalosis caused by excessive vomiting.
• Thyroid function test: This test is used to eliminate alternative causes of amenorrhea.
• Chest radiograph: Helps in detecting any rib fractures caused due to repetitive vomiting.
• Blood test: To detect hematological abnormalities like leukopernia and thrombocytopenia. Low levels of sodium in blood (hyponatremia) indicate excessive intake of water.
• Stool test: Fecal occult blood may indicate laxative abuse.
• ECG: To check the severity of malnutrition.
• Urine analysis: High level of ketones in the urine sample is indicative of starvation or malnutrition.