Learning objectives
- Describe the physiological changes associated with anorexia nervosa
- Manage anorexia nervosa patients in the perioperative period
Definition
- Anorexia nervosa is a psychiatric disorder characterized by an intense fear of gaining weight and a distorted perception of weight, resulting in an abnormally low body weight
Physiological changes
| System | Changes |
|---|---|
| Cardiovascular | Hypotension, bradycardia, mitral valve prolapse, impaired myocardial contractility, cardiomyopathy, ECG changes (risk of arrhythmias) |
| Respiratory | Metabolic alkalosis, decreased lung compliance, aspiration pneumonia, pneumothorax, and pneumomediastinum |
| Renal | Proteinuria, reduced glomerular filtration rate, ↓Na+, ↓K+, ↓Mg2+, ↓Cl−, ↓H+, ↓Ca2+, ↓PO42− hypophosphatemia, renal calculi |
| Gastrointestinal | Enlarged salivary glands, dental caries, periodontitis, Mallory–Weiss tears, esophageal strictures, esophagitis, gastritis, gastric dilatation/infarction/perforation, ↑ gastric emptying time, risk of refeeding syndrome, fatty liver, hepatomegaly, cirrhosis, ↑amylase, abnormal liver function tests |
| Endocrine | FSH, ↓LH, ↓GnRH, ↑cortisol, ↑GH, ↓glucose, ↓insulin ↓T3, ↓T4, ↔TSH, impaired thermoregulation |
| Immunological | Leucopenia, thrombocytopenia, hemolytic anemia |
| Hematological | Bone marrow hypoplasia |
| Neurological | White and gray matter changes, ↓cognitive function, coma EEG abnormalities, seizures, neuropathy, ↑pain threshold |
| Musculoskeletal | Myalgia, myopathy, rhabdomyolysis, osteopenia, osteoporosis, stress fractures |
| Dermatological | Laguno hair, Russell’s sign, poor wound healing |
Management
Suggested reading
- Denner AM, Townley SA. Anorexia nervosa: perioperative implications. Continuing Education in Anaesthesia Critical Care & Pain. 2009;9(2):61-4.
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