Anorexia Nervosa: Examination

A comprehensive clinical examination is the basis for selecting further diagnostic steps:

  • General physical examination – including blood pressure, pulse, body weight, height; further:
    • Inspection (viewing).
      • Skin, mucous membranes [accompanying symptom: dry scaly skin].
      • Oral cavity [accompanying symptoms: sialosis (enlargement of the salivary glands); dental caries] [due topossible sequelae: tooth damage up to the fall out of the teeth].
      • Hairiness [concomitant symptom: alopecia; lanugo hairiness]
      • Extremities [Associated symptoms: Circulatory disturbances; acrocyanosis (blue discoloration of body end limbs such as the fingers); peripheral edema]
      • Abdomen (abdomen):
        • Shape of the abdomen?
        • Skin color? Skin texture?
        • Efflorescences (skin changes)?
        • Pulsations? Bowel movements?
        • Visible vessels?
        • Scars? Hernias (fractures)?
    • Inspection and palpation (palpation) of the thyroid gland [due todifferential diagnosis: hyperthyroidism (hyperthyroidism)].
    • Auscultation of the heart [due toaccompanying symptoms: Bradycardia (too slow heartbeat: < 60 beats per minute); cardiac arrhythmias] [due topossible sequelae: heart failure; cardiac arrhythmias].
    • Auscultation of the lungs
    • Examination of the abdomen (belly)
      • Percussion (tapping) of the abdomen [attenuation of tapping sound due to enlarged liver or spleen, tumor, urinary retention?]
      • Palpation of the abdomen (tenderness?, knocking pain?, coughing pain?, defensive tension?, hernial orifices?, renal bearing knocking pain?)
    • Digital rectal examination (DRU): examination of the rectum (rectum) [due todifferential diagnoses: inflammatory bowel disease such as ulcerative colitis or Crohn’s disease].
  • Gynecological examination [due toleading symptom: amenorrhea (absence of menstruation); due toaccompanying symptom: absence of breast development in young girls]
  • If necessary, orthopedic examination [due topossible secondary diseases:
    • Osteoporosis (bone loss)
    • Growth disorders]

    Psychiatric examination [due toaccompanying symptoms:

    • Depression
    • Psychic compulsions
    • Sleep disorders]

    [due todifferential diagnoses:

    • Acute adjustment disorders
    • Alcohol abuse (heavy drinking; alcohol abuse).
    • Anxiety disorders
    • Substance abuse
    • Personality disorders
    • Schizophrenia (psychiatric disorder with multiple manifestations).
    • Obsessive-compulsive disorder]

    [due topossible sequelae:

    • Other addictive diseases
    • Anxiety disorders
    • Bulimia (binge eating disorder)
    • Depression
    • Personality disorders
    • Recurrence (recurrence) of anorexia nervosa
    • Obsessive-compulsive disorder]
  • Health Check

Square brackets [ ] indicate possible pathological (pathological) physical findings.