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Initial Medical Assessment

Concerns should always be taken seriously

An initial assessment requires a combination of medical and psychological assessment.

At the initial appointment it is important to:

Assess risk - eating disorders are associated with serious physical and psychiatric complications
Book in follow-up appointment - to monitor ongoing risk and conduct further medical investigations (see Medical monitoring)

History / Assess Risk:

Heart	SOB Chest pain Palpitations Syncope Oedema
Endocrine	Menstruation Cold sensitivity
Food intake	Current intake and recent changes Presence of food rules Compensatory behaviours (i.e. binge/purge, laxatives, exercise)
Weight	Sensitively discuss weight loss or fluctuations
Concern of loved ones	Ask: "Has anyone been worried about you?" Any concern a family member or carer should be taken seriously.

Physical Exam

BP/HR	Lying & Standing (after 2 minutes)
Temperature	Check for hypothermia
General Appearance	E.g.: Skin, hydration, circulation, self-harm, parotids, dentition, etc UA (for SG) Consider MSU (for SG)
Weight & Height (if appropriate)	Use sensitively (i.e. give option to blind weigh, make it quick and easy)
Bloods	"New ED" - FBC, ESR/CRP, E/LFT, CMP, E/P/LH/FSH, BSL, Iron B12, folate, Zinc, TSH/TFT Consider coeliac serology, amylase, chol/trigs, if indicated "Routine ED" - FBC, E/LFT, BSL, CMP
ECG	Rate QTc

Ensure that any physical exam is carried out sensitively. It can be highly distressing for a person with severe body image disturbance to expose their body to an unfamiliar person.

GP Practice Management Toolkit

Customise your software with autofill templates and patient info

Medical Assessment

Use this detailed guide to undertake a full medical assessment of your patient

Other signs to look out for:

Skin Examination	Look for: acrocyanosis (blue discolouration) jaundice carotenaemia (orange skin) dry skin hair loss/thinning lanugo hair (soft downy hair on back, arms) callused knuckles (repeated induced vomiting) skin infections lesions from self-harm
Dehydration	Look for: sunken eyes dry lips and tongue poor skin turgor slow capillary return
Oral Examination	Look for signs that may occur with recurrent vomiting. These include: dental erosions pharyngeal redness parotid enlargement
Signs of Vomiting	Look for: swollen parotid glands recurrent sore throat bouts of tonsillitis halitosis callused knuckles (repeated induced vomiting) bloodshot eyes broken capillaries in the cheeks and eyelids
Cardiovascular/Respiratory Symptoms	It is important to assess: Blood pressure (seated and standing) - a fall or rise of 10-20 beats per minute on standing indicates cardiac compromise. Heart rate (seated and standing) - bradycardia/tachycardia on minimal exertion indicates deconditioning. Core temperature Shortness of breath – orthopnoea, paroxysmal nocturnal dyspnoea, exercise tolerance Palpitations – sudden onset, frequency, duration chest pain – onset, frequency, duration, associated symptoms, precipitating factors examination of peripheries – circulation, coldness in hands and feet, oedema fainting, collapse, light-headedness, dizziness
Gastrointestinal and Renal Symptoms	Assess for: Delayed gastric emptying - causes prolonged fullness Post prandial symptoms - distension, abdominal pain, bloating and early satiety Reflux Diarrhoea Constipation Urinalysis
Musculoskeletal System	Assess for: stress fractures overuse injuries bone mineral density, if indicated
Menstrual Disturbances	Although primarily considered a manifestation of low weight or malnutrition, amenorrhea can be associated with many factors irrespective of the individual's weight, including: prolonged weight loss erratic eating behaviours poor nutrition excessive exercise stress

Amenorrhoea and Eating Disorders

The persistence of amenorrhea for longer than 6 months can be associated with lowered bone mineral density, and therefore needs to be addressed as a priority.

References