Investigation and management of anorexia
| Investigations | Potential results | Clinical management plan |
|---|---|---|
| Actions from history, medication and dietary assessment | ||
| History findings | Weight loss/sweats/fatigue | Routine and additional blood tests. CT chest, abdomen, pelvis. Refer for dietetic advice. |
| Depression, sadness, anxiety | Refer for psychological support. | |
| Underlying eating disorder | Refer for psychiatric assessment. | |
Pre-existing comorbidities, eg,
| Refer for dietetic advice and appropriate GP/specialist advice to optimise these conditions. | |
| Constipation | See management of constipation (p. 26). | |
| Medication findings | Antibiotics, eg, cotrimoxazole, metronidazole, chemotherapy, eg, cytarabine, hydroxyurea, opioids, metformin, NSAID | Discuss possible alternative medications and adequate antiemetics while on treatment. |
| First line | ||
| Routine and additional blood tests | Infection | Treat with antibiotics within level of confidence or discuss with microbiologist/supervising clinician within 24 hours. |
| Endocrine dysfunction | Refer the patient to the GP or endocrinology team for further management. | |
| Other abnormalities | Follow treatment for abnormal blood results (p. 2). | |
| Second line | ||
| OGD and SI aspirate (p. 25) | Inflammation (acid/bile) | See management of acid or bile related inflammation (p. 25). |
| Gastric dysmotility | Consider prokinetic medication (p. 26). ± pyloric dilatation. | |
| SIBO | Management of SIBO (p. 27). | |
| Malignancy/tumour recurrence | Discuss and refer urgently to the appropriate cancer MDT requesting an appointment within 2 weeks. Refer for dietetic advice. | |
| Glucose hydrogen methane breath test | SIBO | Management of SIBO (p. 27). |
| CT/MRI/PET | Malignancy/tumour recurrence | Discuss and refer urgently to the appropriate cancer MDT requesting an appointment within 2 weeks. Refer for dietetic advice. |
| Infection | Treat with antibiotics within level of confidence or discuss with a microbiologist and supervising clinician immediately. | |
| Small bowel obstruction | If acute, this is an emergency. Discuss immediately with a GI surgeon. If subacute/chronic discuss immediately with supervising clinician. | |
| Third line | ||
| If normal investigations/no response to intervention | Reassure. | |
CT, computerised tomography; GI, gastrointestinal; GP, general practitioner; MDT, multidisciplinary team; NSAID, non-steroidal anti-inflammatory drug; OGD, upper GI endoscopy (oesophago-gastroduodenoscopy); MRI, magnetic resonance imaging; PET, positron emission tomography; SI, small intestine; SIBO, small intestinal bacterial overgrowth.