Anorexia Nervosa Case Study
Anorexia Nervosa Case Study
There are two types of anorexia nervosa: the restrictive and the binge/purge types. In the case of the binge type, the patient consumes food normally, but then initiates voluntary vomiting or uses laxatives. In addition, these patients usually exercise at an extreme rate. In the case of the restrictive type, the patients fiercely limit the quantity of food they consume at every sitting. They typically eat negligible amounts of food well under the body’s caloric needs. With a limited amount of food being taken, patients with anorexia nervosa are in constant deficiency of important nutrients. This causes physiological disorders associated with electrolyte imbalance, which can seriously affect further health status. In this case study, the 18-year-old Amanda has become a victim, and her ‘fat’ limbs are symptoms of the disease. What she refers to as fat hands and feet is edema. It is interesting to note that she continued to subject herself to a restricted diet using the fat hands and feet as a reason without the knowledge that hypoalbuminemia had already developed with edema as the representative manifestation.
Protein Causing Edema
Physiology through Which Albumin Causes Edema
Albumin is the predominant serum-binding protein, contributing to about 80% of normal plasma colloid oncotic pressure (Chen et al., 2016). In addition, it comprises up to 50% of total body protein (Chen et al., 2016). Therefore, deficiency in albumin leads to an inability to withstand adequate colloid osmotic pressure, which leads to edema. The edema can result due to either an extreme build-up of fluid in tissues or inside cells (cellular edema) or due to an accumulation of fluid within the collagen-mucopolysaccharide matrix that is located within the interstitial spaces (interstitial edema). For hypoalbuminemia, edema is usually caused by aberrant changes in the oncotic and hydrostatic pressures. These pressures act across the microvascular walls and the osmotic reflection coefficient of plasma protein, chiefly albumin, causes hydraulic conductivity changes, resulting in fluid retention. The Starling equation has been used to explain these oncotic and hydrostatic pressure changes in case of edema formation. As stated earlier, blood in capillaries is usually under the effect of two pressures: hydrostatic and oncotic ones. When fluid leaks out of capillaries into the interstitial spaces, there is a balancing pressure that drives tissue fluid into the capillaries from the interstitial spaces. However, it is the oncotic pressure that plays more in the physiology of edema. With hypoalbuminemia, the oncotic pressure in blood capillaries is higher, leading to a lower gradient, which in turn contributes to fluid retention within the interstitial spaces.
Pitting and Non-pitting Edema
There are two major types of edema: pitting and non-pitting. The pitting type is usually identified by depressing the skin with the fingers, which results in a persistent dimple. On the other hand, the non-pitting type is not characterized by the formation of dimples after pressing. The pitting type is usually caused by pathological processes in the vital organs of the body, such as hepatic, cardiovascular, and renal systems (Weaver &Yao, 2016). Malfunctioning of these important organs causes the pitting type of edema. In addition, the pitting type can also be identified in patients with rheumatoid-like diseases, such as Systemic Lupus Erythematosus (SLE) and rheumatoid arthritis.
Non-pitting type, on the other hand, is usually associated with lipoedema, myxoedema, and lymphedema. In these cases, the development of edema is not necessarily associated with fluid accumulation only but occurs rather due to some internal pressure explaining its turgid nature. Using myxoedema as an example, water-loving molecules, such as hyaluronan, and carbohydrate-like molecule, gradually fills the tissues. They are responsible for the attraction of fluid into the tissues, and therefore, lead to edema through the absorption of water. As a result, the osmotic pressure caused by the accumulation of these hydrophilic molecules results in the formation of non-pitting edema. Interestingly, the osmotic pressure makes them appear taut with a turgid feeling (Weaver & Yao, 2016). The same mechanism lies in the basis for the development of lymphedema. In this case, the lymphatic system is damaged, resulting in swelling of lymph nodes, which in turn leads to an increase in osmotic pressure. It is explained by the persisting internal pressure that thrusts the fluid against the skin, even when pressure is applied against the affected part.
Effects of Lack of Exercise on Edematous Tissues
With the accumulation of fluids in the lower limbs, it was important for Amanda to exercise in addition to the prescribed compression therapy to reach the best treatment outcome. However, it was not possible because of Amanda’s weakened condition. After such patients understand the role of compression stockings in the management of edema, the use of exercise remains to be a great challenge for them. It is attributed to the fact that exercising also induces peripheral edema (Weaver &Yao, 2016). In edema treatment, aerobic exercises are useful, as they help load the muscles, lungs, and heart. This will help in the increase in blood flow, hence the redistribution of fluid in the body.
On the other hand, during exercising, blood flow to the extremities interferes with blood circulating to the heart and lungs. As a result, blood vessels in the extremities dilate to compensate for the lack of blood flow by reducing pressure. In addition, for the reduction in body temperature, the already dilated blood vessels are pushed closer to the skin to dissipate heat. It causes fluid leakage out of the blood vessels into the extracellular spaces, resulting in swelling. Thus, Amanda’s lack of exercise put her at higher risk for the worsening of her edematous condition. Instead of having her edema reduced, she was at risk of having progression of the problem. In addition, the gravitational force causes increased capillary hydrostatic pressure considering her consistently sitting in the wheelchair as a result of her weakened condition. This stimulates further swelling of the edematous tissue, which might cause the cells to burst (Weaver &Yao, 2016). Therefore, it is necessary to consider additional treatment options, such as physiotherapy. It will help in fluid redistribution, thus reducing the edema.
Anorexia nervosa has been a common and emerging trend in society today. This condition has highly affected young ladies, who wish to have slim bodies. However, people need to know the risks associated with a lack of necessary nutrients, such as protein as in Amanda’s case, which led to electrolyte imbalance. Anorexia nervosa is a life-threatening condition, and once diagnosed with it, patients should be closely monitored. In this case study, Amanda was reluctant to take the necessary medications despite of her already worrying BMI. She was convinced of being overweight based on the assumption that her clothes were still fitted tight on her, and yet she had a desire to lose weight. In addition, the girl became extremely weak due to a lack of necessary nutrients, which should normally come from the diet. Her deficiency in albumin caused peripheral edema, and her weakened condition only worsened the situation, as she was unable to exercise to manage the edema.