Assessment

HISTORY. Take a thorough history of existing illnesses because secondary hyperlipoproteinemia is related to a number of other conditions. Ask the patient if he or she has a history of renal or liver disease, diabetes mellitus, other endocrine diseases, or immune disorders.

Ask if the patient is taking corticosteroids or oral contraceptives, and determine the extent of the patient's alcohol use. Because hyperlipoproteinemia is sometimes treated with a range of bile acid sequestrant medications, which can affect the absorption of other medications, ask if the patient is taking any of the following: warfarin, thiazides, thyroxine, beta-adrenergic blockers, fat-soluble vitamins, folic acid, diuretics, or digitoxin.

Symptoms of hyperlipoproteinemia vary, depending on which of the five types the patient has. Ask about recurrent bouts of severe abdominal pain, usually preceded by fat intake, or if the patient has experienced malaise, anorexia, or fever.

PHYSICAL EXAMINATION. Observe general appearance for signs of obesity, which may be an exacerbating factor for hyperlipoproteinemia. Inspection may reveal papular or eruptive deposits of fat (xanthomas) over pressure points and extensor surfaces; likely locations include the Achilles' tendons, hand and foot tendons, elbows, knees, and hands and fingertips (where you may observe orange or yellow discolorations of the palmar and digital creases). Ophthal-moscopic examination typically reveals reddish-white retinal vessels. In some forms of hyper-lipoproteinemia, an opaque ring surrounding the corneal periphery (juvenile corneal arcus) is visible. Palpate the abdomen for spasm, rigidity, rebound tenderness, liver or spleen tenderness, and hepatosplenomegaly. Check for signs of hypertension and hyperuricemia.

PSYCHOSOCIAL. Hyperlipoproteinemia is not an abrupt illness; it develops over years. The patient may have developed coping mechanisms during that time, but the patient may be anxious because of accelerated symptoms of atherosclerosis and CAD. The patient may have experienced the premature death of parents from this disorder and have long-lasting fears about her or his own early death. Body image disturbance may also occur because of obesity or the presence of unsightly xanthomas.

Diagnostic Highlights

Test

Normal Result

Abnormality with Condition

Explanation

Total cholesterol

Varies with

Borderline high: 200-239 mg/dL;

Used for screening and Ini

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