1.4 Anorexia

Question 1

Define Anorexia Nervosa

Answer 1

BMI <17.5%
OR
bw >15% below expected

Characteristic behaviour

avoiding food
Self induced vomiting
purging
over exercising
appetite suppressants
laxatives diuretics

Additional psychological disturbances -
body dysmorphia/ocd/depression

Endocrine dysfxn
HPA
ammenorrhoea
loss libido

Question 2

Physiological abnormalities + affect Anaesthetic

Preop Ix

bloods

Answer 2

1
FBC
Risk thrombocytopaenia / Anaemia
- 2* BM suppression

Low plt - no RA / Increased risk bleeding

2
U+E
Hypo: Na, K, Cl, Mg
Metabolic alkalosis (vomiting / laxatives)

3. Renal
   Fxn impaired d/t decr GFR/ protein
4. Blood glucose
   risk hypoglycaemia
   -starvation impaired cortisol

5 LFTs / Clotting
risk fatty liver - cirrhosis
- starvation / sub abuse

Impair synthetic fxn - no RA / worse bleeding

Question 3

Pre op Ix

other

Answer 3

6. ECG -
   Brady - 2* BMR
   ST or T wave changes

Arrhythmia - AV block / SVT/ VT

QT prolongation - drugs / electrolytes / starvation

7. Echo - cardiac dysfxn
   Impaired LV Fxn + contractility - drug/electrolyte

MV prolapse

8/ CXR - increased risk aspiration pneumonitis

Question 4

Intraop Mx

considerations

5

Answer 4

1. Gastric dilation + delayed emptying
Consider 
NGT
Antacid 
Prokinetic

2. RSI advised
3. Increased risk PTX + Pneumomediastinum
   avoid high airway pressure PC vent
4. Invasive CVS monitoring - myocardial dysfxn
5. Cautious IV fluid -
   risk inducing cardiac failure if dyxn
   CO monitor guide fluids

Question 5

Intraop Mx aims

4

Answer 5

1. Minimise cardiac depression
2. Prolong NDMR in electrolyte abnorm - monitor
3. Altered Liver fuxn and low albumin
   - drug bind / metab
4. Impair renal function - drug metab excretion
   hinder ability cope fluit shift

Question 6

Intraop consideration environment

Answer 6

1. Low BF SKin qulit
   sores / nerve injuries/ damage tourniquet

care moving / position

2. Perio hypoterhmia
   low bf and thermoreg
   - temp monitoring and warming devices