6: Eating disorders Flashcards
What are the two most common eating disorders?
Anorexia nervosa
Bulimia nervosa
What are the five ICD-10 criteria for anorexia nervosa?
BMI < 17.5
Self-induced weight loss
Body image disturbance
Fear of fatness
Amenorrhoea
A BMI below what is diagnostic of anorexia?
17.5
How do anorexic patients behave re: food portions?
Obsession with portion sizes
Portion sizes themselves are tiny
How do anorexic patients encourage their own weight loss?
Overexercise
Self-induced vomiting
Laxatives
Anorexic patients obsess over their ___ ___.
body weight
What are some of the physical features of anorexia nervosa?
Significant weight loss and muscle atrophy
Dry skin
Lanugo hair
Swollen salivary glands
Why do patients with anorexia develop dry, cracked skin?
Dehydration
What is lanugo hair?
Which disease does it present in?
Fine, soft, unpigmented hair which sheds - usually seen in newborns
Anorexia nervosa
Patients with anorexia often present with jaundice - true or false?
Yellow skin pigmentation
but NOT jaundice
Which pigment is responsible for yellow skin decolouration seen in anorexia nervosa?
Beta-carotene
Hypercarotenaemia
Why do some anorexic patients present with hypercarotenaemia?
Excess of beta carotene
Diet consisting of excess veg
Which bilateral structures hypertrophy in anorexia nervosa?
Parotid and submandibular glands
The physical features of anorexia nervosa are
widespread ___
___ skin
___ hair
hypertrophy of the ___ glands.
widespread atrophy
dry skin
lanugo hair
hypertrophy of the salivary glands
Eating disorders often co-exist or precipitate other psychiatric conditions. Can you name some?
Mood disorders - depression, bipolar
Anxiety - e.g OCD
Psychosis
Which chronic disease may anorexic patients mismanage on purpose to lose weight?
Diabetes mellitus
Patients may omit insulin injections to lose weight (hyperglycaemia)
A BMI < ___ or rapid weight loss are red flags for poorly managed anorexia nervosa.
BMI < 13
Rapid weight loss
Which arrhythmia may anorexic patients develop?
Prolonged QT interval
As muscles atrophy in anorexia nervosa, they become weaker.
How is muscle weakness assessed?
Sit up squat stand test
Some patients won’t be able to do it
What investigations should you ask for in anorexic patients and why?
FBC - anaemia
U&Es - electrolyte abnormalities
ECG - arrhythmias
LFTs - hepatocellular autophagy in starvation
DEXA scan - osteopenia/porosis
Which test is used to assess muscle weakness in anorexia nervosa?
Sit up squat stand test (SUSS)
Patients with extreme anorexia nervosa may present with ___ impairment.
cognitive impairment
What is an extreme form of electrolyte imbalance which may be seen when managing an anorexic patient?
Refeeding syndrome
How is refeeding syndrome avoided?
Feed patient slowly
Monitor their U&Es closely
Can a patient with an eating disorder be detained against their will?
Yes, under the MHA (anorexia and bulimia are classed as mental disorders)
If that patient is posing significant risk to themselves
Which guidelines explain how to manage anorexia nervosa?
MARSIPAN guidelines
Which AHP has a crucial role in the management of patients with anorexia?
Dietician
What are the five ICD-10 criteria for diagnosing bulimia nervosa?
Persistent preoccupation with food
Irresistible food cravings
Binges
Compensatory behaviour (starving, overexercise, purging)
Fear of fatness
What is Russell’s sign?
Callused knuckles
caused by self-induced vomiting
Which structures hypertrophy in both anorexia and bulimia?
Parotid and submandibular glands
Which electrolyte disturbance is caused by repeated vomiting?
Hypokalaemia
The management of bulimia nervosa is largely the same as that of anorexia (psychological therapy, AHP input).
Which class of drug can be given to patients to help reduce food cravings?
SSRIs
