Adolescent Medicine Flashcards
List of Eating Disorders
Anorexia Bulimia ARFID Elimination Disorders PICA Rumination Disorder
Anorexia Simplified Criteria
- Restriction leading to low body weight, AND
- intense fear of gaining or behaviours that interfere with gaining AND
- disturbed experience of body shape
Types: Restricting, binge-purge
Severity based on BMI or percentiles in kids
Bulimia Nervosa Simplified Criteria
- Recurrent binge eating (eat lost, feel loss of control)
- Compensatory behaviours
- 1x/wk for at least 3mo
- self evaluation effected by body weight
- not only during anorexia nervosia
types: purging (vomit, laxatives, diuretics, enemas), non-purging (fasting + exercise)
Avoidant Restrictive Food Intake Disorder Definition
- weight loss / FTT or nutritional deficiency, or dependence on tube/supplement, or psychosocial interference
- not due to poverty / social norms
- not due to anorexia or bulimia, no disturbed experience of shape
- not explained by another condition
Eating Disorder Physical Signs
- orthostatic changes
- bradycardia
- acrocyanosis
- hypothermia
- delayed puberty + amenorrhea
- lanugo
- hair loss
- loss of muscle, SC fat
Bulimia:
- average or high BMI
- rough skin
- erosion of teeth
- russels sign (callous)
- parotitis
Eating disorder Ddx
- malignancy
- CNS tumor
- IBD, celiac
- DM
- hyperthyroid
- hypopituitarism
- addison’s
- depression, OCD, psychosis
- other chronic disease / infection
Eating Disorder Work-up
CBC
ESR
lytes
TSH, T4
amenorrhea:
LH/FSH, estradiol, bHCG, PRL
others based on hx
ECG if severe bulimia, cardiac sx, electrolytes issue
bone density if amenorrhea >6-12mo
Hospitalization Criteria
abnormal vitals not eating at all esophageal tear/bleed cardiac sx protracted vomiting <10% body fat <75% ideal body weight, or continued losses despite tx
Management of Eating Disorders
- Group, family, individual therapy (inc CBT, DBT)
- 1st line for adolescents is family based treatment - maudsley approach
- dietician counseling
- psychotropic meds for comorbidities
- sometimes use Olanzapine
Depression Diagnosis
2+ weeks of
- depressed mood or anhedonia
- weightloss
- insomnia/hypersomnia
- psychomotor agitation or slowing
- fatigue
- worthlessness, guilt
- poor concentration, indecisiveness
- thoughts of suicide
- in kids especially: irritable, hypersomnia, hyperphagia, weight gain, mood reactivity, substance use, behaviour issues, academic decline
Diagnosing depression in children (& organic causes ddx)
- children’s depression inventory
- Beck depression inventory
r/o: hypothyroid, anemia, substance use
Management Depression in Teens
- fluoxetine (only approved for youth)
- citalopram, paroxetine, sertraline also used
- do 6-8wk trial, refer to psych if not responding to 2 meds
- CBT, psycho education, mindfulness
- DBT, interpersonal therapy
Which contraception in teens is preferred?
1st tier: IUD
2nd tier: CHC, prog pill, depot
3rd tier: barrier, spermicide
