Anorexia Flashcards
What are the risks of rapid weight loss?
Refeeding syndrome
Hypoglycaemia
Risk of infection
Cardiac arrhythmia
What can cause rapid weight loss in adolescents?
Coeliac disease T1DM Hyperthyroidism Anorexia IBD Depression Addisons
What tests should you do?
ECG U&E BM Phosphate, calcium, magnesium LFTs CRP TFTs Coeliac screen ESR
What is the aim of the short term treatment for anorexia?
Physical stabilisation
What is the aim of the medium term treatment for anorexia?
MDT treatment in the community
What is the aim of long term treatment for anorexia?
Relapse prevention
What does physical stabilisation involve for Weight:height ratio less than 75%?
thiamine, vitamin B complex and multivitamins
What is the diet plan for anorexia?
Aim for 0.5-1kg weight gain per week
What must be monitored in physical stabilisation?
Phosphate - a drop may show referring syndrome
ECGs
Vital signs
Which specialities are involved in the community MDT for anorexia?
Paediatrician Child psychologist Nurse therapist Family therapist Dietician
What is the paediatrician’s role in the community for anorexia?
Monitor physical health
Consider osteoporosis and osteopenia (DEXA scans)
When are anorexics at high risk of relapses?
Transition phases e.g. going to uni
What is the aetiology of anorexia nervosa?
Neuro-biological
- Genetic factors
- Events around puberty
- Cultural promotion of thinness
What are the three main types of eating disorder in young people?
Anorexia nervosa
Bulimia nervosa
EDNOS (eating disorder not otherwise specified)
What are the features of bulimia nervosa?
Binging
Vomiting
Self-harm
(normal weight)
What are the behavioural features of anorexia?
Pre-occupation with food
Won’t eat in front of others
Hiding food
What are the psychological features of anorexia?
Feeling fat
Disturbed body image
What are the clinical features of anorexia?
Low weight Lethargy Fainting Dry skin Hair loss Cool peripheries Hypotension Hypothermia Bradycardia Headaches Amenorrhoea
What are common co-morbidities with anorexia?
Depression
OCD
What are the most significant mortality risks in anorexia?
Sudden cardiac death
Suicide
Chronic emaciation + pneumonia
Why do anorexics become constipated?
Small amount of food ingested leads to slowing of gastric motility
What are the short term consequences of laxative abuse?
Potassium and sodium depletion
Dehydration
Cardiac arrest
What are the long term consequences of laxative abuse?
Loss of bowel motility
Rectal prolapse
What pattern of bloods is seen in refeeding syndrome?
Hypophosphataemia
Hypomagnesaemia
Hypokalaemia
Low thiamine
What is refeeding syndrome?
Potentially fatal shifts in fluids and electrolytes in malnourished patients receiving artificial refeeding
