Anorexia

Question 1

What are the risks of rapid weight loss?

Answer 1

Refeeding syndrome
Hypoglycaemia
Risk of infection
Cardiac arrhythmia

Question 2

What can cause rapid weight loss in adolescents?

Answer 2

Coeliac disease
T1DM 
Hyperthyroidism 
Anorexia 
IBD 
Depression 
Addisons

Question 3

What tests should you do?

Answer 3

ECG
U&E
BM
Phosphate, calcium, magnesium
LFTs
CRP
TFTs 
Coeliac screen 
ESR

Question 4

What is the aim of the short term treatment for anorexia?

Answer 4

Physical stabilisation

Question 5

What is the aim of the medium term treatment for anorexia?

Answer 5

MDT treatment in the community

Question 6

What is the aim of long term treatment for anorexia?

Answer 6

Relapse prevention

Question 7

What does physical stabilisation involve for Weight:height ratio less than 75%?

Answer 7

thiamine, vitamin B complex and multivitamins

Question 8

What is the diet plan for anorexia?

Answer 8

Aim for 0.5-1kg weight gain per week

Question 9

What must be monitored in physical stabilisation?

Answer 9

Phosphate - a drop may show referring syndrome
ECGs
Vital signs

Question 10

Which specialities are involved in the community MDT for anorexia?

Answer 10

Paediatrician 
Child psychologist 
Nurse therapist 
Family therapist 
Dietician

Question 11

What is the paediatrician’s role in the community for anorexia?

Answer 11

Monitor physical health

Consider osteoporosis and osteopenia (DEXA scans)

Question 12

When are anorexics at high risk of relapses?

Answer 12

Transition phases e.g. going to uni

Question 13

What is the aetiology of anorexia nervosa?

Answer 13

Neuro-biological

1. Genetic factors
2. Events around puberty
3. Cultural promotion of thinness

Question 14

What are the three main types of eating disorder in young people?

Answer 14

Anorexia nervosa
Bulimia nervosa
EDNOS (eating disorder not otherwise specified)

Question 15

What are the features of bulimia nervosa?

Answer 15

Binging
Vomiting
Self-harm
(normal weight)

Question 16

What are the behavioural features of anorexia?

Answer 16

Pre-occupation with food
Won’t eat in front of others
Hiding food

Question 17

What are the psychological features of anorexia?

Answer 17

Feeling fat

Disturbed body image

Question 18

What are the clinical features of anorexia?

Answer 18

Low weight
Lethargy
Fainting 
Dry skin
Hair loss
Cool peripheries 
Hypotension
Hypothermia 
Bradycardia 
Headaches
Amenorrhoea

Question 19

What are common co-morbidities with anorexia?

Answer 19

Depression

OCD

Question 20

What are the most significant mortality risks in anorexia?

Answer 20

Sudden cardiac death
Suicide
Chronic emaciation + pneumonia

Question 21

Why do anorexics become constipated?

Answer 21

Small amount of food ingested leads to slowing of gastric motility

Question 22

What are the short term consequences of laxative abuse?

Answer 22

Potassium and sodium depletion
Dehydration
Cardiac arrest

Question 23

What are the long term consequences of laxative abuse?

Answer 23

Loss of bowel motility

Rectal prolapse

Question 24

What pattern of bloods is seen in refeeding syndrome?

Answer 24

Hypophosphataemia
Hypomagnesaemia
Hypokalaemia
Low thiamine

Question 25

What is refeeding syndrome?

Answer 25

Potentially fatal shifts in fluids and electrolytes in malnourished patients receiving artificial refeeding