Anorexia and Bulimia

Question 1

anorexia

Answer 1

preoccupied with weight, body image and being thin. associated with OCPD traits
restricting type: no binge eating or purging, wt loss achieved through diet, fasting or excessive exercise
binge/purge type: self-induced vomit, laxatives, enemas, diuretics

DSM: restriction of energy, low body wait, intense fear of gaining weight or becoming fat, persistent behaviors that prevent wt gain. disturbed body image, undue influence of weight or shape on self eval or denial of seriousness of current low body weight

physical findings associated to wt loss and purging

physical: amenorrhea, cold intolerance, hypotension, brady, arrhythmia, ACS, cardiomyopathy, MVP, constipation, lanugo hair, alopecia, edema, dehydration, peripheral nephropathy, sz, hypoTH, osteopenia, osteoporosis
labs: hypoNa, HypoCl HypoK alkalosis, QTc prolonged, hyperCholesterolemia, transaminitis, leukopenia, anemia, elevated BUN, inc GH, inc cortisol, reduced LH/FSH/E/T, hypoTH, hypoglycemia

tx: food, lytes, CBT

Question 2

refeeding syndrome

Answer 2

lytes and fluid shifts that occur when malnourished pts are re-fed too quickly

fluid retention and dec levels of phosphorus, mag, calcium
complications: arrhythmia, resp failure, delirium, seizures

Question 3

bulimia

Answer 3

binge eating with behaviors intended to counteract wt gain (vomiting, laxatives, enemas, diuretics), fasting, exercise. embarrassed by binge eating, overly concerned with weight. but MAY have normal BMI

1. recurrent episodes of binge eating
2. recurrent inappropriate attempts to compensate for overeating and preventing wt gain
3. at least once a week for 3 mos
4. perception of self worth excessively influences by body weight and shape

physical: salivary gland enlargement, dental erosion/caries, callouses and abrasions on dorsum (Russel’s sign), petechiae, peripheral edema, aspiration
labs: hypoCl hypoK alkalosis, metabolic acidosis (Laxatives), elev Bicarb, hyperNa, inc BUN, inc Amylase, altered TSH, cortisol homeostasis, esophagitis

tx: SSRI (fluoxetine 60-80mg)

Question 4

binge eating

Answer 4

suffer emotional distress over binge eating, but dont control wt by purging or restriction.
not fixated on body shape or BMI

1. recurrent episodes of binge eating with at least 3: eating rapidly, eating until uncomfortably full, eating large amounts when NOT hungry, eating alone (embarrassed), feel disgust/depressed or guilty after eating
2. distress over binge eating
3. Qwk every week for 3 mos
4. NOT associated with compensatory behaviors

typically obese and suffer from metabolic (DM, CVD)
tx: CBT, psychotherapy
stimulants to suppress appetite
topiramate and zonisimide: wt loss
orlistate (xenical) inhibits lipase, dec fat absorbed from GIT