anorexia and bulimia Flashcards
What are some common features of Anorexia Nervosa and Bulimia?
Dysfunctional eating patterns Underlying psychosocial issues Low self-esteem Depression Family dynamics Body image disturbance Weight changes/fluctuations
What are the three DSM-5 criteria for anorexia?
Restriction of energy intake
Intense fear of weight gain even though underweight
Distortion in body weight/shape experience
Large amount of food intake in a short amount of time (less than 2 hours) with loss of control
Definition of binge eating
What is DSM-5 criteria for bulimia?
Cycles of binge eating
Recurrent inappropriate compensatory behaviors to prevent weight gain
Frequency of episodes: one time per week
Eating disorders primarily affect males or females?
Females
***More than 90 percent female; 95 percent Caucasian
In regards to eating disorders, athletes, diabetics, and obese adolescents are at an increased or decreased risk?
Increased risk
Peak onset for anorexia is between ______ and _____ years
15-19
Peak onset for bulimia is between ______ and _______ years.
18 and 23 years
**Bulimia may arise out of anorexia
BMI below _______ indicates anorexia?
below 17.5%
What are some symptoms or conditions you can see in an individual with an eating disorder?
Dizziness, blackout, weakness Pallor, easy bruising Cold intolerance Hair loss, dry skin Vomiting, diarrhea, bloating, abdominal pain Muscle cramps, joint pains, chest pains Menstrual irregularities
If a patient presents with the following symptoms (clues) which eating disorder am I? Anorexia or bulimia Rapid/severe weight loss Dieting, taboo foods, calorie counting Excessive exercise Focus on body image Symptoms such as weakness or fatigue
anorexia
What three cardiac conditions can be seen in a patient with anorexia?
bradycardia
arrhythmias (EKG abnormalities)
mitral valve prolapse
*** can also see hypotension and syncope
What GI complications are seen in patients with eating disorders?
Hypomotility/constipation
Abdominal pain
Elevated liver enzymes
What are some Musculoskeletal Complications seen with anorexia?
Muscle wasting Loss of sub-Q fat tissue Low weight Low body mass index and low bone density Pathologic/stress fractures
What are some Neurological Complications seen with anorexia?
Seizures Cognitive and memory dysfunction Depression Anxiety Abnormal EEG
What are some Hematologic Complications seen with anorexia?
Easy bruising
Leukopenia
Anemia
Thrombocytopenia
What are some routine lab tests to do if you suspect an eating disorder?
CBC with differential
Sed rate
Electrolytes ( especially if frequent vomiting)
Urine, serum protein, and albumin
Hemoglobin and BUN can be falsely __________ due to dehydration
elevated
What happens to potassium if patient is vomiting frequently?
hypokalemia
Cholesterol will increase or decrease if patient is severely underweight?
Increase
What is one of the most dangerous complications of anorexia?
Refeeding Syndrome
With refeeding syndrome sudden high caloric intake leads to possibility of ____________.
heart failure
How do you prevent refeeding syndrome from occurring?
Prevented by refeeding patient slowly
Start with 500 calories above what patient’s taking
Add 200–300 calories every three to four days
What are some indications that the patient needs to be hospitalized?
Blood pressure below 85/50 Severe malnutrition Dehydration Electrolyte imbalances EKG abnormalities Sinus bradycardia Suicidality
Help patient regain and maintain adequate weight equivalent to BMI of at least ________.
16 or above
What are some manifestations seen in patients with bulimia?
Weight cycles (gain/loss)
Trips to bathroom after meals
Vomiting, laxatives, enemas, and excessive exercise
What are some physical signs seen in patients with bulimia?
Russell's sign Parotid swelling Loss of dental enamel Gastroesophageal reflux disease (GERD) Constipation
What is Russell’s sign?
calluses or scars on backs of hands from inducing vomiting
Mean duration of behavior of bulimia before diagnosis is __________.
6 years
What EKG abnormalities are seen with bulimia?
QTc prolongation
What are some comorbidities seen frequently in bulimia patients?
Majority of bulimics meet criteria for at least one personality disorder
Obsessive compulsive disorder (OCD)
Borderline personality disorder
Depression
History of high substance abuse rate
History of sexual conflicts, impulsive behaviors, promiscuity, and self-mutilation
What are some comorbidities seen frequently in bulimia patients?
Majority of bulimics meet criteria for at least one personality disorder
Obsessive compulsive disorder (OCD)
Borderline personality disorder
Depression
History of high substance abuse rate
History of sexual conflicts, impulsive behaviors, promiscuity, and self-mutilation
What lab results would likely be seen in a bulimic patient?
Electrolytes: purging of any kind can cause fluid and electrolyte imbalance Low calcium (hypocalcemia) Low sodium (hyponatremia) Low chloride (hypochloremia) Loss of stomach acid from vomiting can produce a metabolic acidosis
Serum electrolyte screening panel combined with exam of teeth, hands, and salivary glands can detect up to ____ of normal weight bulimics
85%
What is first line medication treatment with bulimia?
SSRI
