Anorexia Nervosa

Question 1

Diagnostic criteria for Anorexia nervosa? (5)

Answer 1

Low body weight: >15% below expected, BMI < 17.5
Self-induced weight loss - avoiding food, vomiting etc.
Body distortion
Endocrine symptoms - e.g. amenorrhoea, reduced libido etc.
Delayed puberty (if onset pre-pubertal)

Question 2

Common problems? (4)

Answer 2

Amenorrhoea
Dental caries
Renal calculi
Osteopenia

Question 3

CV problems?

Answer 3

hypotension, prolonged QT, arrhythmias, cardiomyopathy

Question 4

GI problems?

Answer 4

prolonged GI transit (delay gastric emptying, altered antral motility, gastric atrophy, decreased intestinal mobility), constipation

Question 5

Endocrine problems?

Answer 5

hypokalaemia/natraemia/glycaemia, hypothermia, altered thyroid function, amenorrhoea.

Question 6

Reproductive problems?

Answer 6

infertility, low birth weight

Question 7

Haematological problems?

Answer 7

anaemia

Question 8

Signs? (7 etc)

Answer 8

Decreased muscle mass
dry skin
brittle nails/hair
enamel erosion
callused skin over IP joints (Russel sign)
anaemia + SOB etc
depression 
insomnia

Question 9

Investigations?

Answer 9

FBC, U&E’s, ESR, glucose, TFT’s, cholesterol
Endo - raised GH, low LHRH, LH, oestrogen and progesterone
BMI

Question 10

Complications and red flags? (2)

Answer 10

CV: bradycardia, hypotension

Question 11

Changes on ECG? (4)

Answer 11

Sinus bradycardia
T-wave changes (flat) - hypokalaemia
ST elevation
R axis deviation

Question 12

Psychosocial Rx?

Answer 12

Nutritional education

Family CBT, IPT

Question 13

What biological treatment can be given if there is an obsession regarding food? What can help for weight gain?

Answer 13

Fluoxetine

TCA’s

Question 14

What cardiac complication must you be wary of?

Answer 14

Prolonged QTc (>500 ms)

Question 15

What biochemical are raised in anorexia?

Answer 15

Anorexia features
most things low
G’s and C’s raised: growth hormone, glucose, salivary glands, cortisol, cholesterol, carotinaemia