Anorexia Nervosa

Question 1

Anorexia Nervosa Aetiology

Answer 1

-Multifactorial

Main RFs include

• Female gender
• Age
• Western society
• FHx
• Premorbid experiences (sexual abuse, pressure, puberty)
• Perfectionism, low self-esteem, obsessional traits, premorbid obesity, early menarche, anxiety

Question 2

Anorexia Nervosa Presentation

Answer 2

• Diagnosis based on Hx
• Refusal to maintain normal bodyweight
• Weight below 85%
• Dieting/restrictive patterns
• Rapid weight loss
• Denial
• Social withdrawal
• Test muscle power by sit up test and squat test

Question 3

Anorexia Nervosa Investigations

Answer 3

• ESR and TFT useful screen for weight loss
• Other tests depend on individual presentation
• U&Es if vomiting, laxatives, or water loading
• DXA scan for those below 18

Question 4

Anorexia Nervosa Management

Answer 4

• MARSIPAN
• Urgent referral if very unwell, hypothermic, failed squat test, ECG changes
• Urgent admission if deranged electrolytes, severe disease, bradycardia or ECG changes, suicide risk
• Anorexia focused family therapy if under 18
• CBT if adult (three options, if one fails, try another)

Question 5

Anorexia Nervosa Complications

Answer 5

• Hypokalaemia
• Hypotension
• Cardiac problems
• Anaemia and thrombocytopenia
• Hypoglycaemia