B5-091 Eating Disorders Flashcards
recurrent episodes of binge eating
paired with
recurrent inappropriate compensatory behaviors to prevent weight gain
bulimia nervosa
- often accompanied by lack of self control
- dissociative quality during binging
- relief with purging
bulimia nervosa
vomiting, laxatives, diuretics, enemas, thyroid hormone, omit/reduce insulin dosing, fasting, excessive excercise
may accompany..
bulimia nervosa
30% of patient with bulimia nervosa go on to develop
substance abuse disorder
general constitutional symptoms of eating disorder
3
- fatigue
- significant reduction in resting energy expenditure
- abdominal pain
vital sign changes with eating disorders
- bradycardia
- hypothermia
- hypotension
CNS/psych symptoms with eating disorders
2
suicide risk
social isolation
hematologic symptoms of eating disorders
bone marrow suppression -> pancytopenia
GU symptoms with eating disorders
low estrogen and amenorrhea in females
low testosterone in men
endocrine symptoms of eating disorders
- cold intolerance
- low T4/T3 or elevated T3
MSK symptoms related to eating disorders
decreased bone density
(osteoporosis, frequent fractures)
what dermatologic abnormality might you see in a patient with an eating disorder?
lanugo
cardiac symptoms of eating disorders
4
- bradycardia
- arrythmias
- QT prolongation
- cardiomyopathy
what nutrient deficiencies are associated with eating disorders?
3
magnesium
zinc
phosphate
what GI symptoms are associated with eating disorders?
7
- weight loss
- dehydration
- constipation
- hypoglycemia
- elevated cholesterol
- AST/ALT elevation
- elevated amylase
what renal symptoms are associated with eating disorders?
peripheral edema
what clinical signs are associated with purging?
7
- parotitis
- dental erosion
- metabolic alkalosis (hypochloremia)
- hypoglycemia
- esophageal tears
- gastric rupture
- cardiac arrythmias
what electrolyte imbalances are associated with purging?
- hypokalemia
- hypochloremia
- hyponatremia
laxative abuse can cause metabolic [..]
acidosis
gold standard therapy treatment
Family Based
CBT and DBT are good backups
goals of treatment
listed in order from most to least helpful
- refeeding
- therapy
- medication - if necessary
if the symptoms are severe
the patient is unstable or refusing to eat…
need to be admitted
everyone else can be managed outpatient
life threatening condition characterized by widespread organ dysfunction related to failure to make adequate ATP
refeeding syndrome
prior to refeeding, what happens physiologically?
- prolonged under nutrition cause decreased blood glucose
- catabolism of fat and protein stores
- depeletion of intracellular electrolytes including phosphorus
during refeeding, what happens physiologically to put patient at risk for refeeding syndrome?
- rising glucose stimulates insulin secretion
- phosphorus moves into cells to create ATP
- phophorus concentrations are low from chronic undernutrition
(insufficient amounts within 12-72 hours of feeding)
binging without purging
binge eating disorder
may be the prodromal phase of other eating disorders
binge-eating disorder
associated with anxiety, OCD
anorexia nervosa
- intense fear of weight gain
- restriction of caloric intake with severe weight loss
- at least 3 months duration
- distorted perception of body image
anorexia nervosa
BMI <18.5 or <5th% for age
anorexia nervosa
- binge eating
- recurrent inappropriate compensatory mechanisms
- at least 1x/week for 3 months
- self-evaluation unduly influenced by body shape/size
bulimia nervosa
may have normal/overweight BMI
2
bulimia nervosa
binge-eating disorder
dysfunctional dieting precedes binge eating
bulimia nervosa
associated with BPD and substance abuse
bulimia nervosa
- binge eating without compensatory mechanisms
- at least 1x/week for 3 months
binge eating disorder
dieting follows binge eating
binge eating disorder
associated with bipolar, depressive, anxiety disorders
binge eating disorder
anorexia symptoms but weight is within/above normal range
atypical anorexia
absence of binge eating, only purging
purging disorder
- recurrent episodes of night eating
- awareness and recall
- causes significant distress/impairment in function
night eating syndrome
which deficiency is reversed as a patient begins refeeding
phosphorus
due to shift from fat to carbohydrate metabolism
what should be in the standard admitting orders for a patient with an eating disorder?
CBC
diet history
ECG
electrolyte panel
patients who deprive themselves of calories during their teenage years are at high risk for […] later in life
low bone density
chaotic feeding schedule and decisions around food
frequent fad dieting
bulimia
highly structured day with restrictive intake/purging behaviors/exercise routines
anorexia
associated with OCD
anorexia
associated with BPD
bulimia
loss of acid from the stomach due to chronic vomiting can lead to
metabolic alkalosis
in patients who abuse laxative regularly, you may see a mild metabolic
acidosis
recommended treatment for Avoidant/restrictive food intake disorder
CBT with exposure therapy and FBT
maybe SSRI
3 diagnostic criteria to diagnose anorexia nervosa
- persistent energy intake restriction
- intense fear of gaining weight/becoming fat
- disturbance in self-perceived weight or shape
