Bulimia Nervosa Flashcards
What is bulimia nervosa?
It is an eating disorder characterised by episodes of binge eating followed by compensatory behaviours
What BMI do bulimia patients have?
Normal BMI
What are the three types of purging compensatory behaviours?
Self-induced vomiting
Laxative abuse
Diuretic abuse
What can purging compensatory behaviours lead to?
Neuro-chemical disruption with specific damage to the brain (seizures) and heart (arrythmias)
What is a feature of laxative abuse on colonoscopy?
Pigmetn laden macrophages
What are the three types of non-purging compensatory behaviours?
Excessive exercise
Fasting
Strict diets
What are the eight risk factors associated with bulimia nervosa?
Female Gender
Young Age, 15 - 25 Years Old
Family History
Pregnancy Complications
Puberty
Depression
Anxiety
Traumatic Life Events
What are the eleven clinical features of bulimia nervosa?
Fatigue
Delayed Puberty
Amenorrhoea
Pharyngeal Trauma
Swollen Parotid Glands
Teeth Erosion
Russel’s Sign
Heartburn
Syncope
Bradycardia
Hypotension
What is Russel’s sign? How is it associated with bulimia nervosa?
It is defined as calluses on the knuckles or back of the hand
It results due to repeated self induced vomiting
What are the three ABG features which indicate bulimia nervosa with self-induced vomiting?
Metabolic alkalosis
Hypokalemia
Hypochloraemia
What screening questionnaire can be used to diagnose eating disorders?
SCOFF Questionnaire
What are the five questions included in the SCOFF questionnaire?
Do You Make Yourself Sick Because You Feel Uncomfortably Full?
Do You Worry You Have Lost Control Over How Much You Eat?
Have You Recently Lost More Than One Stone In A Three Month Period?
Do You Believe Yourself To Be Fat When Others Say You Are Too Thin?
Would You Say That Food Dominates Your Life?
What SCOFF questionnaire result would indicate an eating disorder?
2 positive answers
What three investigations can be used to diagnose bulimia nervosa?
Blood Tests
Arterial Blood Gas
ECG Scan
What six blood test results indicate bulimia nervosa?
Decreased Haemoglobin Levels
Decreased Potassium Levels
Decreased Magnesium Levels
Increased Creatinine Levels
Increased Bicarbonate Levels
Increased ALT Levels
What are the two feautres of bulimia nervosa on ECG scans?
Bradycardia
Hypokalaemia Features
What are the five features of hypokalaemia on ECG scans?
Increased P wave amplitude
Prolonged PR interval
ST depression
T wave flattening/inversion
Prominent U waves
What are the six DSM-5 diagnostic criteria of bulimia nervosa?
The recurrence of binge eating episodes, in which individuals eat an amount of food that is definitely larger than most people would eat during a similar period of time and circumstances
A sense of lack of control over eating during the binge eating episodes
A recurrence of inappropriate compensatory behaviours in order to prevent weight gain, such as self-induced vomiting, laxative abuse, diuretic abuse, fasting or excessive exercise
The binge eating and compensatory behaviours occur on average at least once a week for three months
A self-evaluation unduly influenced by body weight and shape
The disturbance doesn’t occur exclusively during episodes of anorexia nervosa
What is the most appropriate step in suspected bulimia nervosa?
A specialist referral is recommended in all cases
What are the three psychological treatment options for bulimia nervosa?
Psychoeducation
Cognitive Behaviour Therapy (CBT)
Focused Family Therapy (FT)
What is psychoeducation?
It involves providing patients with information about anorexia nervosa and ways in which they can control and minimise it
What is CBT?
It is a talking therapy used to manage the way in which patients think, feel and behave
What is the first line management option of bulimia nervosa?
Self-guided CBT
How long should self-guided CBT be trialled for, before INDIVIDUAL CBT is recommended?
Four weeks
When is FFT recommended in bulimia nervosa?
It is the first line management option in children and young people
When is pharmacological management of bulimia nervosa recommended?
It is a second line management option, in which CBT is unavailable or has been deemed as ineffective
What is the pharmcological management option of bulimia nervosa? Name an example
SSRIs (Fluoxetine)
How do we manage hypokalaemia in bulimia patients?
40mmol potassium in normal saline for 4 hours
What is the maximum rate of IV potassium infusion without monitoring?
10mmol/hour
