Bulimia Nervosa Flashcards
Key features:
‘Binging and Purging’ - define
Above what BMI are they?
Eating large amount of food with a subjective loss of control
Starving, inducing vomiting, extreme exercise, or laxative use
> 17.5
Other S+S:
- Energy
- GI
- Where do you get occasional swelling?
- Fertility
- What happens to the parotid gland?
- What is tetany?
Fatigue and lethargy
Bloating
Constipation
Abdo pain
Gastric dilatation (which carries a risk of rupture)
Hands and feet swelling
Irregular menstruation
Parotid enlargement
The involuntary contraction of muscles which may be caused by disorders that increase the action potential frequency of muscle cells or the nerves that innervate them.
What are some effects of repeated vomiting?
- Dental
- Oesophagus
- What is Russel’s sign?
- Metabolic problem?
- Electrolyte changes - 2 - and what may they cause
Dental enamel erosion
Oesophagitis
Tooth mark calluses on the back of hands due to chronic induced vomiting
Metabolic alkalosis
Low chloride and potassium - arrhythmia
Effects of repeated laxative use:
Why do you get oedema, cardiomyopathy and metabolic acidosis?
The body responds by retaining fluid to try to protect itself against dehydration.
Causes electrolyte imbalance
May cause chronic diarrhoea - loss of bicarbonate.
Risk Factors:
What sex is it more common in?
Other factors
10 x more common in women
FH
PMH
Urban living
Investigations:
What tool can be used?
What should be measured?
What may the following metabolic and renal tests show? :
- Potassium
- ABG
- Urea and creatinine
SCOFF screening tool
Height and weight
Hypokalaemia from vomiting or laxatives
Alkalosis from vomiting
Acidosis from laxatives
Raised urea and creatinine due to hypovolaemia
Management - Psychological:
1st line
Who needs to be involved?
Enhanced CBT (CBT-E) can be used. What is the aim?
What type of therapy should be used for children?
Psychoeducation
Dietician - structured eating plan
To establish regular eating habits
Then to identify and address harmful ideas about body size and eating
As well as triggers and stressors
Family therapy
Management - Biological:
When should meds be used?
1st line - antidepressant?
2nd line - antidepressant?
How long should they be continued if they are effective?
If psychotherapy is unavailable or ineffective
SSRI - fluoxetine 60mg or sertraline
SSNRI - Venlafaxine
1 yr
Management - Managing purging behaviours:
What can be said to them to educate them on laxatives and its lack of effectiveness?
What advice should be given for dental care if they are vomiting regularly?
Laxatives act on the large bowel after all the food has been absorbed.
Has little effect on caloric intake.
Regular dental reviews if they vomit regularly
Use a non-acid mouthwash after vomiting
Avoid immediately brushing
