Clin Med - Disordered Eating Flashcards
What mental disorder has the highest mortality per year?
anorexia nervosa
What percent f AN/BN and BED patients are men?
AN/BN: 25%
BED: 36%
Most likely age for eating disorders
- 43% age 16-20
- 33% age 11-15
% of women 50+ trying to lose weight
70%
DSM criteria for anorexia nervosa overview (3)
- body weight
- fear of weight gain
- body image
DSM AN body weight requirements
restriction of energy intake relative to requirements leading to markedly low body weight
DSM AN fear of weight gain requirements
- Although underweight, intense fear of gaining weight or becoming fat
OR - persistent behavior to avoid gaining weight although at a markedly low weight
DSM AN fear of body image requirements
- Disturbance in way one’s body weight or shape is experienced.
- Denial of seriousness of low body weight
- Undue influence of body weight or shape on self-evaluation
DSM criteria for bulimia nervosa overview (4)
- binge eating
- compensatory behavior
- frequency
- self evaluation
DSM BN binge eating requirements
- Eating an amount of food in discrete period of time (2h) that is definitely larger than most people would eat
OR - A sense of lack of control
DSM BN compensatory behavior requirements
Recurrent, inappropriate compensatory behavior in order to prevent weight gain (vomiting, laxatives, diuretics, enemas, fasting, excessive exercise)
DSM BN frequency requirements
once weekly for 3 months
DSM BN self evaluation requirements
unduly influenced by body shape and weight, disturbance does not occur exclusively during episodes of AN
DSM criteria for avoidant restrictive food intake disorder (ARFID)
Eating or feeding disturbance as manifested by persistent failure to meet appropriate nutritional and/or energy needs leading to one or more of:
- Sig weight loss (or failure to achieve expected weight gain or faltering growth in children)
- Sig nutritional deficiency
- Dependence on enteral feeding or oral nutritional supplements
- Marked interference with psychosocial functioning
DSM criteria for avoidant restrictive food intake disorder (ARFID) NOT due to (4)
- Unavailability of food
- Observation of cultural norms (Ramadan)
- AN or BN (no evidence of disturbance in experience of body shape or weight)
- Another medical condition or mental disorder. If occurs concurrently with another condition, the disturbance exceeds what is normally caused by other condition
DSM criteria for binge eating disorder must include
frequent overeating combined with lack of control and marked feelings of distress
DSM criteria for binge eating disorder frequency of overeating
1 / week for 3 months
DSM criteria for binge eating disorder must also be associated with 3 or more of 5:
- Eating much more rapidly than normal
- Eating until feeling uncomfortably full
- Eating large amounts of food when not hungry
- Eating alone d/t embarrassment
- Feeling disgusted with oneself, depressed, or guilty afterwards
DSM definition of atypical anorexia
All criteria for anorexia are met except individuals weight is within or above normal range
Presenting symptoms for a patient with an eating disorder (14)
- Growth charts abnormalities
- Weight change/failure to thrive
- n/v
- fatigue
- syncope: limited CO d/t decreased heart muscle mass
- dizziness
- chest pain
- decreased appetite/intake
- behavioral changes
- constipation
- amenhorrhea
- hair loss
- cold intolerance
- HA
General findings on PE that indicate possible eating disorder (5)
- abnl body weight
- growth failure
- hypothermia
- hypotension (MC) or hypertension
- orthostatic bp or hr change
HEENT findings on PE that indicate possible eating disorder (6)
- Parotid enlargement
- Conjunctiva hemorrhage
- Temporal wasting
- Palate ulcerations/trauma
- Dental erosions
- Atrophic thyroid
Cardiovascular findings on PE that indicate possible eating disorder (4)
- Bradycardia
- Medial displacement of PMI (dt diminished heart muscle mass)
- Heart failure/volume overload
- Irregular rhythm
Gonadal findings on PE that indicate possible eating disorder (2)
- breast atrophy
- testicular atrophy
Skin/extremity findings on PE that indicate possible eating disorder (7)
- Delayed cap refill
- Cool to touch
- Excoriations/callouses on back of hands (Russell’s sign)
- Acrocyanosis (cold/pale hands, not Raynaud’s)
- Lanugo – baby hair
- Pallor
- Easy brusing/petechiae
Neuro/psych findings on PE that indicate possible eating disorder (5)
- Psychomotor retardation
- Abnormal mini mental status exam
- Flat, constricted affect
- Self-injury marks (arms, thighs, abdomen)
- Muscular weakness and atrophy
CBC findings that indicate possible eating disorder (3)
- leukopenia
- anemia
- thrombocytopenia
LFT findings that indicate possible eating disorder (1)
- elevated AST and ALT
BMP findings that indicate possible eating disorder (4)
- electrolyte disturbances
- metabolic alkalosis
- elevated BUN/Cr
- Hypoglycemia
common electrolyte disturbances found in eating disorders
- Hyponatremia if over hydrated
- Vomiting: hypokalemia, hypercapnia, hypochloremia
Other lab findings that indicate possible eating disorder (5)
- low estrogen/testosterone
- low FSH/LH
- high amylase/lipase
- elevated cholesterol
- thyroid (high reverse T3, low free T4)
EKG findings that indicate possible eating disorder (6)
- Bradycardia
- QT prolongation
- Arrhythmias
- Low voltage
- ST/T wave abnormalities
- Rightward axis (decrease in myocardium)
Echo findings that indicate possible eating disorder (3)
- Reduced ventricular mass
- Pericardial effusion
- Mitral valve prolapse
Xray findings that indicate possible eating disorder (1)
osteopenia/fractures
UA findings that indicate possible eating disorder (3)
- SG (low dt water loading, high dt dehydration)
- ketones
- UTI?
Screening questionnaire to determine presence of eating disorder
SCOFF screening tool
Criteria for medical admission d/t eating disorder (13)
- Severe malnutrition (<75% of IBW)
- Dehydration
- Electrolyte abnormalities
- Cardiac arrhythmias
- Growth arrest
- Physiologic instability
- Failure of outpt therapy
- Acute food refusal (<500 calories/day)
- Uncontrollable bingeing and purging
- Medical complications
- Psych emergency (suicidal intentions)
- Co-morbid diagnosis that interferes with t
- Family respite
Physiologic instability (3)
HR < 50
BP < 90/45
Temp < 96F
sequence of events that leads to refeeding syndrome
- Starvation/ malnutrition
- Glycogenolysis, gluconeogenesis, protein catabolism
- Protein, fat, mineral, electrolyte, vitamin depletion, salt and water intolerance
- Refeeding – switch to anabolism
- Fluid, salt, nutrients (carbs) → insulin secretion
- Protein and glycogen synthesis (increased glucose, increased use of thiamine, increased intake into cell of K, Mg, PO4
- Hypokalemia, hypomagnesemia, hypophosphatemia, thiamine deficiency, salt and water retention (edema)
Risk factors for refeeding syndrome (5)
- <70% IBW
- Abrupt weight loss
- Sudden carb load
- Starvation 5-10 days prior to refeeding
- Low levels of K, Mg, phos before refeeding started
- *Highest risk during first two weeks of nutritional replenishment
4 vitamin/mineral deficiencies and associated manifestations seen in eating disorders
- Zinc deficiency: acrodermatitis enteropathica (rash on face)
- B12 Deficiency: angular chelitis
- Biotin (B7) deficiency: hair loss
- Thiamin B1 deficiency: confusion, Wernicke’s encephalopathy
How to treat malnutrition of eating disorder to avoid development of refeeding syndrome
- Feed slowly – 250 kcal/day increase
- Space meals – 3 meals and 3 snacks
- Zinc, multivitamin, vitamin D
Cardiovascular complications associated with eating disorders (5)
- Reduced cardiac mass, chamber volume
- Mitral valve prolapse
- Myocardial fibrosis (permanent?)
- Pericardial effusion
- Ipecac can induce myopathy
gyn/reproductive health complications associated with eating disorders (2)
- Amenorrhea (secondary or primary)
- fertility
Endocrine complications associated with eating disorders (1)
hypothalamic-pituitary abnormalities → bone loss
Dental complications associated with eating disorders (3)
- Discoloration of teeth
- Caries
- Gum disease
GI complications associated with eating disorders (8)
- Gastroparesis and constipation
- GERD
- Barrett’s esophagus (Use PPI)
- Dysphagia
- Superior mesenteric artery syndrome
- Acute pancreatitis and hepatitis
- Diarrhea secondary to villous atrophy
- Mallory-Weiss syndrome (esophageal tear)
Renal complications associated with eating disorders (3)
- Reduced GFR, difficulty concentrating urine → diuresis, hyponatremia, dehydration
- Electrolyte imbalances
- Nephropathy
Pulmonary complications associated with eating disorders (2)
- Weakness/wasting of respiratory m
- Dyspnea, reduced aerobic capacity, decreased pulmonary capacity
Heme complications associated with eating disorders (3)
- anemia
- leukopenia
- thrombocytopenia
Neuro complications associated with eating disorders (3)
- Wernicke encephalopathy
- Korsokoff syndrome
- brain atrophy
Ophthalmic complications associated with eating disorders (1)
Lagophthalmos (severe cases)
Derm complications associated with eating disorders (5)
- Xerosis (dry skin)
- Lanugo
- Telogen effluvium (hair loss)
- Carotenoderma (yellow skin)
- Slow wound healing
