Eating Disorder

Question 1

What are some examples of eating disorder

Answer 1

(1) Anorexia nervosa
(2) Bulimia nervosa
(3) Binge eating disorder
(4) Pica
(5) Rumination disorder

Question 2

Eating Disorder definition

Answer 2

Persistent disturbance of eating that impairs both health and psychological functioning

Question 3

Consider a broad differential when evaluating a patient with weight loss, examples include but not limited to:

Answer 3

(a) Hyperthyroidism
(b) Malignancy
(c) Diseases of the GI tract
(d) Chronic Infectious diseases
(e) Affective disorders (depression)

Question 4

Screening tools for psychiatric causes can help differentiate between an eating disorder and other causes of weight loss:
(SCOFF)

Answer 4

(a) Do you make yourself Sick because you feel uncomfortably full?
(b) Do you worry you have lost Control over how much you eat?
(c) Have you recently lost more than One stone (14 pounds) in a three month period?
(d) Do you believe yourself to be Fat when others say you are thin?
(e) Would you say that Food dominates your life?

Question 5

What issue?
1) Pathophysiology
-(a) Neuroimaging studies have shown structural brain changes
-(b) Deficits in dopaminergic function and serotonergic function
–1) Dopamine: Eating behavior, motivation and reward
–2) Serotonin: Mood, impulse control, obsessive behavior
2) Diagnostic Criteria (DSM V)
-(a) Restriction of energy intake that leads to low body weight
–1) Taking into account the sex, age, developmental trajectory, and physical health
-(b) Intense fear of gaining weight or becoming fat or persistent behavior that
prevents weight gain, despite being underweight
-(c) Distorted perception of body weight and shape, undue influence of weight and shape on self-worth, or denial of the medical seriousness of one’s own low body weight
3) Common physical exam findings
-(a) Low BMI (<17.5)
-(b) Emaciation
-(c) Hypothermia
-(d) Bradycardia
-(e) Hypotension
-(f) Hypoactive bowel sounds
-(g) Xerosis (dry and scaly skin)
-(h) Brittle hair and hair loss
-(i) Lanugo body hair
-(j) Abdominal distent

Answer 5

Anorexia Nervosa

Question 6

What issue?
Diagnostic Criteria
(a) Recurrent episodes of binging and purging and inappropriate compensatory behavior to prevent weight gain
-1) Self-induced vomiting
-2) Misuse of laxatives
-3) Diuretic use
-4) Enemas
-5) Fasting
-6) Excessive exercise
-7) Occurring on average at least once per week for three months
Clinical findings
(a) Dehydration
(b) Menstrual irregularities
(c) Mallory-Weiss syndrome
(d) Pharyngitis
(e) Erosion of dental enamel
(f) ECG changes may occur

Answer 6

Bulimia nervosa

Question 7

What Issue?
(a) Episodes of binge eating
(b) Eating is associated with:
-1) Uncomfortably full
-2) Eating when not hungry
-3) Feelings of embarrassment
-4) Feelings of disgust, depression

Answer 7

Binge eating disorder

Question 8

What Issue?
(a) Eating of nonfood substances
-1) Chalk, dirt, hair, metal, etc
(b) Inappropriate eating behavior for developmental level
(c) Not culturally, socially normal eating
(d) Associated with iron deficiency anemia

Answer 8

PICA

Question 9

What issue?
(a) Repeated regurgitation of food
-1) May be rechewed, reswallowed, or spit out
(b) The regurgitation is not due to GERD, pyloric stenosis, or another medical condition

Answer 9

Rumination Disorder

Question 10

True/False
Once recognized, eating disorders require referral.

Answer 10

True

Question 11

True/False
Forced feeding and/or other interventions should be attempted by the IDC

Answer 11

False

Question 12

Lab Considerations for eating disorders

Answer 12

(a) CBC
(b) Thyroid studies
(c) Metabolic Panel

Question 13

Where should a pt with an Eating disorder be referred to?

Answer 13

(a) Psychiatry
(b) Nutrition Consult