Eating Disorder

Question 1

The main types of eating disorders

Answer 1

• Anorexia nervosa
• Bulimia nervosa
• Binge eating disorders

Question 2

Who are eating disorders more prevelent within?

Answer 2

Females + young people

Question 3

Define anorexia nervosa

Answer 3

Person feels overweight despite evidence of normal or low body weight

Purging:
* It involves obsessively restricting calorie intake to lose weight.
* Often, the person exercises excessively and may use diet pills or laxatives to limit the absorption of food.

Question 4

List some features of anorexia nervosa

Head to toe

Answer 4

• Mood changes (anxiety, depression)
• Lanugo hair (fine, soft hair across most of the body)
• Hypotension
• Hypothermia
• Weight loss (e.g., 15% below expected or BMI less than 17.5)
• Amenorrhoea (absent periods)

Question 5

Why does amenorrhea (absent periods) occur in anorexia nervosa?

Answer 5

Amenorrhoea = occurs due to disruption of the hypothalamic-pituitary-gonadal axis
* There is a lack of gonadotrophins (LH + FSH) from the pituitary → leading to reduced activity of the ovaries (hypogonadism)

Question 6

Cardiac complications of anorexia nervosa

Answer 6

• Arrhythmia
• Cardiac atrophy
• Sudden cardiac death

Question 7

What happens to bone mineral density in anorexia nervosa?

Answer 7

Low bone mineral density

Question 8

What body weight is typical for bulimia nervosa?

Answer 8

Normal
Tends to fluctuate

Question 9

What does bulimia nervosa involve?

Answer 9

Binge eating + followed by purging (by inducing vomiting or taking laxatives to prevent the calories fro being absorbed)

Question 10

Features of bulimia nervosa

Answer 10

• Erosion of teeth
• Swollen salivary glands
• Mouth ulcers
• Gastro-oesophageal reflux
• Calluses on the knuckles where they have been scraped across the teeth (called Russell’s sign)

Question 11

What can occur in bulimia after repeated vomiting of hydrochloric acid from the stomach?

Answer 11

ALKALOSIS

Question 12

A teenage girl presents with abdominal pain and reflux. She has an average body weight and presents with swelling to the face or under the jaw (salivary glands), calluses on the knuckles and alkalosis on a blood gas. Underlying diagnosis?

Answer 12

Bulimia nervosa

Question 13

Define binge eating disorder

Answer 13

• Binge eating disorder = characterised by episodes where the person excessively overeats, often as an expression of underlying psychological distress.
• The person typically feels a loss of control.
• It is not a restrictive condition like anorexia or bulimia, and patients are likely to be overweight.

Question 14

What do binges involve?

Answer 14

• A planned binge involving “binge” foods
• Eating very quickly
• Unrelated to feelings of hunger
• Becoming uncomfortably full
• Eating in a dazed state

Question 15

Possible blood test findings in a restrictive eating disorders

Answer 15

• Anaemia
• Leucopenia (low WBC)
• Thrombocytopenia (low platelets)
• Hypokalaemia (low potassium - due to vomiting or excessive laxatives)

Basically every component of blood low and potassium

Question 16

Restrictive eating disorders cause reduced bone marrow activity, what in turn does this cause?

Answer 16

• Normocytic normochromic anaemia
• Leucopenia (low neutrophils + low lymphocytes)
• Thrombocytopenia

Question 17

Management for eating disorders

Answer 17

Management is centred around changing behaviour and addressing environmental factors:
* Self-help resources
* Psychological therapies (e.g., cognitive behavioural therapy)
* Addressing other psychosocial factors (e.g. depression, anxiety and relationships)

Severe cases may require compulsory admission for:
* Observed refeeding
* Monitoring for refeeding syndrome.

Question 18

What is refeeding syndrome?

Answer 18

• Refeeding syndrome = occurs when someone with an extended severe nutritional deficit resumes eating.
• The lower the BMI + the longer the period of malnutrition → the higher the risk.
• It should be suspected in anyone with minimal nutritional intake for more than five days