Eating Disorder Flashcards
DSM-5 Criteria
Restriction of energy intake relative to requirements
Fear of weight gain
Severe body image disturbance
What does restriction of energy intake relative to requirements lead to in anorexia?
Significantly low body weight in the context of age, sex, developmental trajectory, and physical health
Subtypes of Anorexia Nervosa
Restricting
Binge eating/purging
Signs/Symptoms of Anorexia
Dry skin Cold intolerance Blue hands & feet Constipation Bloating delayed puberty Primary or secondary amenorrhea Fainting Orthostatic hypotension Lanugo hair Scalp hair loss Early satiety Weakness, fatigue Short stature Osteopenia Breast atrophy Atrphic vaginitis Pitting edema Cardiac murmurs Sinus bradycardia Hypothermia
DSM-5 Criteria for Bulimia: 3 of the following 5 Criteria
Eating much more rapidly than normal
Eating until uncomfortably full
Eating large amounts of food when not feeling physically hungry
Eating alone because of embarrassment
Feeling disgusted, depressed, or very guilty over overating
Signs/Symptoms of Bulimia
Mouth sores Pharyngeal trauma Dental caries Heartburn, chest pain Esophageal rupture Impulsivity: stealing, ETOH abuse, drug/tobacco Muscle cramps Weakness Bloody diarrhea Bleeding or easy bruising Irregular periods Fainting Swollen parotid glands Hypotension Russell's sign
Define Russell’s Sign
Calluses on the back of their knuckles/hands from self induced vomiting
Define Binge Eating
Eating in a discrete period of time an amount of food that is larger than most people would eat in a similar period
DSM-5 Criteria for Eating Disorder, Not Otherwise Specified
Anorexia with regular menses
Anorexia except weight still in normal range
Bulimia except
Types of Inappropriate Compensatory Behavior
Self-induced vomiting
Misuse of laxatives, diuretics, or other meds
Fasting
Excessive exercise
Associated Psychiatric Conditions with Eating Disorders
Anxiety disorders
OCD
Personality disorders
Substance abuse
Pathogenesis of Eating Disorders
Combination of psychological, biological, family, genetic, environmental, and social factors
Screening Tools for Eating Disorders
SCOFF Questionaire
ESP
SCOFF Questionnaire
S: sick feel uncomfortably full C: control (loss) over how much you eat O: one stone (14 pounds) F: fat when others think think F: food dominates life
Important History for Eating Disorders
Maximum heigh/weight Exercise habits: intensity, hours/week Stress levels Habits & behaviors: smoking, ETOH, drugs, sexual activity Eating attitudes & behaviors ROS
Anorexia Physical Exam
Vitals: orthostatic
Skin/extremity evaluation
Cardiac exam: bradycardia, arrhythmia, MVP
Abdominal exam
Neuro exam: other causes of weight loss/vomiting
Bulimia Physical Exam
Vitals: orthostatic
Skin/extremity evaluation
Cardiac exam: bradycardia, arrhythmia, MVP
Abdominal exam
Neuro exam: other causes of weight loss/vomiting
Parotid gland hypertrophy
Erosion of teeth enamel
Lab Assessment for Eating Disorders
CBC: anemia Electrolytes BUN/Cr Mg, PO4, calcium Albumin, serum protein B-HCG UA: specific gravity Thyroid function tests Serum prolactin FSH Bone density
Complications of Eating Disorders
Fluid & electrolyte imbalance
Osteopenia
Amenorrhea
Cardiac changes
Fluid & Electrolyte Imbalance
Hypokalemia Hyponatremia Hypochloremic alkalosis Elevated BUN Inability to concentrate urine Decreased GFR Ketonuria
Osteopenia
Most severe complications
Difficult to revers
Treatment of Osteopenia
Weight gain
1200-1500 mg/day of elemental calcium
Multivitamin with vit. D
Estrogen/progesterone replacement
What is amenorrhea caused by in anorexia?
Low FSH
Low LH
Cardiac Changes in Eating Disorders
MVP
Long QT
Risk of HF greatest in first 2 weeks of refeeding
HF during first 2 weeks of Refeeding
Reduced cardiac contractility Refeeding edema Slow refeeding Repletion of K+ Avoidance of Na+ intake
CBT in Anorexia
Emphasizes the relationship of thoughts and feelings
Providers in an Interdisciplinary Care Team for Anorexia
Medical provider
Dietician with experience in eating disorders
Mental health professional
What are medications for in treating eating disorders?
Co-morbid conditions of depression & OCD
When to Hospitalize a Patient with an Eating Disorder
Severe malnutrition (
Nutrition in Anorexia
Regain to goal of 90-92% of IBW
Treatment of Bulimia
CBT is effective
Pharmacotherapy in Bulimia
Fluoxetine (Prozac)
TCAs
Topiramate (Topamax)
Ondansetron (Zofran)
Treatment of Binge Eating Disorder
CBT
Pharmacotherapy
Female Athlete Triad
Eating disorders
Stress fractures
Amenorrhea
Females at Risk for the Female Athlete Triad
Appearance related sports
High performance sports
What to look for with the female athlete triad
Weight HR 40-50 Hypotension Hypothermia Parotid swelling Poor dentition Overuse injuries
Treatment of the Female Athlete Triad
Estrogen replacement Decrease energy expenditure Nutritional consultation Calcium with Vit. D Psychological counseling Avoid NSAIDs
