Eating Disorder Flashcards
Anorexia nervosa definition
Eating disorder characterised by restriction of caloric intake leading to low body weight, an intense fear of gaining weight, and a disturbed body image.
Bulimia nervosa definition
Recurrent (once a week for 3 months) episodes of binge eating followed by compensatory behaviour in order to prevent weight gain.
Compensatory behaviour used in Bulimia nervosa
Vomiting, fasting, excessive exercise.
Binge eating disorder
Recurrent episodes of eating significantly more food in a short period of time than the majority of other people. Feelings of lack of control, no compensatory behaviour.
Atypical eating disorders
“Other specified eating or eating disorder”
Do not meet criteria for one of other eating disorders.
Causes of eating disorders
Female sex
Adolescence or early adulthood
Anxiety disorder, OCD, borderline personality disorder.
Living in a western society and media exposure.
Family history of depression, ED or substance misuse.
Sexual abuse.
Occupational or recreational pressure to be thin (model, athlete, ballet).
Complications of anorexia nervosa
MSK = Loss of muscle strength, loss of bone density, impaired growth in teenagers. Endo = Infertility, polycystic ovaries, thyroid disease. Cardio = Arrhythmia, hypotension, peripheral oedema, mitral valve prolapse. GI = constipation, abnormal LFT, slow GI motility. Haem = anaemia, low WCC, thrombocytopenia. Neuro = cognitive impairment, seizure. Renal = kidney stones, CKD.
Complications of Bulimia nervosa
Anxiety.
Cardio = arrhythmia, peripheral oedema, mitral valve prolapse.
Derm = Russell’s sign.
Dental = erosion of tooth enamel.
Endo = amenorrhoea, irregular menses, osteopenia, hypoglycaemia.
GI = Mallory-Weiss, oesophageal rupture.
Resp = aspiration pneumonia
Screening questionnaire
SCOFF.
Make yourself Sick
Worry lost Control over eating
Lost more than One stone in 3 month period.
Believe you are Fat when people say you are thin
Does Food dominate your life.
Clinical features of anorexia nervosa
Weight maintained at least 15% below that expected for the person.
Psychological:
Self-avoidance of food thought to be fattening or evidence of compensatory behaviours.
Distortion of body image
Dread of fatness
Over-evaluation of self worth defined by weight and shape.
Physiological: Disorder of hypothalamic–pituitary–gonadal axis (amenorrhoea, infertility, loss of libido, potency, poor growth) Dizzy, fatigue, cachexia Constipation Orthostatic hypotension, Bradycardia Cold intolerance, hypothermia Loss of muscle mass Dry skin, hair loss Lanugo = fine hair on trunk and head.
Clinical features of bulimia nervosa
Binge eating (1 a week for 3months) Psychological: Strong caving for food Overvalued idea e.g. dread of fat, self-perception patient is too fat, a target weight. Symptoms of anxiety or tension. Persistent preoccupation with food, shame or guilt. Physiological: Methods to counteract weight fain (vomiting, laxatives, fasting, excess exercise, diuretics, thyroxine) Bloating, constipation, lethargy GORD, sore throat Knuckle calluses Dental enamel erosion.
Binge eating disorder clinical features
No compensatory behaviour after period of excessive eating.
At least 3 of:
Eating more rapidly than normal
Eating until uncomfortably full
Eating large amounts despite no physical hunger
Eating alone due to shame of amount they are eating
Feeling of disgust, guilt or depression afterwards.
Management of eating disorders
CBT, interpersonal or cognitive analytical therapy.
Dietary counselling.
Regular physical, height and weight monitoring.
Antidepressants may be used in bulimia nervosa and binge eating disorder.
Consider hospital admission if - home environment will impede recovery, very low BMI, severe deterioration, risk of suicide, medical complications.
Investigations for eating disorders (AN and BN)
FBC: thrombocytopenia, anaemia.
Urea+electrolytes: hypokalaemia = vomitting, hyponatreamia, raised urea = dehydration.
LFT = raised.
Random blood glucose - hypoglycaemia
ECG = bradycardia, electrolyte imbalance.
TSH = reduced T3.
Refeeding syndrome pathogenesis
HYPOPHOSPHATAEMIA. Hyperglycaemia. Hypokalaemia Hypomagnesemia On feeding, insulin released which causes synthesis of products e.g protein. In order to make these potassium, magnesium and water enter the cells, leaving low serum levels.
