Eating disorder/weight loss Flashcards by Katherine Lee

1 cause of death in anorexia:

anorexia

premature death increase by ____ fold increase

10 fold increase

suicide #1 cause

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Percentage men with eating disorder

10%

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higher rates of ED occur in….

1st degree relative with ED
Identical twins
bulimia- more likely to have family hx of substance abuse

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Dx anorexia

1) restriction of energy intake
2) fear of fat or verbalization or behaviors that interfere with maintenance of healthy weight
3) body image disturbance, body/self evaluation OR denial

no purging in last 3 months

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restricting subtype of anorexia dx

has not purged within last 3 months

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anorexia body weight percentage

85% of what is expected

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BN body weight

maintain weight

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dx bulimia

recurrent episodes of binge (eating large amount AND loss of control)

prevent weight gain via vomiting, laxatives

binge eating once a week***x 3 months

self esteem assoc. with weight

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new proposed diagnostic criteria for binge eating disorder

eat rapidly, uncomfortably fool, large amounts when not hungry, eat alone, disgust

ONCE A WEEK x 3 months
do not occur exclusively during episodes of anorexia or bulimia***

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Binge eating associations

depression
impulse control difficulty
family hx

weight fluctuations, HTN, fatigue

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Clinical presentation anorexia

memory, hair, low bp hr, palpitations, heart failure, anemia, atrophy, swollen joints, osteoporosis, kidney stones failure, electrolyte imbalances (LOW), amenorrhea, infertility, skin

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Clinical presentation bulimia

facial- swelling of cheeks* parotid swelling
dental cavities
throat and esophagus (tears, rupture)
fatigue
GI- ulcers delayed emptying constipation
Skin- irritated knuckles**, russells sign

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PE ED #1 priority

detect emergency- cardiac, hypotension

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urine and orthostatic should be done at ___

every visit, specific gravity for water loading

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amylase often _____

elevated

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do patients with ED report physical symptoms?

generally no- denial

report doesnt match evidence

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considerations when taking weight

use same scale

johnnie only

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BMI less than ___ is underweight

18.5

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BMI guidelines

Mild 17+
Mod 16-17
Severe 15-16
Extreme 15

18.5-25 normal

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heart rate anorexia

bradycardia

can be tachycardia if dehydrated

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temporal wasting often seen in _____

anorexia

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medical complications anorexia

growth 
cardiac- arrest, atrophy, increased PR, first degree heart block 
endocrine- osteoporosis fractures 
renal/electrolyte
pulmonary- wasting, respiratory failure 
low white cells, thrombocytopenia

Bulimia complications most common and associated dx

GI***

esophageal dismotility
loss gag reflex
reflux
parotid submandibular swelling
bloody vomit
mallory weis (es. tears)
esophageal ruptures (boerhaaves)
barrets esophagus

GI continued BN

pancreatitis

BN other physical presentation lab finding

skin- russels sign, xerosis, acne enamel hypo everything metabolic alkalosis

BN ipecac causes

myopathy

Dx labs for ED

``` CBC D K anemia bun cr ca phos mg glucose LFT amylase, alk phos, TSH urine- ketone level, kidney, specific gravity echo for cardiomyopathy ?bone density, head CT ```

differential for ED

``` AIDS tumor Hyperthyroid, diabetes IBD, PUD, malabsorption Cancer Adrenal insufficiency Other mental health d/o ```

key in treating ED patients

patience

hospital criteria

``` <75% ideal weight electrolyte arrhythmia HR,40 hypothermia <36c low BP SBP <80 uncontrollable pinge burge ```

Unintentional weight loss definition

weight loss 5% or more in past 30 days or greater than 10% in last 6 months

consequences Unintentional weight loss

depression immunocompetence decreased muscle wasting complications

correlation between weight loss and mortality in older adult?

HIGH CORRELATION, 5% loss in one month may die within 1 year

changes from Unintentional weight loss

``` taste/smell dentition dec. saliva slower GI (not as hungry) inactivity ```

anorexia def.

generalized loss apettite

cachexia def.

muscle wasting

sarcopenia def.

deg. loss of skeletal muscle mass

satiety def.

how quickly getting full

Def frail adult criteria

NEED 3: - >10 lb in year - exhaustion - slow movement - low activity level (<270 kcal/week) - weakness

nursing home weight loss criteria for medicare/medicaid

MDS MMQ

Evaluation Unintentional weight loss

-hx from caregiver -distinguish cause anorexia difficulty swallowing socioeconomic weight loss despite intake

Treatable causes Unintentional weight loss acronym

``` Meals on wheels m-meds e-emotion a-anorexia l-late life paranoia s-swallowing o-oral n-no money w- wandering, dementia h- thyroid parathyoid e- enteric e-eating problems (cant feed self) L-low salt, low cholesterol diet ```

PE Unintentional weight loss, findings

- cheilosis - glossitis - dental - tenderness - hepatosplenomegaly - cognitive/neuro - temporal muscle wasting - spider nevi, gynecomastia associated with liver - parotid enlargement- ETOH - testicular atrophy - ascites - bulging flank - right sided HF - murphys sign- cholecystitis - jaundice

BMI underweight

less than 18.5 normal 18.5-25

meds Unintentional weight loss

lisinopril lasix wellbutrin digoxin

Labs Unintentional weight loss

``` comp panel CBC TSH Prealbumin glucose renal fx u/a orthostatic EKG Colonoscopy? ```

Albumin vs. prealbumin

total- albumin and globulin in blood albumin- plasma binding protein, reflects overall nutritional status prealbumin- plasma by liver, shows nutrition in last week**** better reflection of intake

better reflection of intake (lab value)

pre-albumin

overall nutrition status (lab value)

albumin

Protein calorie malnutrition ranges Unintentional weight loss

``` albumin <3.4 10% Unintentional weight loss 6 months 5% in one month BMI <18.5 poor nutrition, loss appetite, wasting ```

Appetite stimulants for Unintentional weight loss

``` consider risk vs benefit Megestrol/marinol Megace- increase thromboembolic fluid imbalance, mortality, constipation, delirium remeron Peractin- anticholinergic ```

PEG and dementia?

unfavorable

encourage what documents for Unintentional weight loss

MOLST (pt preferences treatments), advanced directive

palliative performance scale

help outline where patient is at