Eating disorder/weight loss Flashcards
1 cause of death in anorexia:
anorexia
premature death increase by ____ fold increase
10 fold increase
suicide #1 cause
Percentage men with eating disorder
10%
higher rates of ED occur in….
1st degree relative with ED
Identical twins
bulimia- more likely to have family hx of substance abuse
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
restricting subtype of anorexia dx
has not purged within last 3 months
anorexia body weight percentage
85% of what is expected
BN body weight
maintain weight
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
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***
Binge eating associations
depression
impulse control difficulty
family hx
weight fluctuations, HTN, fatigue
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
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
PE ED #1 priority
detect emergency- cardiac, hypotension
urine and orthostatic should be done at ___
every visit, specific gravity for water loading
amylase often _____
elevated
do patients with ED report physical symptoms?
generally no- denial
report doesnt match evidence
considerations when taking weight
use same scale
johnnie only
BMI less than ___ is underweight
18.5
BMI guidelines
Mild 17+
Mod 16-17
Severe 15-16
Extreme 15
18.5-25 normal
heart rate anorexia
bradycardia
can be tachycardia if dehydrated
temporal wasting often seen in _____
anorexia
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
