Eating Disorders Flashcards
What is anorexia nervosa?
Deliberate weight-loss, intense fear of fatness, endocrine changes and distorted body image.
ICD 10 FEEDD
Fear of weight gain
Emaciated (low BW- either <15% less than expected body weight or <17.5 BMI
Endocrine dysfunction- females- amenorrhoea, males- low of sexual interest or potency
Deliberate weight loss- reduced intake or increased exercise
Distorted body image
Needs to be present for 3 months, without any recurrent binge eating and craving to eat.
What is the pathophysiology of anorexia nervosa?
Multifactorial Genetics Female 10:1 Early menopause Social pressure Bullied for weight Starting diets in adolescence Perfectionism Occupation requiring a person to be slim
What are the clinical features of anorexia?
ICD criteria and:
PP SSS
Physical- hypothermia, bradycardia, fatigue, headaches, lanugo hair etc
Preoccupation with food- calorie counting, preparing elaborate meal plans, dieting
Socially isolated
Sexuality feared
Symptoms of depression and obsessions
How is anorexia nervosa investigated?
Hx-
A lot of people find their weight to be integral to their identity. Do you feel like this? (Fear of weight gain)
What would your ideal weight be? (Overvalued ideas about weight)
Some females when they lose weight find their periods stop. Has this been the case with you?
FBC (anaemia, thrombocytopenia, leukopenia), U+Es (increase urea and cre if dehydrated, low k+, po42-, Mg, Cl), LTFs (low albumin), TFTs (low T3 and T4), increased cortisol, low FSH and LH, low glucose, check amylase as pancreatitis is a recognised complication.
VBG- if vomiting metabolic alkalosis, if laxatives metabolic acidosis
DEXA scan to rule out osteoporosis
ECG- sinus bradycardia and long QT
Questionnaires- EAT eating attitudes test
What are the differentials for anorexia nervosa?
Bulimia nervosa Depression OCD Schizophrenia Diabetes, hyperthyroidism, malignancy Alcohol or substance misuse
What are the complications of anorexia nervosa?
Renal failure Renal stones Seizures Osteoporosis Iron deficiency anaemia Amenorrhoea Enlarged salivary glands Increased cortisol
Reseeding syndrome- hypoK, hypoPO4, hypoMg. HypoK- cardiac failure
To name a few
How is anorexia nervosa managed?
Risk for suicide and self harm
Aim to get weight gain of 0.5-1kg a week as an inpatient or 0.5kg per week as an outpatient.
If insight is clouded use MHA (or children Act)
Hospitalise if BMI<14 or if severe electrolyte imbalances/psychiatric (suicide) reasons.
Biopsychosocial
Biological-
Treat medical complications
If do-morbid depression then SSRIs
Psychological (for 6 months at least) CBT IPT Psychoeducation Family therapy Cognitive analytic therapy
Social-
Self help group
Voluntary organisations
Kitchen lessons
What is bulimia nervosa?
Repeated episodes of uncontrollable binge eating followed by compensatory mechanisms of weight loss and overvalued ideas of ideal weight and body image.
ICD 10 Bulimia Patients Fear Obesity
Behaviours which prevent weight gain (compensatory) I.e. self induced vomiting, XS exercise, laxatives, if diabetic may omit insulin
Preoccupation with eating- certain compulsion to eat- leads to binging
Fear of fatness
Overeating- 2 episodes per week for 3 months
What is the pathophysiology of bulimia nervosa?
Role of genetics unclear Typically in younger women Childhood obesity Physical/sexual abuse as a child Preoccupation with being slim Profession Parental obesity Early puberty Low self esteem
What are the clinical features of bulimia nervosa?
Normal weight
Low self esteem
Depression
Irregular periods
Signs of dehydration- low BP, dry mucous membranes, increased capillary refill, turgor
Consequences of repeated vomiting and hypokalaemia (k+<3.5 can lead to renal impairment, cardiac arrhythmias, muscle weakness. If mild encourage k+ foods and give Sando K, if severe requires hospitalisation and IV K+)
What are the twos types of bulimia nervosa?
Purging type- use self induced vomiting and laxatives to control weight
Non purging type- use exercise and fasting to control weight (less common)
What are the differences between anorexia and bulimia?
ANOREXIA Amenorrhoea No friends (socially alone) Obvious weight loss Restricted food intake Emaciation Xerostomia Irrational fear of weight gain Abnormal hair growth (lanugo)
BULIMIA Binge eating Use of drugs to lose weight Low potassium Irregular periods Mood disturbances Irrational fear of weight gain Alternating periods of starvation
How is bulimia nervosa investigated?
Hx
Do you ever feel yourself eating out of control? (Binge)
Have you ever used medication to control your weight? (Self induced purging)
After eating have you ever made yourself vomit to lose weight?
Do you ever get muscle aches? A sense your heart is beating abnormally fast? (Hypokalaemia)
FBC, U+Es, TFTs, amylase, glucose, lipids, Mg, PO4, K+
VBG- metabolic alkalosis
ECG- arrhythmias from hypoK
What are the differentials for bulimia nervosa?
Anorexia nervosa
Depression
OCD
Gastric outlets obstruction- leading to vomiting
How is bulimia nervosa managed?
Biopsychosocial
Biological-
Treat medical complications- monitor electrolytes
Trial high dose antidepressants to stop purging and binging (fluoxetine 60mg)
Psychological-
Psychoeducation
CBT-BN (specific)
IPT
Social- Food diary Techniques to avoid binging (eat in company, distraction) Small regular meals Self help programmes
Risk assessment for suicide and self harm
Hospitalise if severe electrolyte imbalance or suicide risk
Usually have good insight so no need for MHA
50% make a complete recovery
