Eating Disorders Flashcards

1
Q

What are some eating disorders?

A
  • Anorexia nervosa
  • Bulimia nervosa
  • Binge eating disorder
  • Avoidant-restrictive food intake disorder
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2
Q

What are some feeding disorders?

A
  • Pica
    • eating disorder in which people compulsively eat one or more nonfood items, such as ice, clay, paper, ash, or dirt.
  • Rumination-regurgitation disorder
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3
Q

Explain main points of the case and differential diagnosis:

21 year old female admitted to medical assessment via GP, due to concerns regarding weight

▪ Weight was 29kg in clinic (height 5ft 2inch) = BMI 11.7

▪ Returned from first year of university, no issues noted

▪ Over summer has been less sociable, less outgoing, not meeting friends nor engaging in hobbies or interests. Not sleeping well nor feeling refreshed or energised

▪ Subjectively notes a loss of appetite, food isn’t as nice. Eating to stay alive. Was a vegetarian, now vegan

▪ History of anxiety, and trialled antidepressants last year, but found counselling more helpful

A

Important

  • Past medical history of mental health
  • Vegan
  • Female and young
  • Eating to stay alive

Differentials

  • Addisons
  • Eating disorder
  • Depression
  • Anxiety
  • Thyroid
  • OCD
  • Pregnancy
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4
Q

Which people are most at risk in eating disorders?

A
  • Type 1 diabetes (T1DE) → diabulimia
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5
Q

What are the risk factors, complications, and management of eating disorders? (&symptoms and side effects)

A

Risk factors

  • Young people
  • Family history
  • Trauma
  • Stress
  • Female
  • Perfectionist

Complications

  • Refeeding syndrome
  • Malnourished
  • Osteopenia (less bone layering)/osteoporosis
  • Cardiac problems (ECG changes)
  • Mismanagement
  • Scrutiny or certainty about weight measurements
  • Compensatory behaviour
    • Purging
    • Exercising
  • Starvation

Specialist management

  • PIC line (not long as then GI tract problems)
  • NG lines → still stimulate GI tract
  • Therapy (counselling)

Symptoms and side effects

▪ Bradycardia – prolonged QTc and arrhythmia

▪ Hypothermia

▪ Hypotension

▪ Amenorrhoea

▪ BM suppression

▪ Wasting and fatigue/weakness

▪ Growth deficiency

▪ Constipation, bloating
▪ Irritable, low, cognitive issues

▪ Neuropathy
▪ Dry skin, lanugo hair
▪ Anaemia
▪ Electrolyte imbalance
▪ Renal failure/kidney stones

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6
Q

Most common eating disorders?

A
  • Binge eating disorder (most common) almost half develop bulimia or obese
  • Bulimia nervosa (common) and 50% anorexia nervosa patients may develop bulimia
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7
Q

What is the main pathology behind eating disorders (1 main one)?

A

▪ The overvaluation of shape and weight is central to most Eating Disorders (bar ARFID)

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8
Q

% of patients with eating disorders?

A

ARFID → Avoidant Restrictive Food Intake Disorder

OSFED → Other Specified Feeding and Eating Disorder

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9
Q

What is the aetiology of eating disorders?

A

Biological

  • Heritability - 70% MZ twins
  • A child is 10 times more likely to suffer from an eating disorder if they have a family history of eating disorders.
  • Between 58% and 76% of anorexia nervosa occurrences can be attributed to genetic factors.
  • Nearly 10% of patients with either anorexia or bulimia have a relative who also has an eating disorder.
  • Ongoing Genetic Studies on 5HT-2A and 5HT-1A

Psychological

  • Temperament (self esteem and hopelessness)
  • Attachment (trouble expressing emotions)
  • Early feeding issues
  • Life events
  • Stress and self esteem
  • Body concerns
  • Impulsivity and perfectionism traits

Social

  • Culture
  • Profession and influence (encourage thinness)
  • Turbulent childhood
  • Family and interpersonal relationship difficulties
  • Bullying or history of abuse
  • Social Media?
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10
Q

Explain anorexia & its impact long term

A
  • Fear of fatness/weight gain – with an overvalued idea of body, weight or controls
  • Consequently acts to prevent restoration or maintenance of ‘normal weight’, reduces intake, purges or increases expenditure
  • Results in weight loss or maintaining a low weight (BMI <18, or 5th centile for y/p) and metabolic/endocrine disruption*

*May also be considered rapid weight loss (20% TBW) with other criteria met

Long term impact

▪ Interrupts living – development, milestones, biological processes

▪ High morbidity/co-morbidity
▪ High mortality (medical complications, suicide)*
▪ *20% patients die within 20 years of diagnosis

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11
Q

Explain bulimia nervosa

A

▪ Overvalued idea of body (shape), weight (eating) and control – in this case a thin ideal, and fear of fatness

▪ Binge* represents a loss of control, very distressing

▪ Compensate – vomit, laxative, exercise, stimulants

▪ Pre occupied with food

▪ Often patients have had Anorexia Nervosa, or been obese

▪ Usually have a normal, to overweight BMI

▪ *rapid, past fullness, not hungry, disgust/guilt after

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12
Q

Explain binge eating disorder

A

▪ Like Bulimia but without the compensation behaviour
▪ Perceived lack of control
▪ Distressing
▪ Severity is linked to the overvalued idea of body, weight or control

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13
Q

Explain ARFID (avoidant restrictive food intake disorder)

A

▪ Avoid or restrict food intake, appear to have little interest in food

▪ May be related to sensory issues, or experiences of eating

▪ Outcome is weight loss, nutritional deficiency, dependence of supplements or medically supported feeding, poor physical health

▪ No overvalued idea of weight, eating or control Biological Food trauma Negative predictions

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14
Q

Explain SEED (severe enduring eating disorder)

A
  • Consistently unwell for ten years or more
  • Have already had one complete therapeutic treatment/intervention
  • Usually multiple Specialist Eating Disorder Unit (SEDU) admissions
  • Our focus shifts to maintaining weight, improving quality of life and preventing admissions
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15
Q

Explain OSFED (other specified feeding and eating disorder)

A
  • Difficulties that do not meet the diagnostic criteria of other Eating Disorders
  • But do have a significant impact on the persons life, health and functioning
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16
Q

What are physical health risks of eating disorders?

A

▪ Starvation
▪ Compensatory behaviour
▪ Scrutiny or certainty about weight measurements

▪ Re feeding
▪ Chronic – osteopenia/osteoporosis
▪ Mismanagement

17
Q

Explain BMI

A

▪ <18.5 underweight
▪ <15 Mod risk (Exit SEDU)
▪ <13.5 High risk (need admission)

▪ <12.0 Very high risk (intense Rx)

18
Q

What are physical health complications of eating disorders?

A

▪ Bradycarida – prolonged QTc and arrhythmia

▪ Hypothermia

▪ Hypotension

▪ Amenorrhoea → stopped menstruating

▪ BM suppression (blood glucose low)

▪ Wasting and fatigue/weakness

▪ Growth deficiency

▪ Constipation, bloating
▪ Irritable, low, cognitive issues

▪ Neuropathy
▪ Dry skin, lanugo hair (baby hairs - to keep you warm)
▪ Anaemia
▪ Electrolyte imbalance
▪ Renal failure/kidney stones

19
Q

What blood problems can happen in eating disorders?

A

▪ Neutropenia – risks

▪ Anaemia of chronic disease

▪ Creatinine is usually low (fluid balance)

▪ Sodium usually normal (fluid balance)

▪ U&Es usually stable, but monitoring is essential for re-feeding

▪ ALT and AST usually raised in chronic starvation

▪ Albumin low (oedema risk)

▪ Sick euthyroid
▪ Elevated cholesterol (catabolic)
▪ Sex hormones reduced

20
Q

What are some investigations in eating disorders?

A

▪ DEXA scan – gain weight is the treatment!

▪ Echocardiogram
▪ ECG
▪ SUSS (sit up stand test)

21
Q

What are complications of purging?

A

Hypokalaemia and hypochloraemia

22
Q

What are complications of laxatives?

A

If laxative use results in diarrhea, your body can become dehydrated. Diarrhea can also lead to electrolyte imbalance.

23
Q

What are complications of exercise in eating disorders?

A

Rhabdomyolysis, kidney problems, fasciculations

24
Q

What is fear driven falsification?

A

Faking the results (e.g. putting weights under wig to make them look heavier on the scales) can lead to problems

25
Q

Explain refeeding syndrome

A

▪ Very low BMI

▪ Rapid weight loss

▪ Co-morbid (alcohol)

▪ Cancer/sepsis/acute illness

▪ Those needing parenteral feeding

▪ Maintain serum electrolytes at the expense of intracellular stores

▪ When fed, your body starts to build and moves serum electrolytes intracellular, causing serum depletion – leads to multiple complications

26
Q

Explain cardiac, respiratory, neuromuscular affects from refeeding syndrome

A
27
Q

Explain the management of refeeding

A

▪ Early detection and screening! Preventable!

▪ Restrictions on oral intake
▪ B vitamin treatment
▪ High phosphate sources (e.g. milk/yoghurt)

▪ Ongoing daily checks/physical review

▪ Daily bloods > one week

28
Q

Explain SEDU (special eating disorder unit)

A
  • Due to severity and risk, medical instability/concern
  • Or outpatient treatment that has failed/severe co-morbidities
  • Recovery focused – usually for first presentation, or motivated
  • Lengthy admissions – 6-12 months
  • May involve NG feeding whilst progressing to oral
29
Q

Explain anorexia nervosa management (Biopsychosocial)

A
30
Q

Explain bulimia nervosa management (Biopsychosocial)

A
31
Q

Explain community management of eating disorders

A
  • Weekly monitoring in clinic
  • Weekly investigations – physiological, serum, ECG
  • Support and coordinate MDT/physical health referrals
  • Support and advise re occupation, driving, education etc.
32
Q

Explain recovery in eating disorders

A
  • Can be long and difficult
  • 50% fully recover
  • 30% improve
  • 20% have significant burden and remain unwell
  • If intervention is early – 60% fully recover