Eating Disorders

Question 1

How is anorexia nervous a characterised?

Answer 1

Deliberate weight loss, an intense fear of gaining weight, distorted body image, and endocrine disturbances

Question 2

When is typical age of onset for anorexia nervosa?

Answer 2

Mid-adolescence

Question 3

What are the defining clinical features of AN? (FEEDD)

Answer 3

Fear of gaining weight
Endocrine disturbances
Emaciated (abnormally low weight BMI<17.5)
Deliberate weight loss (with increased exercise/decreased intake)
Distorted body image

Question 4

What are some other features of anorexia not mentioned in ICD-10?

Answer 4

Physical: fatigue, hypothermia, bradycardia, arrhythmia, lanugo hair
Preoccupation with food
Socially isolated
Symptoms of depression and obsession

Question 5

How can you differentiate between bulimia and anorexia nervosa in an OSCE situation?

Answer 5

Anorexia: significantly underweight, endocrine dysfunction like amenorrhoea, do not binge eat, may have compensatory weight loss behaviours (excluding purging) e.g cold exposure
Bulimia: normal weight/overweight, strong cravings for food, recurrent episodes of binge eating, compensatory weight loss behaviours

Question 6

What blood tests would you carry out for suspected/confirmed anorexia nervosa?

Answer 6

FBC (anaemia, thrombocytopenia, leukopenia)
U+Es (high urea if dehydrated, decreased electrolytes of potassium,magnesium, phosphate and chloride)
LFTs (low albumin)
lipids (high cholesterol)
cortisol (high)
sex hormones (low LH, FSH, oestrogen and progesterone)
glucose (low)
amylase (pancreatitis is a complication)

VBG- metabolic alkalosis (vomiting), metabolic acidosis (laxatives)

Question 7

What other investigations other than bloods can be done for suspected/confirmed anorexia?

Answer 7

DEXA scan, ECG as bradycardia and long QT associated, EAT questionnaire

Question 8

What are some of the metabolic complications of anorexia nervosa?

Answer 8

Hypokalaemia, hypercholesterolaemia, hypoglycaemia, low phosphate/magnesium/chloride, low albumin

Question 9

What are some of the endocrine complications of anorexia nervosa?

Answer 9

Increased cortisol, growth hormone
Decreased T3 and T4, LH, FSH, oestrogen and progesterone leading to amenorrhoea and low testosterone in men.

Question 10

What are some of the GI complications of anorexia nervosa?

Answer 10

Enlarged salivary glands, pancreatitis, constipation, peptic ulcers and hepatitis

Question 11

What are some of the cardiac complications of anorexia nervosa?

Answer 11

Cardiac failure, ECG abnormalities, arrhythmias, low BP, bradycardia, peripheral oedema

Question 12

What are some of the neurological complications of anorexia nervosa?

Answer 12

Seizures, peripheral neuropathy and autonomic dysfunction

Question 13

What are some of the haematological complications of anorexia nervosa?

Answer 13

Iron deficiency anaemia, thrombocytopenia and leukopenia

Question 14

Other complications of AN?

Answer 14

Hypothermia, dry skin, brittle nails, lanugo hair, infections

Question 15

What is the treatment for anorexia nervosa?

Answer 15

Bio- treat medical complications and SSRI for co-morbid depression/OCD
Psycho- psychoeducation, CBT, interpersonal therapy, family therapy
Social- self help groups

Question 16

What is refeeding syndrome?

Answer 16

A life threatening syndrome that occurs from food intake following prolonged starvation/malnourishment. It occurs as a results of an insulin surge that causes changes in phosphate, magnesium and potassium

Question 17

What is bulimia nervosa?

Answer 17

An eating disorder characterised by repeated episodes of uncontrolled binge eating followed by compensatory weight loss behaviours and overvalued ideas regarding ideal body shape/weight

Question 18

What are the ICD-10 criteria for bulimia diagnosis? (BPFO- bulimia patients fear obesity)

Answer 18

B- behaviours to prevent weight gain (vomiting, starvation, drugs excessive exercise)
P- preoccupation with eating (compulsion to eat, binge followed by shame)
F- fear of fatness/gaining weight
O- overeating (at least 2 episodes per week over 3 months)

Question 19

What are some complications of repeated vomiting in bulimia?

Answer 19

Arrhythmias from hypokalaemia, Mallory Weiss tears, enlargement of salivary glands (parotid), tooth erosion, Russell’s sign, aspiration pneumonitis

Question 20

What is the management of bulimia nervosa?

Answer 20

Biological: trial antidepressant to help reduce frequency of binge eating. Treat medical complications, monitor electrolytes
Psycho: psychoeducation, CBT, interpersonal psychotherapy
Social: food diary, techniques to avoid bingeing, small regular meals