Eating Disorders Flashcards
What are the ICD-10 diagnosis criteria for AN?
Fear of weight gain
Endocrine resulting in amenorrhoea, loss of sexual interest F and potency M
Emaciated: >15% below expected weight or BMI<17.5
Deliberate weight loss with low food or high exercise
Distorted body image
*for 3m with absence of recurrent episodes of binge eating, preoccupation with eating/ craving to eat
What is Anorexia Nervosa?
an eating disorder characterised by deliberate weight loss, intense fear of fatness, distorted body image and endocrine disturbances
What are some potential causes of AN?
- predisposing : genetics, FHx, sexual abuse, low self esteem, anapaestic personality, western pressures, bullying, stressful life events
- precipitating : adolescence, puberty, criticism, occupation
- perpetuating : starvation causing neuroendocrine changes, perfectionism, occupation, western society
What is the epidemiology of AN?
lifetime prevalence between 2-4%
more women (10 times more)
peak age onset - mid-adolescence
How does anorexia differ from bulimia?
- significantly more underweight
- more likely to have endocrine like amenorrhoea
- no strong food cravings
- no binge eating
- compensatory weight loss behaviour (NOT purging)
How might you investigate AN?
FBC - normocytic, normochromic anaemia, low WCC, platelets
U&E - low K+ due to vomiting, low Na+ and K+ from laxatives, low phosphate and magnesium
LFT - loss of proteins
lipids - hypercholestrolaemia
hormones - LH, FSH, Oestridiol TFT, cortisol
glucose - impaired tolerance as high
VBG
DEXA - from ED team
ECG - CVS abn. if low electrolytes
What are some complications of AN?
metabolic: hypokalaemia, hypoglycaemia, hyperchol.
endocrine: high cortisol, low TFT, low sex hormones
CVS: cardiac failure, arrhythmia, bradycardia
renal: failure, stones
neuro: seizures
haematology: iron def. anaemia
How might AN be managed?
risk assessment is vital
psychological treatment 6m (CBT-ED, family therapy, MANTRA)
aim for controlled weight gain
refeeding syndrome risk
hospitalisation if BMI<14 and psychiatric
medications for complications and depression
self help groups etc
What is refeeding syndrome?
results from food intake after prolonged starvation or malnourishment, caused by increased insulin release leading to phosphate, magnesium and potassium to move into cells, causing low levels in blood
*phosphate depletion causes reduction in cardiac activity leading to failure
** prevent by starting at 1200kcal/day then increasing every 5 days monitoring for oedema or tachycardia
What is Bulimia nervosa?
repeated episodes of uncontrollable binge eating followed by compensatory weight loss behaviours and overvalued ideas regarding ideal body shape/weight
Describe the vicious cycle of BN?
pt with BN due to strong cravings, feel guilty and undergo compensatory behaviours like purging, laxatives, exercising.
*leads to large weight fluctuations, reinforcing of the behaviours
What is the epidemiology of BN?
- young women
- equal socioeconomic
- think this in men too!
What are the risk factors for BN?
FH, substance misuse, childhood obesity, abuse, parental obesity, bullying, profession
What other co-morbid psychiatric conditions may they have?
depression
anxiety
deliberate self harm
substance misuse
EUPD
What are the ICD-10 criteria for BN?
- behaviours to prevent weight gain: purging, starvation, laxatives, diabetics omiting insulin
- preoccupation with eating
- fear of fatness
- over-eating
*weight maybe normal
What are some complications which maybe seen O/E in BN?
Russell sign from inducing
BL parotid swelling
dental erosion
What are the subtypes of BN?
purging type
non-purging type : exercise and starving post binge
How does BN differ from AN?
normal weight or overweight
less endocrine
strong food cravings
recurrent binging
compensatory behaviours definitely
What are some complications of the purging?
mallory weiss tears
dehydration
dental erosions
amenorrhoea
aspiration pneumonitis
hypokalaemia
How might BN be managed?
- antidepressants, treat complications, treat co-morbids
- psychoeducation, interpersonal psychotherapy
- food diary, self help
- risk assessment
- 50% fully recover compared to 20% in AN
What signs might a GP see in a suspected case of ED?
- Alopecia
- Lanugo hair
- Emaciation
- Russel’s sign
- Swollen parotids
- Dental erosion
- Bradycardia around 40bpm
- Postural hypotension
- Muscle weakness shown by sit ups, squad stand test
- Dependent oedema
What are some differentials for significant weight loss?
Intentional weight loss (disorder/deliberate)
Depression
Physical health - IBD, coeliac, malignancy, hyperthyroidism, infection
