Eating disorders

Question 1

List the main eating disorder diagnoses

Answer 1

anorexia nervosa
bulimia nervosa
binge eating disorder
avoidant restrictive food intake disorder
pica
rumination-regurgitation disorder

Question 2

Personality features of those who develop eating disorders

Answer 2

anxious
low self-esteem
perfectionism
rigidity

Question 3

Describe anorexia nervosa

Answer 3

restriction of food intake or persistent behaviour which interferes with weight gain which leads to low body weight
associated with body image disturbance + intense fear of gaining weight

Question 4

Describe bulimia nervosa

Answer 4

recurrent (at least once per week for 3 months) episodes of uncontrolled eating of an abnormally large amount of food over a short time (binge eating) followed by compensatory behaviour eg. self-induced vomiting, laxative abuse or excessive exercise)

Question 5

Describe binge eating disorder

Answer 5

recurrent episodes of binge eating in the absence of compensatory behaviours
episodes marked by feelings of lack of control

Question 6

Describe atypical eating disorders

Answer 6

(OSFED)
symptoms of an eating disorder such as anorexia or bulimia which do not meet the precise diagnostic criteria
eg. anorexia sx, significant weight loss, but person’s weight within or above normal range

Question 7

Describe ARFID

Answer 7

feeding disturbance manifested by failure to meet nutritional needs with significant weight loss, significant nutritional deficiency, dependence on enteral feeding or marked interference with psychosocial functioning

Question 8

Describe pica

Answer 8

consumption of non-food substances/objects or materials

Question 9

Describe rumination-regurgitation syndrome

Answer 9

intentional repeated bringing up of previously swallowed food back to mouth which may be re-chewed and re-swallowed or spat out (not vomiting)

Question 10

Describe disordered eating

Answer 10

umbrella term covering lots of eating behaviours and difficulties that do not meet diagnostic criteria for an eating disorder

Question 11

Leptin levels in patients with anorexia

Answer 11

leptin inhibits appetite
leptin levels low in patients with anorexia
leptin levels rise during weight restoration

Question 12

Ghrelin levels in patients with anorexia

Answer 12

ghrelin produced by stomach and increases appetite
elevated in anorexia
thought to be a compensatory mechanism to stimulate food intake and weight gain

Question 13

Assessment and history of eating disorders

Answer 13

social and family history
screen for co-morbid mental and physical health conditions
screen for complications - fatigue, reflux, constipation, hair loss, amenorrhoea, dental problems

Question 14

What is MEED?

Answer 14

medical emergencies in eating disorders
guidance document
focusses on need to monitor and avoid refeeding syndrome but feed enough to avoid underfeeding

Question 15

Reasons behind medical complications in eating disorders

Answer 15

starvation on body
fluid and electrolyte disturbance
local damage secondary to ED behaviour
endocrine changes
liver function changes
refeeding

Question 16

A&E presentations of eating disorders

Answer 16

syncope
sports injuries
fractures
palpitations, chest pain, cardiac arrest
abdominal pain
atypical infections/sepsis
self-harm
substance misuse
DKA - diabulimia

Question 17

What is diabulimia?

Answer 17

patients with T1DM reduce or stop insulin to lose weight

Question 18

Body’s response to starvation

Answer 18

low metabolic state
first glycogen is depleted (hence risk of hypoglycaemia in refeeding due to insulin production)
then fat is metabolised (ketogenesis)
in prolonged starvation proteins are catabolised resulting in organ dysfunction

Question 19

Effects of self-induced vomiting and laxative abuse

Answer 19

low potassium
dental erosion
swollen parotids (due to excess saliva production)
trauma to mouth/oesophagus
conjunctival haemorrhage
impact on large bowel - water + electrolyte loss
dehydration
abdominal cramos
rebound constipation/pseudo-obstruction

Question 20

Presentation of low potassium

Answer 20

muscle weakness
cramps and aches
ECG abnormalities (flattened T waves, U waves, QTc prolongation)
cardiac arrhythmias (palpitations, chest pain, SOB, collapse)

Question 21

Physiology of refeeding syndrome

Answer 21

in starvation state - endogenous energy stores are catabolised, decreased insulin production, low electrolytes especially phosphate, potassium and magnesium

on refeeding, insulin production increases in response to carbohydrate intake
stimulates electrolyte uptake into cells leading to further decrease in already low serum electrolytes
results in peripheral oedema
phosphate can drop v low (<0.5 needs urgent attention to prevent multiorgan failure, coma and death)

Question 22

When is risk of refeeding syndrome higher

Answer 22

BMI<12
weight loss>1kg/week
alcohol misuse
binging and purging
comorbid physical illness

Question 23

Symptoms/signs of refeeding syndrome

Answer 23

low phosphate = muscle weakness, SOB, double vision, swallowing problems, seizures, coma, cardiomyopathy

low magnesium = nausea + vomiting, anorexia, tremors, muscle spasms, seizures, coma, cardiac ischaemia, arrhythmia

low potassium = muscle weakness, cramps, fatigue, constipation, arrhythmia, resp failure

thiamine deficiency = delirium, vision problems, hypothermia, ataxia, amnesia, confabulation

Question 24

Physical risk assessment of eating disorder patients

Answer 24

weight/BMI (note: can be falsified)
temperature
rate of weight loss
BP and pulse (sitting and standing)
blood glucose
bloods - U+E, FBC, LFT, Mg, phosphate, bone group)
ECG
squat test