Eating disorders Flashcards
List the main eating disorder diagnoses
anorexia nervosa
bulimia nervosa
binge eating disorder
avoidant restrictive food intake disorder
pica
rumination-regurgitation disorder
Personality features of those who develop eating disorders
anxious
low self-esteem
perfectionism
rigidity
Describe anorexia nervosa
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
Describe bulimia nervosa
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)
Describe binge eating disorder
recurrent episodes of binge eating in the absence of compensatory behaviours
episodes marked by feelings of lack of control
Describe atypical eating disorders
(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
Describe ARFID
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
Describe pica
consumption of non-food substances/objects or materials
Describe rumination-regurgitation syndrome
intentional repeated bringing up of previously swallowed food back to mouth which may be re-chewed and re-swallowed or spat out (not vomiting)
Describe disordered eating
umbrella term covering lots of eating behaviours and difficulties that do not meet diagnostic criteria for an eating disorder
Leptin levels in patients with anorexia
leptin inhibits appetite
leptin levels low in patients with anorexia
leptin levels rise during weight restoration
Ghrelin levels in patients with anorexia
ghrelin produced by stomach and increases appetite
elevated in anorexia
thought to be a compensatory mechanism to stimulate food intake and weight gain
Assessment and history of eating disorders
social and family history
screen for co-morbid mental and physical health conditions
screen for complications - fatigue, reflux, constipation, hair loss, amenorrhoea, dental problems
What is MEED?
medical emergencies in eating disorders
guidance document
focusses on need to monitor and avoid refeeding syndrome but feed enough to avoid underfeeding
Reasons behind medical complications in eating disorders
starvation on body
fluid and electrolyte disturbance
local damage secondary to ED behaviour
endocrine changes
liver function changes
refeeding
A&E presentations of eating disorders
syncope
sports injuries
fractures
palpitations, chest pain, cardiac arrest
abdominal pain
atypical infections/sepsis
self-harm
substance misuse
DKA - diabulimia
What is diabulimia?
patients with T1DM reduce or stop insulin to lose weight
Body’s response to starvation
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
Effects of self-induced vomiting and laxative abuse
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
Presentation of low potassium
muscle weakness
cramps and aches
ECG abnormalities (flattened T waves, U waves, QTc prolongation)
cardiac arrhythmias (palpitations, chest pain, SOB, collapse)
Physiology of refeeding syndrome
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)
When is risk of refeeding syndrome higher
BMI<12
weight loss>1kg/week
alcohol misuse
binging and purging
comorbid physical illness
Symptoms/signs of refeeding syndrome
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
Physical risk assessment of eating disorder patients
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
