eating disorders Flashcards
1. Define Eating Disorders and their subtypes 2. Discuss clinical features of Eating Disorders in the framework of malnutrition 3. Discuss common medical complications and management issues of patients with Eating Disorders 4. Outline the risks, clinical manifestations and complications of refeeding syndome
DSM criteria for Anorexia Nervosa
refusal to maintain 85% IBW
intense fear of gaining weight
body image disturbance, or denaial of seriousness of low weight
amenorrhea for 3 months
DSM criteria for Bulemia Nervosa
recurrent binge episodes
recurrent use of inappropriate behaviors to prevent weight gain
binging and [urging occur 2x weekly for 3 months
self0evaluation unduly influenced by weight/shape
does not meet the criteria for AN
how non purging bulemics prevent weight gain
excess exercise
ways of purging in bulemia
vomiting, abusing laxatives, abusing diuretics
russells sign is:
callouses on back of hand from rubbing the skin over incisors
perimyolysis is
decalcification of back of the teeth from vomiting
facial sign of bulemia
salivary gland hypertrophy
clinical signs of anorexia
hypercarotenemia, lanugo hair
CV coplications of anorexia
brdycardia, decreased LV mass, arrythmias
causes of arrythmias in anorexia
decreased LV mass+ electrolyte imbalances+ SSRIs
GI consequences of anorexia
GERD, constipation, delayed gastric emptying, colon hypofunction
treatment for delayed gastric emtpying
metoclopramide and PPI
Walking after meals
possible jejunal feedings or gastric pacing
how to treat constipation in anorexia
increase fluid intake, fiber/stool softener, polyethylene glycol
how NOT to treat constipation in anorexia
avoid stimulant laxitives
endocrine issues with anorexia
euthyroid sick syndrome, amenorrhea, osteopenia/osteoporosis
primary marker of health in anorexia
menses
factors contributing to low bone density in AN
hypogonadism, undernutrition, low IGF levels, excessive exercise
treatment for low bone density in AN
primary restoration of health and weight
purgative that can cause
IPECAC syrup
GI consequenses of purging
esophagitism GERD, mellory-weiss tears, laxative toxicity
long term consequenses of laxative abuse
constipation, nerve damage
initial workup for eating disorder
HX, with substance abuse, sexual abuse, PTSD screenning, family dynamics, dietary habits
weighing
baseline ECG, electrolytes and CBC
treatment for eatingdisorder
prompt weight restoration (1200-1500 kCal)
weekly office visits
manage the medical complications
CBT
SSRI approved for Bulemia
Fluoxetine
SSRI approved for anorexia
NONE
admission criteria for eating disorders
HR < 40 symptomatic hypoglycemia arrythmias rapid weight loss dehydration
electrolyte involved in refeeding syndome
Phosphorus, K, Mg
sign of refeeding syndrome
tachycardia
weight gain caloric standards to prevent refeeding syndome
1200-1500 kcal/day increase by 500 kcal every 4 days
