Eating Disorders

Question 1

DSMV Anorexia

Answer 1

A. Restriction of energy leading to significantly low body weight
B. Intense fear of gaining weight
C. Disturbance in the way ones weight is experienced

specify if purging or restrictive type

Question 2

DSMV Bulimia

Answer 2

A. Recurrent binge eating (time, amount, control)
B. Recurrent inappropriate compensatory behaviour
C. 1/week for 3 months
D. Self evaluation
E. Exclude anorexia nervosa

Question 3

RF Anorexia

Answer 3

Family History (restrictive dieting, eating disorder)

Personal history ( childhood obesity, depression, substance abuse, OCD, social anxiety)

Personal characteristics (perfectionist, low self esteem, female, occupation)

Question 4

Comorbidities AN

Answer 4

1. Mod disorders
2. Anxiety disorders (PTSD, OCD, panic)
3. SAD
4. Everything else

Question 5

Physical Indications for admission

Answer 5

Adult;

• BMI < 14, rapid weight loss
• HR < 40 min, BP <90/60
• postural drop > 20mmHg
• temp < 36

Children

• rapid weight loss
• HR < 50
• BP < 80/50

General; (HELP)

1. Hypoglycaemia
2. Electrolyte imbalance
3. Lack of proximal muscle
4. Petichial rash

Question 6

Psychiatric reasons for admission (AN)

Answer 6

1. Suicidal plan
2. Anorexic cognitions
3. Other psych disorders
4. Non-sompliance with eating
5. Compulsive uncontrolled weight control ; purging, exercise
6. Severe family problems
7. treatment available only in hospital

Question 7

What are the signs of AN?

Answer 7

General inspection; emaciated, conscious state (stupor)

Vitals: postural drop, temp, bradycardia, arrhythmia (all indicate autonomic dysfunction)

Hands; russels sign, lanugo, pallor

Face/ mouth; parotid enlargement, dentition

chest; breast atrophy, systolic flow murmur

Periphery; shutdown, myopathy, edema, neuropathy

Risk; scars/ cuts

Question 8

Important Ix for AN

Answer 8

1. ECG; hypokalaemia = wide U waves, QTC 450
2. UEC
3. LFTs
4. FBE
5. Endocrine; LH, FSH, fasting GH, TFTs

Question 9

What are the complications of management? Pathophysiology.

Answer 9

Refeeding Syndrome;

• Starvation = Low CHO intake = low insulin, hence fat catabolism predominates creating more FFA and ketones cf glucose
• Starvation = depletion K, Mg, PO4 bosy stores (although serum levels maintained)
• Reffeding = CHO metabolism = insulin increase = electrolytes into cells = falls in serum concentration
• Occurs within 3-4 days of refeeding.
• COmplications;
  1. Acute cardiac failure
  2. Respiratory failure
  3. Wernickes encephalopathy
  4. Sepsis
  5. ARF