Eating Disorders

Question 1

What are the ddx for weight loss?

Answer 1

1. organic: hyperthyroid, GI disease e.g. coeliac disease, diabetes, medication SE, cancer (more likely if older), Addison’s Disease, inflammatory conditions, AIDS.
2. loss of appetite: depression (unlikely to deny weight loss)
3. food restriction: psychosis- food “poisoned”
4. Body Dysmorphic Diorder- deliberate weight loss is unusal
5. Bulimia Nervosa: if binge and vomit predominant behav and pt is not underwt
6. Anorexia Nervosa: deliberate restriction of food intake, obsession with food and weight loss and concern about becoming/being fat

Question 2

What is the ICD criteria for Anorexia Nervosa?

Answer 2

• BMI <17.5
• Persistent deliberate restriction of energy intake leading to significantly low body weight- this threshold is imposed by pt. Methods include: restricted dietary choice, excessive exercise, induced vomiting and purgation, and use of appetite suppressants and diuretics.
• Intrusive overvalued idea: Either an intense fear of gaining weight or that they are fat, or persistent behaviour that interferes with weight gain
• Disturbance in the way one’s body weight or shape and weight on self-evaluation, or persistent lack of recognition of the seriousness of current low body weight
• There is usually undernutrition of varying severity with secondary endocrine and metabolic changes and disturbances of bodily function. Endocrine- HPG axis affected leading to amenorrhea/ impotence. Libido is also lost. If AN starts pre-puberty menarche and breast development are delayed/ stopped.

Question 3

What is the ICD criteria for Bulimia

Answer 3

Repeated bouts of overeating “bingeing” w/ a sense that they lack control during an eating episode and an excessive preoccupation with the control of body weight, leading to a pattern of overeating followed by vomiting or use of laxative/diuretics/ excess exercise. This is known as “compensatory behaviour”.
This disorder shares many psychological features with anorexia nervosa, including an overconcern with body shape and weight. Self evaluation is centered on body shape and wt
On average this occurs at least 1x per week for at least 3m.
- Repeated vomiting is likely to give rise to disturbances of body electrolytes and physical complications.

Question 4

What are the examination findings in Anorexia Nervosa ie of Malnutrition?

Answer 4

General: emaciation, dry skin, brittle hair, fine lanugo hair over face etc, reduced sexual maturation, blue/ cold extremities, oedema, anaemia, low SaO2, hypothermia
CVD: brady, low BP/ postural drop, peripheral oedema
GI: tender abdo
MSK: muscle wasting- general/ proximal, short stature (young onset), previous/ current #
Metabolic: hypercholesterol, hypercarotenaemia- yellow skin tinge (soles/palms)
Neurol: peripheral neuropathy

Question 5

What are common co-morbidities for Eating Disorders?

Answer 5

self harm, depression, anxiety, OCD

Question 6

What are the examination findings of those who purge/ vomit/ binge?

Answer 6

General: Russell’s sign- calluses/ cuts on knuckles from self- induced vomiting, swollen salivary glands (swollen face), oedema
CVD: arrhythmias
GI: tender abdo, erosion of dental enamel, caries
Metabolic: hypercholesterol, hypercarotenaemia- yellow skin tinge (soles/palms)
Neurol: peripheral neuropathy

Question 7

What is the epidemiology of Anorexia Nervosa, Bulimia Nervosa?

Answer 7

AN- 0.6%

BN- 1.0%

Question 8

What are the social and psychiatric consequences of Eating Disorders?

Answer 8

social: withdrawl and possible exclusion due to difficulty eating with others and preoccupation with food and loss of interest in other things
psychiatric: depression , irritable mood,

Question 9

What is refeeding syndrome?

Answer 9

The potentially fatal shifts in fluids and electrolytes that may occur in malnourished patients (Anorexia Nervosa, Chronic Alcoholism) receiving artificial refeeding (whether enterally or parenterally). These shifts result from hormonal and metabolic changes. The hallmark biochemical feature of refeeding syndrome is hypophosphataemia (even if P is contained in feed given). However, the syndrome is complex and may also feature abnormal sodium and fluid balance; changes in glucose, protein, and fat metabolism; thiamine deficiency; hypokalaemia; and hypomagnesaemia.
The net result of metabolic and hormonal changes in early starvation is the body switches from using carbohydrate to using fat and protein as it’s main source of energy, and the basal metabolic rate decreases by as much as 20-25%

increased risk of CVD complications