Eating disorders Flashcards
What is Russel’s sign?
A sign of anorexia/bulimia nervosa
Calluses on the knuckles or back of the hand due to repeated self-induced vomiting over long periods of time
What mortality rate is associated with anorexia nervosa?
10 - 15%
Describe the diagnostic criteria for anorexia nervosa
Restriction of intake to reduce weight
Relies on compulsive compensatory behaviours when food cannot be avoided, Self-induced vomiting, laxative abuse, excessive exercise, abuse of appetite suppressants/diuretics
Considered anorexic if he/she is 15% below ideal body weight/BMI 17.5 or <
Fear of weight gain
[In postmenarchal females, absence of the menstrual cycle or amenorrhoea (greater than 3 cycles)]
Describe the diagnostic criteria for bulimia nervosa
Episodes of binge eating with a sense of loss of control
Binge eating is followed by compensatory behaviour of the purging type (self-induced vomiting, laxative abuse, diuretic abuse) or non-purging type (excessive exercise, fasting, or strict diets).
Binges and the resulting compensatory behaviour must occur a minimum of two times per week for three months
Dissatisfaction with body shape and weight
What differential diagnoses should be considered for a patient presenting with symptoms of an eating disorder?
Chronic debilitating physical disease Brain tumour GI disorder e.g. Crohn's, malabsorption Loss of appetite e.g. secondary to drugs Depression OCD Personality disorder
List the physical signs that may be found in anorexia
Loss of muscle mass Dry skin, brittle hair/nails Russel's sign (callused knuckles) Anaemia Hypercarotinaemia (yellow skin/sclera) Fine, downy lanugo body hair Eroded tooth enamel Peripheral cyanosis Hypotension, bradycardia, hypothermia Atrophy of the breasts Swelling of parotid/submandibular glands Tender abdominal distension Peripheral neuropathy
What is the most common cause of death associated with eating disorders?
Cardiac complications (7 - 10%)
What cardiac complications are associated with eating disorders?
Hypotension
Prolonged QT interval
Arrhythmias
Cardiomyopathy
What psychiatric symptoms are associated with eating disorders?
Problems with concentration/memory/decision-making Irritability Depression Low self-esteem Loss of appetite Reduced energy Insomnia Loss of libido Social withdrawal Obsessiveness regarding food
Describe the general/systemic symptoms associated with eating disorders
Amenorrhoea Cold hands and feet Weight loss Constipation Dry skin Hair loss Headaches Fainting, dizziness Lethargy
What investigations should be done for a patient presenting with a possible eating disorder?
Weight and height; calculate BMI
Assess physical signs of starvation and vomiting
Blood tests
ECG
Describe the pharmacological management options for eating disorders
Antidepressants –> Fluoxetine
May require antipsychotics –> Olanzapine
Describe the non-pharmacological management options for eating disorders
Nutritional education
CBT
Family therapy
Group therapy
Describe the potential risks associated with re-feeding
Cardiac decompensation
- excessive bloating
- oedema
- congestive heart failure (rare)
Describe the physical health problems specifically related to purging
Arrhythmias Cardiac failure Electrolyte disturbance - metabolic acidosis (laxatives) - metabolic alkalosis (vomiting) Oesophageal/gastric erosions/perforations Gastric/duodenal ulcers Pancreatitis Constipation/steatorrhoea Dental erosion Leukopenia/lymphocytosis
