Eating Disorders Flashcards
What is anoreixa nervosa
Restriction of food intake + Compulsive compensatory behaviour + BMI <17.5 or 15% below ideal weight + Low self target weight + Fear of weight gain +
Used to need widespread endocrine disorder but no longer part of criteria
- Amenorrhoea in F
- Loss of sexual interest in M
What are compensatory behaviours in anorexia
Self-induced vomiting
Laxative / diuretics / appetite suppressant
Excessive exercise
What are other symptoms of anorexia
Absence of menstrual cycle Late menarche Absence of 2 sexual characterisitcs Delayed puberty Short stature Languo hair growth Cold intolerance Blue hands and feet Low BP Bradycardia Fainting Bloating / constipation Dry. skin Early satiety Enlarged salivary glands Weakness Fatique Hypothyroid Osteopenia / osteoporosis - bone density scan
What causes Brady and low BP
Heart slows and peripherally shut down
What do you do due to risk of osteoporosis
Bone density scan
What is it called if normal BMI but anorexic symptoms
Bulimia + anorexic drive
What is it called if low BMI but bulimic symptoms
Anorexia + bulimia sub type
What is atypical anorexia
Don’t meet full criteria
Are symptoms reversible
Yes with good nutrition
What questionnaire
SCOFF
How do you assess
Nutrition
BMI
Bloods - electrolytes
What are physiological consequences
Hypokalaemia - risk of arrhythmia Low FSH and LH Low oestrogen and testosterone Hypothyroid Hypothermia Raised cortisol Raised GH Raised glucose/ imapired Raised cholesterol / carton
Summarisie physioogical
Most low
G+C up - glucose / GH / glands / cortisol / cholesterol
If someone presents to ED what may they have
Hypokalaemia
Do ECG
ABG - alkalosis + low Cl due to vomit
- Can cause palpitation
What is Bulimia Nervosa
Episodes of binge eating with a sense of loss of control +
Compensatory behaviour / purging
2x a week for 3 months
What are compensatory measures
Vomiting Laxatives Diuretics Metformin Thyroxine as increase HR Aphetamine - appetite suppressant and increase HR Refusing insulin Exercise Fasting / strict diet
What is it called when refusing insulin
Dibulimia
What are dibulimics at risk of
Early diabetic complications
What do people with Bulimia often have
Normal BMI
What are other symptoms of bulimia
Mouth sores Pharyngeal trauma Dental Heartburn Oesophageal rupture Red knuckes = Russel signs Muscle cramps Weakness Bloody diarrhoea Irregular period / amenorrhoea despite normal BMI Swollen salivary gland Impulsivity Akalosis on bloods Hypokalaemia
Dx of swollen salivary
Mumps
What is binge eating disorder
Binge eating
Absence of burning
Ongoing and repetitive
What is eating behaviour associated with binge
Fasting eating alone
Large amounts
Uncomfortably full
Get buzz then shame
How do you treat binge
Outpatient CBT / group
Psychoeducation
What is symptomatic Rx
PPI / H2
Laxative
What other behaviour associated with eating disorder apart from avoid calories and getting rid
Body checking Pro-ana website Compete lower target Self harm Personality disorder OCD Anxiety
What are physical consequences
Biochemical disruption K = important Seizures / arrythmia Malnutrition Hypoglycaemia Heart damage Fertility Anaemia Bone loss Poor immune Puberty delayed Brain growth delayed Suicide
What is patient at risk of with Rx
Refeeding Sx
What are psychological consequences
Over-valuation Narrow interest Depression Anxiety OCD Poor concentration
Social consequences
Wtihdrawal
Isolation
What causes / precipitates
Genetic predisposition Personality - high achieving / OCD / anxious Biological - altered 5HT Puberty Diet Increased exercise Stesss Social pressure
What perpetuates
Delayed gastric emptying so feel full and think fat
Narrowing focus
High obsession
High EE
How do you treat bulimia
REFER
CPT / IPT / family = 1st line
SSRI - Fluoxetine for obsessional thoughts
What is important to do
Monitor electrolyte
K supplement
How do you treat anorexia
Family = 1st line in<21 CBT / IPT = 1st line in adult Nutritional supplements - vit B / thiamine / calcichew Be careful of re-feeding Daily blood + ECG monitoring
What psychiatric meds
Anti-Depressant if low mood - SSRI
Olanzaprine to reduce anxiety and obsession - stimulate appetite and weight gain