Eating disorders Flashcards
what are the ICD-10 diagnostic criteria for anorexia nervosa
BMI = 17.5 self induced weight loss (strict dieting, vomiting, excessive exercise, medication) body image disturbance fear of fatness amenorrhoea
what can be seen on physical exam in AN
muscle wasting hair loss lanugo hair cold, blue peripheries dry skin hypercarotenaemia (yellowing of skin) bradycardia hypotension bruising
what might be found on psychological assessment of AN
depression
OCD
substance missuse
diabetes mellitus
what features means a patient with AN is high risk
BMI <13 weight loss >1kg per week prolonged QT HR < 40 systolic BP <80 core temp <34 unable to rise from squat without using arms for leverage cognitive impairment
what is the sit up squat stand test
sit up: patient lies on the floor and sits up without using hands if possible
squat stand: patient squats down and rises without using hands if possible
0= unable 1= able only using hands to help 2= able with noticeable difficulty 3= able with no difficulty
what investigations for AN
haematology (GGT, ALT, protein, albumin)
biochemistry
ECG
DXA
what systems can be affected by AN
cardio GI renal endo MSK dental skin and hair metabolic
what blood results are seen in AN
albumin 34 (low) GGT 485 (high) ALT 442 (high) protein (high)
what is refeeding syndrome
heart failure caused by eating after prolonged starvation -depletion of already inadequate stores of nutrients e.g. magnesium, potassium, phosphate which are quickly used up as body starts to repair itself
how is refeeding syndrome prevented
frequent blood monitoring and slow pace of initial refeeding
what blood results are seen in refeeding syndrome
ALT 208 -high albumin 27- low phosphate 0.66 (low) magnesium 0.68 (low) Hb 96 (low)
what is marsipan
used for the management of v sick AN patients
aims to reduce mortality of starved patients admitted to wards
what is involved in the psychological management of AN
pyschological therapies- Cognitive behavioural therapies medical monitoring art/ drama therapy family therapy admission if high risk
what are the diagnostic criteria for bulimia nervosa
persistent preoccupation with eating irresistible craving for food binges attempts to counter the effects of binges (starvation, vomiting, laxatives, drug misuse) morbid dread of fatness
what might be seen on physical exam in BN
calluses on knuckles (russells sign)
parotid hypertrophy
dental caries
abnormal U&Es
