Eating disorders Flashcards
Suggest possible aetiological factors for AN
- genetic factors
- neurobiological factors - disorder of endogenous reward system
- psychiatric factors - associated with OCD, anxiety disorders and mood disorders
- psychosocial factors
- trauma
- high-pressure careers and sports (e.g. modeling, ballet…)
- unrealistic standards of beauty
Suggest risk factors for AN
- female gender (10:1)
- age/onset of puberty
- Western society
- FHx of eating disorder, depression or substance abuse
- premorbid experiences - sexual abuse, dieting behaviour within family, premorbid obesity
- occupational or recreational pressure to be slim (e.g. dancers, gymnasts…_
- personal characteristics e.g. perfectionism, low self-esteem, EUPD
describe the clinical features of AN
- maintained body weight <15% expected, i.e. BMI <17.5
- body image distortion and dread of fatness
- weight loss behaviours inc.
- excessive dieting, exercise or fasting
- vomiting, diuretic and laxative abuse
- secondary endocrine and metabolic changes e.g. amenorrhoea in women, loss of libido in men, delayed/arrested growth if prepubertal
explain why AN can cause amenorrhoea
Suppression of hypothalamic-pituitary-gonadal axis (hypogonadotropic hypogonadism):
Decreased body mass/adipose tissue… decreased leptin and kisspeptin… cannot stimulate pulsatile release of GnRH from hypothalamus… decreased FSH/LH and thus decreased oestrogen (and testosterone)… amenorrhoea.
describe the hormonal changes seen in AN
- decreased FSH/LH and oestrogen/testosterone
- increased stress hormones: cortisol and adrenaline
- euthyroid sick syndrome: low T3, normal/low TSH
what should examination of a person with AN include?
- height, weight and BMI
- core temperature (<35 high risk)
- HR (<40 bpm high risk)
- BP sitting/standing (sBP <90, dBP <70, postural drop >10 high risk)
- peripheral examination for circulation and oedema
- test of power (sit up test, squat test)
- ECG
- bloods
what are the possible ECG findings in a person with AN?
Bradycardia, prolonged QTc, T wave changes
describe possible electrolyte abnormalities seen in AN
- hypokalaemia (risk of arrhythmias)
- hyponatraemia
- hypophophataemia
- hypoalbuminaemia
- increased bicarbonate (metabolic alkalosis)
describe possible management strategies for AN
- Psychotherapy (1st line)
- individual eating-disorder focused CBT
- AN-focused family therapy (in under 18s) - Nutritional support: monitor weight gain and provide support, usually through oral intake or hospitalisation if necessary
suggest possible indications for hospitalisation in an AN patient
- BMI <15
- unstable vital signs: hypothermia (<35), bradycardia (<40 bpm), hypotension
- acute medical complications e.g. seizures, liver failure, pancreatitis
- arrythmias
- hypoglycaemia
- electrolyte disturbances, marked dehydration
- severe refeeding syndrome
what is refeeding syndrome?
Rapid increase in daily food intake (increased blood glucose) after period of starvation can cause massive insulin release… displacement of magnesium, potassium and phosphate from extracellular to intracellular space… abrupt serum hypokalaemia.
Features: oedema, tachycardia (torsades de pointes), seizures, ataxia, rhabdomyolysis.
