Eating Disorders Flashcards
What is the prevalence of anorexia nervosa?
10-30 per 100,000
What is the prevalence of bulimia nervosa?
50-150 per 100,000
What are the two subtypes of anorexia nervosa?
Restrictive type
Binge eating/ purging type
What is the ICD10 diagnostic criteria for anorexia nervosa?
- refusal to maintain or achieve normal body weight BMI < 17.5
- intense fear of gaining weight or becoming fat
- body shape disturbance
- undue influence of weight and shape on self evaluation
- amenorrhoea (although can still have periods with low BMI)
What are some purging behaviours?
Self induced vomiting (after binges or small amounts of food) Laxatives Diuretics Slimming aids/ fat blockers Amphetamine like drugs
What are some typical rules associated with anorexia nervosa?
Calorie limitation - may start at 1500 then repeatedly revised down
Food groups avoided
Rules around eating e.g less than others, never eat if others don’t, exact times or not at all, not in-front of others
What is the ICD 10 criteria for bulimia nervosa?
A. Recurrent episodes of overeating (binges)
B. Persistent preoccupation with eating and a strong desire to eat (cravings)
C. The patient attempts to counteract the fattening effects of food by compensatory behaviours
D. A self perception of being too fat, with an intrusive dread of fatness (usually leading to underweight)
What are the two types of bulimia nervosa?
Purging type
Non- purging type
What are the compensatory mechanisms associated with purging in BN?
Self induced vomiting and laxative abuse are most common
What are the compensatory mechanisms associated with non purging type of BN?
Exercise
Fasting
What’s so different about a binge?
Subjective loss of control Large amounts, typically calorie laden, “forbidden” foods I just can’t stop Associated guilt afterwards Secretive Alone Hiding the event
Is it true that if you have bulimia you must vomit?
No - there is non purging type
If you binge and vomiting you must have bulimia. True or false?
False - may have binge purge anorexia nervosa
What clinical signs are associated with anorexia nervosa?
Reduced BMI
Bradycardia
Hypotension
Enlarged salivary glands
What physiological abnormalities are associated with anorexia nervosa?
Hypokalaemia Low FSH, LH, oestrogens and testosterone Raised cortisol and growth hormone Impaired glucose tolerance Hypercholesterolasmia Hypercarotinaemia Low T3
What cardiovascular complications can occur due to anorexia?
Myocardial thinning Bradycardia Hypotension Arrhythmias Cardiomyopathy Mitral prolapse HF
What electrolyte complications can occur due to anorexia nervosa?
Low K, Sodium, calcium, phosphate, zinc, thiamine, magnesium
What GI, liver and endocrine complications can occur due to anorexia?
GI: delayed gut motility/ gastric emptying, constipation, Mallory weis tears
Liver: fatty liver/ hepatitis, liver failure - refeeding risk
Endocrine : amenorrhea, sick euthyroid syndrome - low T4 and normal TSH
What skeletal and blood complications can occur due to anorexia?
Osteopenia
Bone marrow suppression - low Hb, WCC and platelets
At what BMI is mortality a risk ?
Less than 13
When is the most dangerous time for patients with anorexia?
Rapid refeeding
What type of patients are at greatest risk during refeeding?
Very low weight, malnourished patients
What type of refeeding is most risky?
High carbohydrate refeeding
What happens during refeeding syndrome?
As the body rushes to rebuild itself it quickly runs out of trace elements/ vitamins - the deficiency of phosphate, K, and magnesium are most dangerous and can be fatal
