Eating disorders Flashcards
what is the criteria for diagnosis anorexia nervosa according to ICD-10
BMI < 17.5 or (< 15% of expected) self induced weight loss e.g. starvation, excessive exercising, vomiting body image disturbance fear of fatness amenorrhoea
when is anorexia nervosa most commonly seen
teen girls
what is the most common cause of death in anorexia nervosa
cardiovascular complications
what are some common co-morbidities with anorexia nervosa
depression
OCD
substance misuse
diabetes
what are some s/s of anorexia nervosa
appearance - bruising, hypercarotenemia, blue cold peripheries, muscle wasting, dry skin, lanugo hair,
cognitive - reduced concentration, poor sleep, depression
bradycardia and hypotension
cold sensitivity
amenorrhoea
what is an oral complication of anorexia nervosa
dental caries
what are some cardiovascular complications of anorexia nervosa
hypotension
bradycardia
QT prolongation
what are some GI complications of anorexia nervosa
delayed gastric emptying
bloating
what are some derm complications of anorexia nervosa
dry skin
hair loss
lanugo hair
what are some neuro complications of anorexia nervosa
peripheral neuropathy
cognitive impairment
what are some endocrine complications of anorexia nervosa
HYPO - glycaemia, kalaemia, natraemia, thermia
altered TFT, osteoporosis, reduced fertility, delayed puberty, growth arrest
low risk BMI
16-17.5
moderate risk BMI
15-16
high risk BMI
13-15
very high risk BMI
< 13
what are some investigations for anorexia nervosa
haematology
biochemistry
ECG
DEXA
what is the management for high risk anorexia nervosa
immediate treatment as an inpatient
what is the general management for anorexia nervosa
education/monitoring/dietician
psychological therapy e.g. CBT, family therapy
antidepressant if comorbid illness
weight loss over what per week would be high risk
1kg
HR and SBP are indicative of high risk
HR < 40
SBP < 80
failure of what test indicates high risk
SUSS - sit up squat stand test
- patient lies on floor and sits up without using hands
- patient squats down and rises without using hands
what is the scoring system for SUSS
0 = unable 1 = able only using hands to help 2 = able with noticable dificulty 3 = able with no difficulty
what is refeeding syndrome
metabolic abnormalities that occur on feeding a person following a period of starvation - occurs when an extended period of catabolism ends with abruptly switching to carbohydrate metabolism
how can refeeding syndrome be avoided
frequent blood monitoring
slow pace of initial feeding
no more than 50% of requirements for 1st 2 days
why does refeeding syndrome occur
depletion of already inadequate stores of nutrients which are used up quickly as body starts to repair itself
what nutrient imbalances are seen in refeeding syndrome
HYPO - phosphataemia, kalaemia, magnesaemia
what may refeeding syndrome lead to
organ failure
electrolyte imbalance may predispose to TdP
according to ICD-10 what are the requirements for Bullimia Nervosa
- persistent preoccupation with food
- irresistable craving for food
- binge eats (2 times a week for at least 3 months, during binge cannot control amount of food eaten)
- attempts to counter binge e.g. exercise, drugs, starvation, vomiting
- morbid dread of fatness
in Bullimia Nervosa the BMI is typically within what range
healthy
when is Bullimia Nervosa most often seen
teen girls
what are some signs seen in Bullimia Nervosa
Russels sign
parotic hypertrophy
what is russels sign
callouses on knuckles caused by fingers being used to induce vomiting
people with Bullimia Nervosa often have comorbidities such as
depression anxiety substance misuse self harm impulsive personality
what are some oral complications seen in Bullimia Nervosa
dental caries
what are some general complications seen in Bullimia Nervosa
dehydration
hypokalaemia
subconjunctival haemorrhage
what are some cardiac abnormalities seen in Bullimia Nervosa
arrhythmia
what are some GI complications seen in Bullimia Nervosa
oesophageal erosions
oesophageal perforation
peptic ulcer
gastric perforation
what are some neuro complications seen in bullimia nervosa
seizures due to electrolyte imbalance
what is the management of Bullimia Nervosa
guided self help
CBT
SSRI - fluoxetine
what is binge eating disorder
uncontrollable binges as in bullimia but no compensatory mechanism
once per week for 3 months
what is Pica disorder
disorder associated with appetite for substances that are not nutritious e.g. hair, ice, chalk
what is EDNOS
eating disorder not otherwise specified - when patient doesnt meet criteria for BN or AN but has an eating disorder - common
