Eating disorders Flashcards
What are the two types of bulimia nervosa
- purging: self induced vomiting, laxative abuse
- non purging type: exercise, fasting
What is the definition of bulimia? (4 parts)
- recurrent episodes of binge eating characterised by uncontrolled over eating
- preoccupation with control of body weight
- regular use of mechanisms to overcome the fattening effects of binges eg starvation, vomiting, laxatives of over exercise
- a self perception of being too fat, with intrusive dread of fatness
What symptoms may arise from bulimia complications?
- MW tears
- low k+
- arrhythmias
- low sodium-> convulsions
- hypercarotanaemia : yellow palms and soles
- caries
- dental erosions
- russles sign: callous/ cuts on knuckles from self induced vomiting
- often presents w/ complications as secretive behaviour
How should bulimia be managed?
- mild: support, self help books, food diary, binge analysis, regular eating
- CBT ED is effective
- SSRI (fluoxetine) are effective at improving impulse control
- if under 18 then needs immediate referral to age appropriate specialist eating disorder service- family therapy
- manage medical needs: risk of hypokalaemia, osteoporosis, dental reviews, reduce laxatives slowly
What is refeeding syndrome?
- potentially fatal condition from reduced phosphate due to rapid initiation of food after >10 days of undernutrition
How does refeeding syndrome present?
- rhabdomyolysis
- resp or cardiac failure
- hypotension
- arrhythmias
- seizures
- sudden death
- low phosphate
- high calcium
- low K+ and Mg
How should refeeding syndrome be managed?
- monitor phosphate, hyperglycaemia, hypokalaemia, hypomagnesia
- correct electrolyte imbalances
- prescribe thiamine, vit B, mutlivitamines
- best to avoid by planing slow refeeding diet, slowly increasing calories
What is the diagnostic criteria of anorexia nervosa? (4)
- weight <85% predicted (considering height, sex and ethnicity) or BMI <17.5 and refusal to maintain or achieve normal body weight
- intense fear of gaining weight or becoming fat with persistent behaviour that interferes with weight gain
- feeling fat when thin body shape disturbance
- endocrine changes (amenorrhoea, decreased libido impotence, arrested sexual development)
What is thought to cause anorexia?
Biological: genetics, serotonin dysregulation
Psychological: depression, anxiety, obsessive compulsive features, perfectionism, low self esteem
Developmental: adverse life events and difficulties, dietary/ feeding problems in early life, parents preoccupied with food
Sociocultural: substance misuse, negative body images due to media exposure, image aware activities (eg ballet), past teasing or criticism for fatness
Describe the signs of anorexia
- general: fatigue, decreased cognition, altered sleep, sensitive to cold, dizziness
- GI: delayed emptying, constipation, MW tears, pancreatitis, hepatitis, ulcers, liver failure in refeeding
- Repro: psychsexual problems, subfertile, amenorrhoea
- Haem: bone marrow surpression (pancytopenia), reduced TAG
- Endocrine: high/ low glucose, hypokalaemia, hypophosphate, increased bicarb, increased LFT, increased cortisol, decreased renal function
- skeletal: osteoporosis, osteopenia, fractures
- CVS: myocardial thinning, brady, hypotension, arrhythmias, prolonged QT
- neuro: decreased visual mem, peripheral neuropathy
- derm: dry skin, brittle hair
Describe the screening tool for anorexia
SCOFF (>2 indicates disorder)
- do you ever make yourself SICK because you feel to full?
- do you worry youve lost CONTROL overeating
- Have you recently lost more than ONE stone in 3 months
- Do you believe you are FAT when others say youre thin
- Does FOOD dominate your life?
State 8 red flags for anorexia?
- BMI <13
- Weight loss >1kg/ week
- temp >34.5
- vascular: bp <80/50, pulse <40, sats <92%, cold blue limbs
- muscles: unable to stand up without using arms
- skin: purpura
- blood: K+ <2.5, Na+ <130, phosphate <0.5
- ECG: long QT, flat T waves
How should anorexia be managed?
- admit if: BMI<13, serious physical complications, suicide risk
- nutritional management and weight restoration
- treat comorbid physcial and psych illness
- Psychotherapy: family therapy, motivational interviewing, CBT, interpersonal therapy
- pharmacological: olanzapine to stimulate appetite, fluoxetine for depression
What are clinical features of bulimia?
- binge eating (loose control of eating, often distressing)
- puring (shame and guilt, may be with laxatives, excessive exercise, self induced vomiting, fasting)
- body image distorsion and preoccupation w/ weight gain
- BMI >17.5
