Eating disorders

Question 1

Anorexia diagnostic criteria

Answer 1

1. Weight loss (or in children lack of weight gain), leading to a body weight of at least 15% below the normal or expected weight for age and height
2. Weight loss is self induced
3. A self perception of being too fat with an intrusive dread of fattness
4. Widespread endocrine disorder involving the hypothalamic pituitary axis

Question 2

How does endocrine disorder in anorexia manifest

Answer 2

As amenorrhoea in women
Male as loss of sexual interest and potency
If onset is pre pubertal- sequence of pubertal events is delayed or even arrested. With recovery- puberty is often completed but menarche late

Question 3

Diagnostic criteria bulimia nervosa

Answer 3

1. Recurrent episodes of overeating (at least 2 times per week for a period of 3 months) binging
2. Persistent preoccupation with eating and cravings
3. The patient attempts to counteract fattening effects of food by- self induced vomitting, self induced purging, alternating periods of starvation, use of drugs such as appetite suppressants, thyroid preparations or diuretics
4. Self perception of being too fat, intrusive dread of fatness

Question 4

Signs of eating disorder

Answer 4

dental caries
russels sign- on hands
fatigue, decreased cognition, altered sleep

Question 5

epidemiology of anorexia and bulimia

Answer 5

most common age at presentation- 18 anorexia, 20 bulimia

anorexia- 7.7-8.2%

Question 6

Causes of anorexia

Answer 6

genetic, psychological eg depression, developmental- adverse life events and difficulties, sociocultural- substance abuse, negative body image due to media etc

Question 7

Haematologic and metabolic signs of anorexia

Answer 7

low WCC, anaemia, low platelets.
Low potassium, phosphate, increased bicarbonate, increased LFT, increased amylase, increased T3and t$, decreased TSH, low LH/oestrogen, increased GH, high cortisol, hugh CCK, decreased renal function and osteoporosis

Question 8

CV signs of anorexia

Answer 8

decreased BP, prolonged QT, arrhythmia

Question 9

Screening

Answer 9

SCOFF questionnaire

Question 10

Red flags for anorexia

Answer 10

BMI <13 or below second gentile, weight loss >1kg in 1 week. BP <80/50, pulse <40, sao2 <92%, ;imps blue and cold, muscles enable to get up without using arms for leverage, skin purport, K <2.5, Na<130, phosphate <0.5, ECG long QT, flat T waves

Question 11

Treatment of anorexia

Answer 11

Aim to restore natural balance - weight gain to BMI of 20-25
Severe anorexia- referral to eating disorder unit - re feeding is considered treatment
moderate- refer to local eating disorder service or EDU if possible
mild- focus on rebuilding trusting relationship- referral to secondary care if no change within 8 weeks
CBT, interpersonal, supportive or family therapy,

Question 12

Pharmacological therapies

Answer 12

limited evidence, mostly used for comorbid conditions
olanzapine can increase appetite (not licensed)
antidepressants used in bulimia to decrease binging and purging - fluoxetine

Question 13

Refeeding syndrome

Answer 13

potentially fatal- caused by low phosphate due to rapid initiation of food after over 10 days of undernutrition
Signs- rhabdomyolysis, respect or cariac failure, decreased BP, arrhythmia, seizures and sudden death.

Question 14

severity of anorexia

Answer 14

severe- BMI<15, rapid weight loss, evidence of system failure
moderate- BMI 15-17.5, no evidence of system failure
mild- BMI>17.5