Eating Disorders Flashcards
What is the ICD10 criteria for anorexia nervosa?
BMI <17.5 or <85% expected Morbid fear of fatness Deliberate weight loss Distorted body image Amenorrhoea Loss of sexual interest/potency in men
Describe sub-clinical anorexia nervosa
Not all diagnosis criteria are met and some patients don’t experience amenorrhoea even at low body weight
Name the co-morbidities in anorexia nervosa
Anxiety, OCD, depression, alcohol/substance misuse, increasing evidence for autism, diabetes mellitus
How will patients with anorexia nervosa behave?
Over-exercising, food restrictions, secrecy, obsession with weight/calories, use of laxatives or diuretics
What are the major red flags in anorexia?
Loss of <1kg/week, prolonged QTc, temperature of <34, unable to rise from squat (muscle wasting, BMI <13 and cognitive impairment
State the investigations done in patients with anorexia
Haematology
Biochemistry
ECG
DXA - amenorrhoea for >1year
What electrolyte disturbance will be seen in anorexia?
Hypokalaemia
Hyponatraemia
What cardiac abnormalities can occur due to anorexia?
Low heart rate/BP
Long QTc
Arrhythmias
Arrest
What can happen to your teeth in anorexia?
Dental caries due to vomiting acidic/sugary foods
Describe the GI complications of anorexia
Discomfort, GORD, oesophageal rupture/tears, constipation, diarrhoea/incontinence with laxative abuse, delayed gastric emptying
Why does oedema occur in anorexia?
Rebound retention
What are the neurological complications of anorexia?
Peripheral paraesthesia, tentany or seizures, reduced grey matter and enlarged ventricular space
Describe the hepatic complications of anorexia
Raised LFTs - GGT/ALT liver breakdown can lead to failure
What endocrine features will be seen in anorexia?
Amenorrhoea as ovaries shut down to reduce fertility, hypothalamus is impaired and TFTs may be abnormal
What skin features are complications of anorexia?
Dry skin, carotenaemia, lanugo hair, poor circulation, hair loss
Describe the MSK complications of anorexia
Muscle wasting, weakness, osteopenia/porosis, russel’s sign
What is Russel’s sign?
Callous on back of hand from induced vomiting
What are the haematological complications of anorexia?
Low WBC, reduced ability to fight infection, anaemia (B12 and iron), bone marrow suppression, thrombocytopenia
Describe a patients mood in anorexia
Anxiety, low mood, irritability/angry outbursts, labile when refeeding, episodes of elation, obsessions and compulsions
What happens to patients personality in anorexia?
Narrow range of interests, rigid thinking, autism, social withdrawal
Describe a patients cognition in anorexia
Poor concentration, impaired decision making, drowsiness
How can anorexia be treated?
- family based therapy
- cognitive behaviour therapy
- interpersonal therapy
- specialist supportive clinical management
- medication
- art/drama therapy
What medication can be given in anorexia?
Multivitamin supplement - calcium and vit D
Oestrogen patches
Antidepressants
What is the ICD 10 criteria for bulimia nervosa?
Morbid fear of fatness, craving for food and binge eating with compensatory behaviours, preoccupation with body weight and shape and episodes not exclusively during episodes of anorexia
At least once a week for 3 months and excessive pre-occupation with body shape and weight
Define binge
Consumption of an unusually large amount of food within a short amount of time associated with loss of control
What co-morbidities often present with bulimia?
Depression, impulsive behaviours - alcohol, substance misuse, shop lifting
How is bulimia treated?
Individual (guided self help)
CBT
High dose fluoxetine can reduce cravings
What is binge eating disorder?
Recurrent bingeing at least once a week for 3 months without compensatory behaviours
What needs to be present for a diagnosis of binge eating disorder?
3 of
- rapid eating
- eating until uncomfortably full
- eating large amounts when not hungry
- eating alone due to embarrassment
- disgusted
- depressed
- guilty
What is avoidant restrictive food intake disorder?
Persistent failure to meet appropriate nutritional needs
- sensory issues
- co-existing autism
Describe diabulimia
Eating disorder in a person with diabetes - deliberate restriction of insulin in order to lose weight. Chronically raised blood sugar and ketoacidosis
What condition do body builders often have?
Bigorexia/megorexia
Describe bigorexia
Muscle dymorphia - obsession with building muscle and distorted body image believe themselves to be too small, too thin with insufficient muscle (may use steroids)
What is the name given to an unhealthy obsession with healthy food?
Orthorexia
What is the hallmark sign of refeeding syndrome?
Hypophosphataemia
What is the main symptoms of re-feeding syndrome?
Oedema
Acute gastric dilation is rare - abdominal pain, vomiting and distension
How is re-feeding syndrome prevented?
Baseline U/Es, vitamin supplements, start slowly
What are the complications of re-feeding?
Cardiac abnormalities, delirium, respiratory failure, status epileptics, haematological suppression
