Eating Disorders

Question 1

What is anorexia nervosa?

Answer 1

Eating disorder characterised by:

• failure to maintain/achieve BMI of 17.5
• self-induces
• distorted self image
• fear of fatness
• endocrine disturbances

Question 2

What endocrine disturbance is seen in females?

Answer 2

Amenorrhoea

Question 3

What endocrine disturbance is seen in males?

Answer 3

Loss of sexual desire /potency

Question 4

What are biological risk factors for anorexia?

Answer 4

Female

Genetics

Question 5

What are psychological risk factors for anorexia?

Answer 5

Sexual abuse
Personality traits of control
Alexithymia

Question 6

What is alexithymia?

Answer 6

Inability to identify and describe emotions

Question 7

What are social risk factors for anorexia?

Answer 7

Society that values ‘thinness’
Occupation
Family factors

Question 8

What compensatory mehcanisms are seen in anorexia?

Answer 8

Exercise
Microexercise
- standing not sitting
- sitting in cold
- tensing muscles
Medications
Waterloading
Chewing gum

Question 9

What investigations should be done in suspected anorexia?

Answer 9

Weight

Bloods

• FBC
• U&Es
• LFTs
• TFTs
• lipids
• cortisol
• sex hormones

VBG

ECG

DEXA scan

Question 10

What are potential complications of anorexia?

Answer 10

Metabolic disturbances

• hypokalaemia
• hypercholestrolaemia
• hypoglycaemia
• impaired glucose tolerance

Bradycardia
Arrhythmias
Pancreatitis
Constipation
Proximal myopathy 
Osteoporosis 
Anaemia 
Hypothermia 
Lanugo hair

Question 11

What is lanugo hair?

Answer 11

Thin, soft downy hair that appears on newborns and malnourished

Question 12

How is anorexia managed biologically?

Answer 12

Treatment of comorbid conditions

Question 13

How is anorexia managed psychologically?

Answer 13

Psychoeducation
CBT
Family therapy

Question 14

How is anorexia managed socially?

Answer 14

Voluntary organisations

Self-help

Question 15

What is the weight gain aim for outpatients with anorexia?

Answer 15

0.5kg per week

Question 16

When is hospitalisation indicated in anorexia?

Answer 16

BMI <14

Suicidal ideation

Question 17

What is bulimia nervosa?

Answer 17

Eating disorder characterised by:

• recurrent overeating (binging)
• persistent preoccupation iwht eating
• compensatory behaviours
• overvalue ideas about ideal body

Question 18

What is a binge?

Answer 18

Eating within a discrete period of time (2hrs) more than most people would eat during a similar period of time/circumstance

Question 19

What is the criteria for binges in bulimia?

Answer 19

At least 1x a week for 3 months

Question 20

What are biological risk factors for bulimia?

Answer 20

Female

FHx

Question 21

What are psychological risk factors for bulimia?

Answer 21

Physical abuse
Sexual abuse
Emotionally reactive personality traits

Question 22

What are social risk factors for bulimia?

Answer 22

Occupation

Life stressors

Question 23

What compensatory mechanisms are seen in bulimia?

Answer 23

Purging

• self-induced vomiting
• laxatives

Non-purging

• exercise
• fasting

Question 24

What is the VBG picture in vomiting?

Answer 24

Metabolic alkalosis + hypokalaemia

Question 25

What is the VBG picture in laxative use?

Answer 25

Metabolic acidosis

Question 26

What are complications of repeated vomiting?

Answer 26

``` Arrhythymias Hypokalaemia Mallory-Weiss tears Dehydration Dental erosions Russell's sign ```

Question 27

What is Russell's sign?

Answer 27

Calluses on back o hand due to abrasion against teeth

Question 28

How is bulimia managed biologically?

Answer 28

Antideppressant - fluoxetine | Treat comorbid conditions

Question 29

How is bulimia managed psychologically?

Answer 29

Psychoeducation | CBT

Question 30

How is bulimia managed socially?

Answer 30

Food diary | Techniques to avoid bingeing

Question 31

When is inpatient treatment indicated in bulimia?

Answer 31

Suicide risk | Severe electrolyte imbalances

Question 32

What is a key complication while managing eating disorders?

Answer 32

Refeeding syndrome

Question 33

What is refeeding syndrome?

Answer 33

Potentially life threatening complications that results from feeding after period of starvation

Question 34

What causes refeeding syndrome?

Answer 34

Insulin surge

Question 35

Who is most at risk of refeeding syndrome?

Answer 35

Very low weight for height Minimum/no intake for more than 3/4 days Weight loss >15% in 3 months Abnormal electrolytes before refeeding

Question 36

What are the symptoms of refeeding syndrome?

Answer 36

``` Oedema SOB N+V Muscle weakness Confusion ```

Question 37

What are the features of refeeding syndrome?

Answer 37

Low phosphate Low potassium Low magnesium Low sodium

Question 38

What is a potential complication of refeeding syndrome?

Answer 38

Heart failure

Question 39

How can refeeding syndrome be prevented?

Answer 39

Monitor bloods daily | Start refeeding at 20kcal/kg/day

Question 40

How is refeeding syndrome managed?

Answer 40

Replace electrolytes

Question 41

What is binge eating disorder?

Answer 41

Recurrent episode of binge eating without compensatory behaviour