Eating Disorders Flashcards
What is anorexia nervosa?
Eating disorder characterised by:
- failure to maintain/achieve BMI of 17.5
- self-induces
- distorted self image
- fear of fatness
- endocrine disturbances
What endocrine disturbance is seen in females?
Amenorrhoea
What endocrine disturbance is seen in males?
Loss of sexual desire /potency
What are biological risk factors for anorexia?
Female
Genetics
What are psychological risk factors for anorexia?
Sexual abuse
Personality traits of control
Alexithymia
What is alexithymia?
Inability to identify and describe emotions
What are social risk factors for anorexia?
Society that values ‘thinness’
Occupation
Family factors
What compensatory mehcanisms are seen in anorexia?
Exercise Microexercise - standing not sitting - sitting in cold - tensing muscles Medications Waterloading Chewing gum
What investigations should be done in suspected anorexia?
Weight
Bloods
- FBC
- U&Es
- LFTs
- TFTs
- lipids
- cortisol
- sex hormones
VBG
ECG
DEXA scan
What are potential complications of anorexia?
Metabolic disturbances
- hypokalaemia
- hypercholestrolaemia
- hypoglycaemia
- impaired glucose tolerance
Bradycardia Arrhythmias Pancreatitis Constipation Proximal myopathy Osteoporosis Anaemia Hypothermia Lanugo hair
What is lanugo hair?
Thin, soft downy hair that appears on newborns and malnourished
How is anorexia managed biologically?
Treatment of comorbid conditions
How is anorexia managed psychologically?
Psychoeducation
CBT
Family therapy
How is anorexia managed socially?
Voluntary organisations
Self-help
What is the weight gain aim for outpatients with anorexia?
0.5kg per week
When is hospitalisation indicated in anorexia?
BMI <14
Suicidal ideation
What is bulimia nervosa?
Eating disorder characterised by:
- recurrent overeating (binging)
- persistent preoccupation iwht eating
- compensatory behaviours
- overvalue ideas about ideal body
What is a binge?
Eating within a discrete period of time (2hrs) more than most people would eat during a similar period of time/circumstance
What is the criteria for binges in bulimia?
At least 1x a week for 3 months
What are biological risk factors for bulimia?
Female
FHx
What are psychological risk factors for bulimia?
Physical abuse
Sexual abuse
Emotionally reactive personality traits
What are social risk factors for bulimia?
Occupation
Life stressors
What compensatory mechanisms are seen in bulimia?
Purging
- self-induced vomiting
- laxatives
Non-purging
- exercise
- fasting
What is the VBG picture in vomiting?
Metabolic alkalosis + hypokalaemia
What is the VBG picture in laxative use?
Metabolic acidosis
What are complications of repeated vomiting?
Arrhythymias Hypokalaemia Mallory-Weiss tears Dehydration Dental erosions Russell's sign
What is Russell’s sign?
Calluses on back o hand due to abrasion against teeth
How is bulimia managed biologically?
Antideppressant - fluoxetine
Treat comorbid conditions
How is bulimia managed psychologically?
Psychoeducation
CBT
How is bulimia managed socially?
Food diary
Techniques to avoid bingeing
When is inpatient treatment indicated in bulimia?
Suicide risk
Severe electrolyte imbalances
What is a key complication while managing eating disorders?
Refeeding syndrome
What is refeeding syndrome?
Potentially life threatening complications that results from feeding after period of starvation
What causes refeeding syndrome?
Insulin surge
Who is most at risk of refeeding syndrome?
Very low weight for height
Minimum/no intake for more than 3/4 days
Weight loss >15% in 3 months
Abnormal electrolytes before refeeding
What are the symptoms of refeeding syndrome?
Oedema SOB N+V Muscle weakness Confusion
What are the features of refeeding syndrome?
Low phosphate
Low potassium
Low magnesium
Low sodium
What is a potential complication of refeeding syndrome?
Heart failure
How can refeeding syndrome be prevented?
Monitor bloods daily
Start refeeding at 20kcal/kg/day
How is refeeding syndrome managed?
Replace electrolytes
What is binge eating disorder?
Recurrent episode of binge eating without compensatory behaviour
