Eating Disorders Flashcards
What is anorexia nervosa?
An eating disorder which is characterised by deliberate weight loss, an intense fear of fatness, distorted body image and endocrine disturbances.
What are the risk factors for AN?
Biological... . Genetics . Family history . Female . Early menarche
Psychological . Abuse . Low self esteem . Anankastic personality . Premorbid anxiety/depressive disorder
Social…
. Western society
. Bulllying
. Stressful life events
What is the ICD-10 criteria for anorexia?
1) Low body weight (at least 15% below expected or BMI <17.5)
2) self induced weight loss
3) Overvalued idea
4) Endocrine disturbance (Raised GH, cortisol, T3, amenorrhoea)
The above must be present for 3 months and there must be absence of bingeing and preoccupation with eating/craving to eat.
What are the features of anorexia nervosa?
Physical- fatigue, amenorrhoea, headaches, bradycardia, arrhythmias, peripheral oedema, lanugo hair
Preoccupation with food
Socially isolated
Sexuality feared
Symptoms of depression and obsessions
What are the investigations you carry out for AN?
Blood tests…
FBC (anaemia, leukopaenia, thrombocytopenia), glucose (low), U and Es (increase in urea and creatinine if dehydrated, decrease in K+, phosphate, magnesium and chloride), LFTS (decrease in albumin), lipids (increase in cholesterol), amylase (pancreatitis can be a complication)
May do a VBG- would get metabolic alkalosis in vomiting and metabolic acidosis if taking laxatives
DEXA scan to look for osteoporosis
ECG- arrhythmias such as: sinus Brady and prolonged QT
Questionnaires- eating attitudes test
What are the differentials of Anorexia nervosa?
Bulimia nervosa
Eating disorders not otherwise specified
Depression
Obsessive compulsive disorder
Schizophrenia
Organic causes of low weight- diabetes, hyperthyroidism, malignancy
Alcohol/substance misuse
What are the complications of AN?
Metabolic-
Hypokalaemia, increase in urea and creatinine, hypoglycaemia, hypercholesterolaemia, decrease in phosphate/magnesium/albumin/chloride
Endocrine
- increase in cortisol
- increase in GH
- decrease in T3/T4
- decrease in LH/FSH/oestrogens
- decrease in testerone in men
Cardiac Cardiac failure ECG abnormalities Arrhythmias Decrease in BP Bradycardia Peripheral oedema
Renal
Renal failure
Renal stones
Neurological
Seizures
Peripheral neuropathy
Autonomic dysfunction
Neurological
Seizures
Peripheral neuropathy
Autonomic dysfunction
Haematological
Iron deficiency anaemia
Thrombocytopenia
Leukopenia
MSK
Proximal myopathy
Osteoporosis
Others; hypothermia, dry skin, brittle nails, lanugo hair, infections and suicide
What is the management of AN?
The management is outlined using the bio-psychosocial model
Risk Assesment is really important
Biological treatment= treat electrolyte disturbance and SSRIs for co morbid depression
Psychological treatment= CBT, IPT, family therapy, cognitive analytic therapy, psycho education about nutrition.
Social p= self help groups and voluntary organisations.
What is bulimia nervosa?
Eating disorder characterised by repeated episodic uncontrolled binge eating, followed by compensatory weight loss behaviours and overvalued ideas regarding ideal body shape and weight.
What are the clinical features of bulimia nervosa?
- binge eating (2x episodes per week for 3 months)
- compensatory weight loss methods
- overvalued ideas (dread of fatness, low target weight)
What are the subtypes of bulimia nervosa?
Purging type= patient uses self induced vomiting and other ways from expelling food from the body ie: laxatives, diuretics, enemas
No purging type= patients use excessive exercise or fasting
ICD-10 doesn’t differentiate between these
What investigations are done to check for bulimia nervosa?
Blood tests: FBC, U and Es, amylase, lipids, glucose, TFTs, magnesium, calcium, phosphate
VBG: metabolic alkalosis
ECG
Hypokalaemia changes
Classic changes- prolongation of the PR interval, flattened or inverted T waves, prominent U waves after T wave
What are the physical complications of repeated vomiting?
Cardiovascular- arrhythmias, mitral valve prolapse, peripheral oedema
GI- Mallory Weiss tears, increase size of salivary glands, especially parotid
Metabolic/renal- dehydration, hypokalaemia, renal stones, renal failure
Dental- permanent erosion of dental enamel secondary to vomiting
Russell’s signs
Aspiration pneumonitis
Cognitive impairement, peripheral neuropathy, seizures
What is the management of BN?
Biological
Trial of antidepressant can be given as this can decrease the frequency of bingeing and purging- normally fluoxetine
Psychological
Psycho education, CBT, interpersonal psychotherapy
Social Food diary Techniques to avoid bingeing Risk assesment Inpatient treatment for suicide risk and severe electrolyte imbalances
