Eating disorders

Question 1

Clinical features of Anorexia Nervosa

Answer 1

(1. ) Weight loss arising from food avoidance, binging, purging, excessive exercise, used of diuretics, laxatives
(2. ) Distorted body image despite being grossly underweight
(3. ) May be associated with anxiety or depression
(4. ) Lanugo hair may develop on back, forearm, cheeks
(5. ) All organ systems may be affected with cardiac and skeletal being the most serious

Question 2

Aetiology of Anorexia Nervosa

Answer 2

Unclear but may be a combination of:

(1. ) Personality (high neuroticism)
(2. ) Genetic
(3. ) Environmental factors - societies, social pressures
(4. ) Trauma

Question 3

Diagnosis of Anorexia Nervosa

Answer 3

Based on pronounced fear of fatness despite being thin and the absence of an adequate alternative explanation for weight loss

(1. ) BMI <17.5
(2. ) Avoidance of high calorie food
(3. ) Distorted body image
(4. ) Amenorrhoea for at least 3m

Question 4

Management of Anorexia Nervosa

Answer 4

• Aim = pt physical well-being, help them gain weight by addressing their beliefs and behaviours that maintain the low weight, pt-clinician relationship is important.
• FBT, Family behavioural therapy
• Antidepressants if depressive order is present

Question 5

Subtypes of Anorexia Nervosa

Answer 5

• Restricting

- Binge-eating/purging subtypes

Question 6

What is Bulimia Nervosa?

Answer 6

• Recurrent episodes of binge eating characterized by both of the following:
• Eating in a discrete amount of time (within a 2 hour period) large amounts of food.
• Sense of lack of control over eating during an episode.
• Recurrent inappropriate compensatory behaviour in order to prevent weight gain (purging).

Question 7

Clinical features of Bulimia Nervosa

Answer 7

• Usually normal weight but display a fear of fatness associated with disordered eating behaviour
• binge eating followed by self-induced vomiting

Physical signs

• Pitted teeth (from gastric acid, vomiting)
• Russel Sign - calluses on knuckles
• Parotid gland enlargement

Question 8

Diagnosis of Bulimia Nervosa

Answer 8

• Recurrent bouts if binge eating
• Lack of self-control over eating during binges
• Self-induced vomiting, purgation or dieting after binges
• Weight maintain within normal limits

Question 9

Investigations of Bulimia Nervosa

Answer 9

U&E

• Electrolyte disturbances due to self vomiting or abuse of diuretic/laxative
• Hypokalaemia

ECG
- cardiac arrythmias

Endoscopy
- Repeated vomiting can give rise to mallory-weiss tears in oesophagus

Question 10

Management of Bulimia Nervosa

Answer 10

• CBT

- SSRI - Fluoxetine

Question 11

Prevalence and incidences of eating disorders?

Answer 11

Among females aged 14-40

Question 12

What signs and risk should be assessed and managed in eating disorders? (11)

Answer 12

Important signs to look out/test for:

(1. ) Severe restriction of food/fluid
(2. ) Electrolyte imbalance
(3. ) Bone deterioration
(4. ) Tears to oesophagus; blood in vomit
(5. ) Alcohol/drug intake
(6. ) Muscular weakness e.g. SUSS test
(7. ) Problems in breathing
(8. ) Deterioration of consciousness
(9. ) Cardiac signs: ectopic beats, tachycardia, bradycardia, low BP
(10. ) Rapid weight loss
(11. ) Risky behaviours: e.g., suicidal intent, risk to others such as driving