Eating disorders Flashcards
What is teh DSM 5 diagnostic criteria for anorexia nervosa
- Restriction of energy intake that leads to a low body weight given the patients age, sex, developmental trajectory and physical health
- Intense fear of gaining weight or becoming fat, or persistent behavior that prevents weight gain despite being underweight
- Distorted perception of body weight and shape undue influence of weight and shape on self worth or denial of the medical seriousness of ones low body weight
Discuss complications associated with severe anorexia nervosa
Constituational
- cachaexia and low BMI
- Arrested growth
- hypothermia
CVS
- Mycocardial atrophy
- mitral valve prolapse
- pericardial effusion
- bradycardai
- arryhtmia which may cause sudden death
- ECG ( increased PR interval, 1st degree herart block, ST-T wave abnormalities, long QTC)
- Hypotension
- acrocyanosis
Gynecological
- amenorrhagea
- unplanned pregnancy and neonatal complications
Endocrine
- Osteoporosis and pathologcial stress fractures
- euthyroid sick syndrome
- hypercortisolemia
- hypoglycaemia
- neurogenic diabetes insipidus
- poos DM controll
GIT
- Gastroperisis
- constipation
- GI dilation
- increased colinc tranist time
- hepatitis
- SMA syndrome
- diarrhoae
Renal
- decreased GFR
- renal calculi
- Impaired concentration of urine
- dehydration
- hypokalaemia
- hypomagnesiemia
- hypovolaemic nephropathy
Pulmonary
- Pulmonary muscle wasting
- decreased pulmonary capacity
- repistaroy failure
- spont pneumo
Haem
- Aneami
- -Leukopenia
- thrombocytopanenia
Neuro
- cerebral atrophy
- enlarged ventricles
- cognitive neuropathty
- seizures
Refeeding
List common physical signs
●Low body mass index (<17.5 kg/m2)
●Emaciation (body weight less than 85 percent of ideal body weight)
●Hypothermia (core temperature <35°C or 95°F)
●Bradycardia (pulse <60 beats per minute)
●Hypotension (systolic blood pressure <90 mmHg and/or a diastolic blood pressure <50 mmHg)
●Hypoactive bowel sounds
●Xerosis (dry, scaly skin)
●Brittle hair and hair loss
●Lanugo hair growth
●Abdominal distention
Indication for hospitalisation
1) Unstable vital sings
- Brady <40
- BP <80/60
2) Cardiac dysrhytmia
- QTC >500
- any rhythm other than sinus
3) Weight
- >70% ideal weight or BMI <14
4) CVS, renal or hepatic compromise requiring medical stabiltisation
5) Marked dehyradration
6) serious medical complications of malnutrition (syncope, seizures, cardiac failure, pancreatitis, hypoglycaemia, or marked electrolyte disturbance)
7) moderat to severe refeeding syndrome
- makred oedema
- serum phosphate <3
8) poor repsonse to OPD treatment or major recent and rapid weight event
Discuss refeeding syndrome
In significant malnorusihed patients the intitial stage of oral enteral or pareneteral nutritional causes electrolyte and fluid shift that may precipitate disbaling or fatal medical complications
It is marked by
- Hypophophatemia
- hypokalaemia
- CCF
- peripheral oedema
- rhabdo
- seizure
- haemolysis
Disucss pathogenesis of refeeding
Stores of phosphate are depleted during episodes of anorexia nervosa and stravation.
Nutritional replenshiment starts and pateitn release insulin which triggers cellular uptake of phosphate (K and MG as well) leading to a further decrease in serum phosphate level.
Insulin also causes cells to produce a variety of depleted molecules that require phosphate (ATP, 2-3DPG) further depleting stores.
The lack of phosphorylation intermediates causes tissue hypoxia, myocardial dysfunction, respiratory failure and inability of the diaphragm to contract, haemolysis, rhabdo amd seizures
Discuss risk factors
Directly related to the amount of weight loss during the current episdoe.
Patient who weigh less than 70& of iedal body wieght or lose weight rapidly are at greatest risk of the syndrome.
Discuss medical complications of refeedgin
CVS
- Imparied contractility
- decreased SV
- HF
- arrhythmias.
- -Brady is expected with a normal HR may be a sign of pending HF
- Hypotension, peripheral oedema
Resp
- imparied diaphragmatic contractility due to overal weakness or hypophophataemai
- Dyspnoea,
- resp failure
Muscular
- Impaired contractility
- weakness
- myalgy
- tetany
- Rhabdo
GIT
- Dearanged LFT
- Diarrhoea
Neuro
- Tremors
- Paraethesia
- Delirium
- Seizures
electrolyte abnormalities
