Eating Disorders and Obestiy Flashcards
What is the ICD 10 criteria for the diagnosis of anorexia nervosa?
FEEDD
Fear of weight gain
Endocrine disturbance causing amenorrhoea in females and loss of sexual interest in males
Emaciated with weight >15% expected or BMI<17.5
Distorted body image with reduced food intake and increased exercise
Deliberate weight loss
How long do the anorexia FEEDD symptoms need to be present for?
3 months at lease with absence of recurrent bingeing episodes and preoccupation with eating/a craving to eat
What are indications for hospital admission with anorexia nervosa?
SHE called CPS
Severe electrolyte imbalance
Hyopothermia < 34.5 or cold peripheries
Extremely low body weight BMI < 14 or loss of 1kg in last week
Cardiovascular- bradycardia <40 bpm, long QT or hypotension <80/50
Purpuric rash
Severe electrolyte abnormalities
When would you admit an AN patient?
Severe electrolyte imbalance
Hyopothermia < 34.5 or cold peripheries
Extremely low body weight BMI < 14 or loss of 1kg in last week
Cardiovascular- bradycardia <40 bpm, long QT or hypotension <80/50
Purpuric rash
Severe electrolyte abnormalities
SHE called CPS is a mnemnonic for what in anorexia nervosa?
Severe electrolyte imbalance
Hyopothermia < 34.5 or cold peripheries
Extremely low body weight BMI < 14 or loss of 1kg in last week
Cardiovascular- bradycardia <40 bpm, long QT or hypotension <80/50
Purpuric rash
Severe electrolyte abnormalities
In the SHE called CPS imnemnonic for anorexia nervosa, what does the SHE stand for?
Severe electrolyte imbalance
Hyopothermia < 34.5 or cold peripheries
Extremely low body weight BMI < 14 or loss of 1kg in last week
n the SHE called CPS imnemnonic for anorexia nervosa, what does the CPS stand for?
Cardiovascular- bradycardia <40 bpm, long QT or hypotension <80/50
Purpuric rash
Severe electrolyte abnormalities
What are the physiological parameters in anorexia nervosa?
hypokalaemia low FSH, LH, oestrogens and testosterone raised cortisol and growth hormone impaired glucose tolerance hypercholesterolaemia hypercarotinaemia low T3
Most things low
G’s and C’s raised: growth hormone, glucose, salivary glands, cortisol, cholesterol, carotinaemia
Anorexia nervosa
In anorexia nervosa, what physiological parameters are raised?
Most things low
G’s and C’s raised: growth hormone, glucose, salivary glands, cortisol, cholesterol, carotinaemia
If the patient has the SHE CPS features, how would you detain?
Under the section 2 of the MHA you could detain for assessment if any of these are present and treat under section 63 of MHA or agree on community treatment order section 17a if they lack capacity
What electrolyte abnormalities will you see in an AN patient either using laxatives or vomitting
If vomitting, metabolic alkalosis
If laxative, metabolic acidosis
What are some differentials for anorexia
Anorexia nervosa, bulimia nervosa, binge eating [ 3months], ENDOS, depression, OCD, anakastic personality disorder, schizophrenia with delusions about food
How would you investigate a patient with anorexia
FBC, venous blood gas for metabolic acidosis if laxatives or metabolic alkalosis if vomitting, U+E, LFT, glucose, calcium, TFT, cortisol, magnesium and bone profile and consider DEXS to rule out osteoporosis if suspected , blood pressure, ECG, sex hormones
What is the SCOFF questionnaire for anorexia nervosa
Do you make yourself Sick because you feel uncomfortably full?
Do you worry you have lost Control over how much you eat?
Have you recently lost more than One stone in a 3 month period [6kg]?
Do you believe yourself to be Fat when others say you are too thin?
Would you say that Food dominates your life?
*One point for every “yes”; a score of >=2 indicates a likely case of anorexia nervosa or bulimia
