Eating Disorders (anorexia Flashcards
Name 3 eating disorders?
Anorexia Nervosa
Bulimia nervosa
Binge eating
Anorexia
MC or LC?
Mortality?
Sex and age
LC
Highest mortality
Female
20-40 y/o
What is anorexia nervosa diagnosed as?
<17.5 BMI with body dysmorphia, purging (vomiting, laxative) and compensation (excessive exercising/calorie restriction) + Physical Sx
RF for anorexia?
PHx fat, Family Hx (x12), EUPD, depression, trauma and abuse, body building/social media
Physical: Coeliacs, achalasia, Addisons
BMI centiles and meaning?
17-17.5 = Dx
16-17 = Moderate
<15 = extreme
Typical Px for anorexia?
Female adolescent, low self esteem
Sx of Anorexia?
Low BMI, Purging (laxatives/vomiting), Compensation (high exercise/calorie restriction), deliberate weight loss and body dysmorphia for 3+ months
what systemic Sx in anorexia?
Dry Thin skin and lanugo hair
Dental caries + gum recession
CVS = Arrhythmias, bradycardia, hypotension
Endo = Impaired glucose tolerance, amenorrhoea (2^ - hypogonadotrophic hypogonadism)
Osteopenia + muscle wasting
what criteria is used for anorexia screening?
SCOFF
what does SCOFF stand for and score that means +ve?
-Make self SICK after food
-lost CONTROL of food
-ONE stone + lost in last 3 months
-FOOD dominates life
- FAT perception
3+ = +ve
What other test is done in eating disorders?
SUSS test
What is the SUSS test and what is it out of?
Sit up Stand Squat
/3
What would be seen on the bloods?
FBC (ANEMIA)
U+E (low Na, K, Mg, Ca, Po)
TFT (Low?)
Oestrogen (Low?)
HbA1C
Everything will be low except?
GH + Cortisol
What happens to BP and ECG in anorexia?
Low BP
ECG (Low K+)
Treatment for Anorexia?
- Structured eating plan + supplements (AdcalD3, vitamins, K+, Na+)
Tx in community with CBT (MANTRA - maudsley model of anorexia nervosa for adults)
Tx for anorexia if severe?
<15 BMI
Consider Inpatient and Fluoxetine
When referring, what do we monitor and why?
Electrolytes for risk of REFEEDING SYNDROME
What is the pathophysiology of referring syndrome?
Anorexic state = everything Is LOW
(Low Mg2+, K+, PO, B1, Glucose, Na+)
Therefore feeding fast means there is an insulin spike and body is in an anabolic state
Starts to build + use already depleted supply of electrolytes every more
Worse Sx
How do we ensure referring syndrome doesn’t happen?
Introduce food SLOWLY
Monitor electrolytes regularly
Complications of anorexia?
Referring syndrome
infertility
amenorrhoea
osteoporosis
what other screening tool can be considered and what does it stand for?
typically used for?
out of?
MUST
Malnutrition Universal Screening Tool
(typically for gerries)
/5
what is the MC eating disorder?
Atypical eating disorders
do not fit into one category
eg. body dysmorphia, severe weight loss, binge eating <2/wk + normal BMI
What is bulimia nervosa?
Preoccupation with body image with 2+ weekly episodes for 3 months of binging + purge
what is meant by binging?
time period?
feelings after?
Alone
less than 2 hours
eating till uncomfortable full
feel guilty
loss of control
Typical Px?
age?
Female 20-35y/o Model/athlete
Sx of bulimia?
2+ episodes weekly for 3+ months of binge + purge with Normal BMI
Russel Sign - knuckle callouses due to vomiting
GORD/Reflux
Parotitis (atrophy of salivary gland)
Halotosis (bad breath)
Dental caries
Dx of bulimia?
bloods?
Other?
VBG
SUSS -ve
SCOFF questionnaire
what would be seen on VBG?
Hypokalaemia, hypochloremic, metabolic alkalosis
Tx for bulimia?
CBT alone
what is binge eating?
Planned binge eating episodes 3+ months with overweight BMI
Tx for binge eating?
CBT
