Eating disorders-ILA

Question 1

What are risk factors for anorexia?

Answer 1

being female, a teenager, western society, FHx, personal qualities such as perfectionism, obsessional traits and low self-esteem.

Question 2

What are the features of anorexia?

Answer 2

BMI less than 17.5kg/m2
Intense fear of gaining weight
Feel that are bigger than they are

According to the DSM-5, the core features of anorexia nervosa are:
Restriction of energy intake relative to requirements
Intense fear of gaining weight or behaviours that prevent weight gain
Disturbance in body image

Question 3

What are physical signs of anorexia?

Answer 3

Fatigue, decreased cognition, feel cold and dizzy
Constipated
Amenorrhoea
Signs of anaemia eg sub conjunctival pallor
Low WCC, anaemia, low platelets
Low B12 and haematinics
Low K+, low phosphate (suspect vomiting)
low Na+ (suspect water loading)
High LFTs and low TSH
Low glucose
Increased GH and cortisol
Osteoporosis
Arrythmias (due to low potassium) and prolonged QT
Dry skin and brittle hair
Lanugo hair- fine downy hair all over body

Question 4

What are red flags for concern over anorexia?

Answer 4

BMI less than 13, lost over 1kg in a week, pulse less than 40. Oxygen sats less than 92. core temperature less than 35 degrees. Proximal myopathy, QT elongation, bloods very abnormal

Question 5

What investigations should you do for eating disorders?

Answer 5

investigate vitals and proximal myopathy.
check TSH, sodium, potassium, transaminases, glucose and ureas (raised for kidney damage to assess risk of re feeding)
ECG for QT elongation, bradycardia and hypokalaemic changes

Question 6

What guidelines are used to asses ED

Answer 6

marsipan guidelines

Question 7

What is the management for anorexia?

Answer 7

Family therapy 
CBT 
SSRI if comorbidities 
Bed rest  
Use mental capacity act first then use mental health act 
Dialectical behaviour therapy

Question 8

What is refeeding syndrome?

Answer 8

Due to low phosphate due to rapid initiation of food after 10 days of malnutrition
Causes cardiac or resp failure
Milk is often used due to high phosphate
Increase diet steadily and give vitamins eg thiamine

Question 9

What is bulimia?

Answer 9

it involves a cycle of “binging” where the patient uncontrollably eats and then “purges” by vomiting, exercising, fasting or using laxatives.

Question 10

What is the BMI typically for bulimia?

Answer 10

Much more likely to have a normal BMI than anorexia. Be around 17.5.

Question 11

What are some signs exclusive to bulimia?

Answer 11

Can get cardiomyopathy from laxative use
Look for Russell’s sign- tooth marks on hand from self-induced vomiting
Erosion of dental enamel
Enlarged parotid glands
Oedema if use laxatives
Metabolic alkalosis
Low k+ due to vomiting