ED: Anorexia

Question 1

What is the definition of anorexia?

Answer 1

Ed characerised by deliberate weight loss resulting in wt below 15% of expected or BMI < 17.5, with secondare endocrine and metabolic disturbances.

Question 2

What is the aetiology of anorexia?

Answer 2

· Genetic link.

· Dysfunction of 5HT

· Sociocultural view of thin is desirable. Family relationships.

· Personality – perfectionism and obsessiveness.

Question 3

What is the epidemiology of anorexia?

Answer 3

Associated with certain occupations (i.e. modelling) and comorbid depression, substance misuse and personality disorder. Mainly female, peak age 15.19. Higher In high SES.

Question 4

What may you find in the history of someone with anorexia?

Answer 4

Weight loss induced by vomiting, excessive exercise, appetite suppression, diuretics and laxatives.

Morbid fear of fatness, body image distortion, loss of libido, fatigue, amenhorrea, obsessional thoughts and rituals.

Question 5

What may you find in the examination of someone with anorexia?

Answer 5

O/E: dehydration, proximal myopathy, cold extremities, bradycardia and hypotension, fine lanugo hair, peripheral odema, perotid enlargement and erosion of tooth enamel (vomiting). Low mood likely.

Question 6

What investigations may you do on someone with anorexia?

Answer 6

Investigate other potential causes. FBC, UE, Ca, LFT, TFT. Hormone screen. Glucose, amylase, lipids, toxicology, electrolytes. Bone scan – very high risk of osteoporosis.

Question 7

What is the management of anorexia?

Answer 7

Correct medical complications (hydration, electrolytes). Psychiatric admission and feeding (either controled or NG tube if will not take food). Negotiate dietary aims. CBT, family therapy, SSRIs may help.

Question 8

What are the complications and prognosis of anorexia?

Answer 8

Osteoporosis, arrhythmias, electrolyte disturbances, renal failure, pancreatitis, hepatitis, seizures, peripheral neuropathies, suicide

Some patients recover after single episode, some relapse with chronic deteriorating course over years. 10% mortality due to cmx. Poor coutcome if older onset age, long duration of illness, low weight at presentation and poor childhood social adjustment