ED: Bulimia Nervosa Flashcards
Define bulimia nervosa.
ED characterised by uncontrolled binge eating with vomiting/ laxative abuse. Preoccupation with body weight + shape.
Explain the aetiology/risk factors for bulimia. Summarise the epidemiology of bulimia nervosa.
Personal + family hx of ED, affective disorder, substance misuse.
Half have previous anorexia.
High prevalence of depression, self harm + substance abuse comorbidity.
3% young females
~18y
What are the symptoms of bulimia nervosa?
Persistent preoccupation with eating + craving food.
Binge eating up to 20k Kcal per session may occur.
Followed by vomiting, starvation etc.
How would a bulimia patient appear on examination? (9)
Weight may be normal
Dental erosion
Finger calluses
Callus on dorsum of hand (Russel sign)
Parotid swelling (due to high serum amylase)
Menstrual abnormalities
Low mood
Self loathing
More insight than anorexia + keen for help
What are the investigations for bulimia nervosa?
FBCs: may self phlebotomise- anaemia
U+Es: hypokalaemia/ alkalosis due to vomiting
LFTs: transaminitis
Mg2+: low
Pregnancy test
ECG: abnormal Mg2+/ K+ arrhythmias
What is the management for bulimia nervosa?
Nearly all OP MX
Medical stabilisation + dental care
Self help
CBT
Nutrition + meal support
SSRI may be useful (fluroxetine): reduce binging + purging by enhancing impulse control
Screen for co-morbid psych illness
What is the psychological management for bulimia?
Bulimia nervosa focused guided self-help
Eating disorder focused CBT (CBT-ED)
What are 7 complications associated with bulimia nervosa?
Arrhythmias
MW tears
Renal failure
Osteoporosis
Pancreatitis
Oesophagitis
Secondary amenorrhoea
What is the prognosis of bulimia nervosa?
Most patients make full recovery.
What treatment is recommended for children with bulimia?
Bulimia nervosa focused family therapy
