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Diagnosis Management 2 > Feeding and Eating disorders > Flashcards

Feeding and Eating disorders Flashcards

1
Q

how long does eating of nonfood items have to be present for a dx of pica

A

at least 1 month

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2
Q

what is the minimum age for pic dx

A

2

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3
Q

when does pica tend to come to clinical attention?

A

after a complication like infection or mechanical bowel issue

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4
Q

when does pica manifest

A

usually in early childhood
typically if older it is in the context of developmental disability

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5
Q

when would you make a pica dx in pregnancy

A

when symptoms are severe enough to possibly cause medical complications

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6
Q

when would anorexia be the appropriate dx over pica

A

when nonnutritive eating is done as a means of hunger control

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7
Q

what are the most common pica comorbidities

A

autism and intellectual disability

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8
Q

when would pica be associated with trichotillomania and/or excoriation disorder

A

when there is ingestion of hair and/or skin

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9
Q

definition of rumination disorder

A

repeated food regurgitation not d/t another medical/mental condition

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9
Q

when would pica be associated with avoidant/restrictive food intake disorder

A

when there is a strong sensory component to the presentation

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9
Q

how long do sx have to be present to meet criteria for rumination disorder

A

at least 1 month

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10
Q

how do infants present when attempting to regurgitate

A

straining and arching back while making sucking movements with tongue

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11
Q

features of rumination disorder in infants

A

-may gain satisfaction from behavior
-may be irritable/hungry between episodes
-may result in malnutrition
-weight loss/failure to gain common

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12
Q

what are some differential diagnoses for rumination disorder

A

GI conditions that would cause vomiting

anorexia and bulimia

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13
Q

basic definition of avoidant/restrictive food intake disorder

A

avoiding eating d/t lack of interest or sensory issues with at least 1 manifestation

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14
Q

what are possible manifestations of avoidant/restrictive food intake disorder and how many are required for dx

A

at least 1:
-significant weight loss/failure to gain
-significant nutritional deficiency
-dependence on enteral feeding or nutritional supplements
-marked interference with psychosocial functioning

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15
Q

temperamental risk factors for avoidant/restrictive food intake disorder

A

risk is increased if anxiety disorders, autism, OCD, ADHD are present

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16
Q

what are the 3 main criteria for dx of anorexia

A

-restriction of intake that results in significantly underweight
-preoccupation with thinness or fear of fatness
-disturbance in body image perception and lack of recognition of serioussness

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17
Q

what are the 2 subtypes of anorexia

A

restricting type
binge/purge type

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18
Q

what is the qualifier for anorexia restricting type

A

no binging/purging behavior for at least 3 months

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19
Q

anorexia binging/purging type

A

may purge after small amounts of food

purging typically involves vomiting, laxatives, or diuretics

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20
Q

mild anorexia

A

BMT >= 17

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21
Q

moderate anorexia

A

BMI 16-16.99

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22
Q

severe anorexia

A

BMI 15-15.99

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23
Q

Extreme anorexia

A

BMI <15

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24
Q

what are some associated features of anorexia

A

-amenorrhea
-bone mineral density loss
-depressive symptoms
-OCD sx

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25
Q

what behaviors are more likely to occur in anorexia binge/purge type than restricting type

A

more likely to be impulsive and abuse substances

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26
Q

when is anorexia onset and what is it associated with

A

adolescence to early adulthood usually associated with stressful life event

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27
Q

hematology labs in anorexia

A

leukopenia
mild anemia
rarely bleeding problems

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28
Q

chemistry results in anorexia

A

dehydration may raise BUN
hypercholesterolemia
elevated hepatic enzymes

29
Q

why would someone with anorexia have an elevated bicarb level

A

if they were in metabolic alkalosis d/t vomiting

30
Q

endocrine abnormalities with anorexia

A

low estrogen in females and low testosterone in males

31
Q

what is the main difference between bulimia and anorexia binge/purge type

A

anorexia may purge after small ingestion of food and bulimia tends to maintain normal or slightly above weight

32
Q

general definition of bulimia

A

recurrent episodes of binge eating with compensatory purging behaviors to avoid gaining weight

33
Q

what constitutes a binge eating episode

A

-eating significantly more food than normal in a discrete time period
-sense of lack of control over eating

34
Q

how often do binge/purge episodes have to occur for a dx of bulimia

A

at least weekly for at least 3 months

35
Q

mild bulimia

A

1-3 episodes weekly

36
Q

moderate bulimia

A

4-7 episodes weekly

37
Q

severe bulimia

A

8-13 episodes weekly

38
Q

extreme bulimia

A

14+ episodes weekly

39
Q

common electrolyte imbalances in bulimia

A

hypokalemia
hypochloremia
hyponatremia

40
Q

what can cause metabolic alkalosis and metabolic acidosis in bulimia

A

vomiting can cause alkalosis d/t fluid loss (elevated bicarb)
laxative/diuretic use can cause acidosis

41
Q

what disorders are frequently comorbid with bulimia

A

personality disorders
substance use disorders
depression
bipolar

42
Q

basic definition of binge eating disorder

A

recurrent episodes of binge eating not associated with purging

43
Q

what are characteristics of binge eating episodes in binge eating disorder and how many must be present for dx

A

At least 3
-eating more rapidly than usual
-eating until uncomfortably full
-eating large amounts when not hungry
-eating alone d/t embarassment
-feeling disgusted/guilty or depressed afterward

44
Q

how often do binge eating episodes have to occur for dx of binge eating disorder

A

at least weekly for at least 3 months

45
Q

mild binge eating disorder

A

1-3 episodes weekly

46
Q

moderate binge eating disorder

A

4-7 episodes weekly

47
Q

severe binge eating disorder

A

8-13 episodes weeklyx

48
Q

treme binge eating disorder

A

14+ episodes weekly

49
Q

what are the other specified feeding or eating disorders

A

-atypical anorexia nervosa
-bulimia of low frequency or limited duration
-binge eating of low frequency or limited duration
-purging disorder
-night eating syndrome

50
Q

atypical anorexia

A

criteria for anorexia met except weight is still WNL

51
Q

bulimia of low frequency/limited duration

A

criteria for bulimia met except frequency of episodes or duration of symptoms

52
Q

binge eating disorder of low frequency/limited duration

A

criteria met for binge eating disorder except frequency of episodes or duration of symptoms

53
Q

purging disorder

A

purging behaviors in the absence of binge eating

54
Q

night eating syndrome

A

-eating large quantities after evening meal
-there is awareness of eating
-not better explained by another disorder

55
Q

geophagia

A

when pregnant women eat clay

56
Q

amylophagia

A

when pregnant women eat excessive starch

57
Q

characteristic of regurgitation in rumination disorder

A

effortless and painless
no nausea, retching, or disgust

58
Q

how do you rule out pyloric stenosis when diagnosing rumination disorder

A

pyloric stenosis is associated with projectile vomiting and usually manifests prior to 3 months

59
Q

treatment of rumination disorder

A

education/behavioral combo
aversive techniques sometimes

60
Q

common age range affected by rumination disorder

A

3-12 months

61
Q

appetite loss in anorexia

A

usually not present until late in disease

62
Q

odd behaviors with anorexia

A

will hide food around the house
carry large amounts of candy
somatic complaints
may compulsively steal
decreased interest in sex

63
Q

what are some physical signs of anorexia

A

hypothermia, dependent edema, bradycardia, hypotension, and lanugo

64
Q

when does an anorexic patient need to be hospitalized

A

when 20% below desired weight
if 30% below likely will need treatment for 2-6 months

65
Q

3 types of psychotherapy used for anorexia

A

family-based
CBT
dynamic psychotherapy

66
Q

3 phases of family based psychotherapy in anorexia

A

1 - restoration of physical health
2 - patient gradually takes responsibility for eating decisions
3 - focus on patient’s growth/development

67
Q

first-line treatment for bulimia

A

CBT

68
Q

what med is usually used to treat bulimia

A

fluoxetine (60-80mg)
higher dose than used in depression

69
Q

what med is contraindicated in the treatment of bulimia and why

A

wellbutrin because of seizure risk

70
Q

first-line tx for binge eating disorder

A

CBT
better results when used with SSRI

71
Q

medication for treatment of binge eating disorder with strong evidence for reduction of episodes and weight loss

A

lisdexamfetamine

Diagnosis Management 2 (8 decks)

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