Feeding or Eating Disorders

Question 1

anorexia nervosa

Answer 1

• MC F 14-21yo, F:M (3:1), homosexual men, child sex abuse, OCD, childhood/parental obesity
• starvation induces protein and fat catabolism → loss of cellular volume and atrophy in kidneys, brain, heart, liver, intestines, and muscles
• restriction of energy intake, intense fear of gaining weight, distorted perception of body weight and shape, palpitations, dizziness, weakness, exertional fatigue, cold intolerance, amen, abd pain or bloating, early satiety, const, swelling of feet
• signs: bradycardia, ortho hoTN, BMI <17.5, hypotherm, hypoactive bowel sounds, brittle hair, hair loss, xerosis (dry skin), lanugo, abd distention
• dx: EKG (inc PR interval, 1st def heart block, ST-T wave abnl, QT prolong.), CBC (anem leukopen, thrombocytopen), hypoK, hypoMg, hypophosph, hypoNa, Cr low, elevated bili/alkphos/AST/ALT, low T3/T4, low FSH/LH, high cholesterol
• tx: psychotherapy, nutritional . rehab, avoid bupropion

Question 2

bulimia nervosa

Answer 2

• F:M 3:1
• RF: childhood trauma
• sxs: recurrent eps of binge eating, compensatory behavior to prevent wt gain (vomiting, laxatives, diuretics, fasting, excessive exercise)
  
  • both of these occur at least 1x/wk for 3mo
  • excessive concern about body wt and shape, lethargy, irreg menses, abd pain, bloating, const
• signs: tachycardia, hoTN, xerosis, parotid gland swelling, erosion of dental enamel, + Russel sign (scarring or calluses on knuckles or back of hands)
• dx: serum alb low, hypoK, met alkalosis, hypoCl, hypoNa, hypoMg
• tx: psychotx, nutritional rehab, pharm (SSRIs, TCAs/MAOIs)

Question 3

indications for hospitalization in anorexia or bulemia

Answer 3

• unstable vitals (ortho inc in pulse >20bpm or dec in syst BP >20mmHg, bradycardia <40 and hypotension or lightheadedness, hypotherm (<35C or 95F)
• cardiac dysrhytmia r any rhythm other than sinus brady
• weight <70% ideal body weight or BMI <15
• marked dehydration
• acute complication of malnourishment: syncope, seizures, cadiac fialure, liver failure, pancreatitis, hypoglycemia, or electrolyte disturb
• moderate to severe refeeding syndrome: marked edema, serum phosph <2
• poor response as outpt