First Aid CH14 Eating Disorders

Question 1

what are the eating disorders?

Answer 1

anorexia nervosa
bulimia nervosa
binge-eating disorder

Question 2

eating disorders associated w/ disturbed body image?

Answer 2

anorexia nervosa

bulimia nervosa

Question 3

why do pts w/ binge-eating disorder binge?

Answer 3

typically to quell negative emotions

Question 4

define anorexia nervosa including the two types

Answer 4

disturbed body image, fixated on wt and being thin/fear of being fat, often associated w/ OCPD traits

• restricting type: wt loss through diet, fasting, excessive exercise
• binge-eating/purging: eating binges followed by self-induced vomiting, laxatives, enemas, or diuretics

Question 5

psychical findings in an anorexic pt

Answer 5

amenorrhea, cold intolerance, hypotension, brady, arrhythmias, constipation, lanugo hair (soft and thin hair), alopecia (hair loss), edema, hypothyroidism, poor bone density

Question 6

lab findings in an anorexic pt

Answer 6

hyponatremia, hypochloremic hypokalemic alkalosis (if vomiting), arrhythmia (QT prolongation), transaminitis, anemia (normocytic normochromic), inc cortisol, dec LH and FSH (gonadotropins), dec estrogen

Question 7

common populations for anorexia

Answer 7

industrialized countries with abundance of food and thus where thin bodies are ideal (suggests fitness), sports with revealing clothing, F&raquo_space;> M

Question 8

etiology of anorexia

Answer 8

manifests from struggle to gain control of something, idealization of thin body, inc prevalence of fad diets, exaggeration of control and perfectionism

Question 9

MDD vs anorexia: appetite

Answer 9

anorexics have great appetites but refuse to eat, MDD appetites are poor

Question 10

define re-feeding syndrome

Answer 10

electrolyte and fluid shifts that occur when malnourished pts are re-fed too quickly > arrhythmias, rep failure, delirium, seizures
- replace nutrients slowly

Question 11

ddx for anorexia

Answer 11

DM, hyperthyroidism, malaborption, IBD, Turner syndrome, cancer, AIDS, MDD, bulimia

Question 12

prognosis for anorexia and tx

Answer 12

variable course, many do recover within 5 years, inc rate of suicide/mortality

FOOD! FEED THEM! CBT, supervised wt gain programs

Question 13

define bulimia nervosa

Answer 13

binge-eating at least once a week for 3 months with wt-loss behaviors (vomiting, laxative use), unlike anorexia they maintain appropriate body wt (or over-wt)

Question 14

define binge-eating

Answer 14

uncontrolled excessive food intake within a 2-hour stretch

Question 15

physical findings in bulimia

Answer 15

salivary gland enlargement (sialadenosis), dental erosion/caries, Russell’s sigh (callouses on dorsum of hand), peripheral edema, aspiraition

Question 16

bulimia nervosa etiology

Answer 16

genetic and social

• childhood obesity and early pubertal maturation
• masochistic (pleasure from pain/humiliation)

Question 17

does anorexia or bulimia have a better prognosis

Answer 17

bulimia nervosa

Question 18

tx for bulimia nervosa

Answer 18

SSRIs (Fluoxetine), nutritional counseling, CBT

Question 19

which medication shouldn’t be used in bulimia nervosa?

Answer 19

Bupropion d/t SE of lowering seizure threshold (vomiting causes electrolyte disturbances which can cause seizures)

Question 20

define binge-eating disorder

Answer 20

pts are often obese and emotionally taxed by binge eating but aren’t obsessed with wt or body habitus, binge-eating is a 2 hour ordeal where uncontrolled intake occurs

Question 21

what is noticeably absent from other eating disorders in binge-eating?

Answer 21

no compensatory behaviors (vomiting, laxative use, exercise)

Question 22

do most obese individuals binge-eat?

Answer 22

no

Question 23

tx for binge-eating

Answer 23

CBT + strict diet + exercise program

- stimulants curb appetite