Pathological Aspects of GI Disease/Eating Disorders Flashcards
Describe how a person may become conditioned to vomiting.
Before vomiting, we feel nauseous, which is not a nice feeling.
After vomiting, the nausea goes away and there is relief of the symptoms.
Therefore, sometimes patients will try to be sick more quickly or make themselves sick to get rid of the symptoms.
How can diarrhoea cause psychological problems?
Patients may avoid going out in the fear they will be caught out in a situation where they cannot get to the toilet in time.
How can GI conditions cause psychological sexual problems?
Not sure if I worded that very well…
But say a patient has a stoma bag, they more worry that it will make them unattractive to others and may be more self-conscious.
Name some types of drugs which can affect the gut.
Opiates
Cocaine
Amphetamines
Anticholinergics
Antidepressants
When the body is in a stage of adapted starvation, what is there a reduced secretion of?
Reduced insulin secretion as reduced carbohydrate intake.
In adapted starvation, there is reduced intake of carbohydrates, hence why the body produces less insulin.
If the body has reduced carb intake, what are the sources of energy?
Protein and fat
What happens if you refeed someone with lots of carbohydrate after they have been in a period of adapted starvation?
Rapid rise in insulin
Rapid generation of ATP- phosphate moves into cells as required for production of ATP
What happens when a lot of phosphate enters the cells of someone during refeeding?
Hypophosphatemia can develop rapidly
What happens during hypophosphatemia?
Muscle weakness
Breathing difficulties
According to NICE guidelines, when is a patient at risk of developing refeeding syndrome?
If they have ONE of the following:
-BMI<16
-Unintentional weight loss >15% in the last 3-6 months
-Little or no nutritional intake in last 10 days
-Low levels of potassium, phosphate or magnesium prior to feeding.
If they have TWO OR MORE of the following:
-BMI<18.5
-Unintentional weight loss >10% in the last 3-6 months
-Little or no nutritional intake in last five days
-History of alcohol abuse or drugs including insulin, chemotherapy, antacids or diuretics
How do you treat/prevent refeeding syndrome?
Start feeding slowly
Give thiamine at least 30mins before starting feeding
Which vitamin is thiamine?
Vitamin B1
If you’re worried about refeeding syndrome, how much would you feed someone for the first 24hrs?
5-10 kcals/kg of body weight
What might need to be replaced in someone with refeeding syndrome?
Phosphate <0.3mmol/l
Magnesium <0.5mmol/l
Potassium <2.5mmol/l
Thiamine
What can happen if someone runs out of thiamine?
Permanent brain damage- condition called Korsakoff psychosis
List some conditions which can result in disordered eating.
NOTE this is not the same as an eating disorder.
Crohn’s disease
Coeliac disease
Missing false teeth
Describe a binge eating disorder.
Binge on food and then purge- sometimes throwing up to compensate for calories consumed.
Which fear drives eating disorders?
Fear of gaining weight
What is the result of binge eating disorders on weight?
Often results in gaining weight as purges do not compensate for vast amounts consumed.
Describe what happens in bulimia nervosa.
Restriction of food -> binge -> purging (making self sick)
What is the weight of those with bulimia like?
Normal or near normal weight.
What is anorexia nervosa?
Obsessive fear of gaining weight
What will the weight of those with anorexia be like?
Significantly weight loss
What will many patients with anorexia develop as a result?
Amenorrhoea- will be unable to menstruate
If you realise a patient has an eating disorder, what should you do?
Very dangerous condition, needs special psychiatric help
What are some psychological/social reasons someone may vomit?
Sexual abuse
Worry- ay be worried about their diagnosis
It’s important to understand that psychiatric conditions can produce gut symptoms. List some examples of these conditions which can produce gut symptoms e.g. vomiting, stress, diarrhoea.
Anxiety
Depression
Eating disorders
