Pathological Aspects of GI Disease/Eating Disorders

Question 1

Describe how a person may become conditioned to vomiting.

Answer 1

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.

Question 2

How can diarrhoea cause psychological problems?

Answer 2

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.

Question 3

How can GI conditions cause psychological sexual problems?

Answer 3

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.

Question 4

Name some types of drugs which can affect the gut.

Answer 4

Opiates
Cocaine
Amphetamines
Anticholinergics
Antidepressants

Question 5

When the body is in a stage of adapted starvation, what is there a reduced secretion of?

Answer 5

Reduced insulin secretion as reduced carbohydrate intake.

Question 6

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?

Answer 6

Protein and fat

Question 7

What happens if you refeed someone with lots of carbohydrate after they have been in a period of adapted starvation?

Answer 7

Rapid rise in insulin
Rapid generation of ATP- phosphate moves into cells as required for production of ATP

Question 8

What happens when a lot of phosphate enters the cells of someone during refeeding?

Answer 8

Hypophosphatemia can develop rapidly

Question 9

What happens during hypophosphatemia?

Answer 9

Muscle weakness
Breathing difficulties

Question 10

According to NICE guidelines, when is a patient at risk of developing refeeding syndrome?

Answer 10

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

Question 11

How do you treat/prevent refeeding syndrome?

Answer 11

Start feeding slowly
Give thiamine at least 30mins before starting feeding

Question 12

Which vitamin is thiamine?

Answer 12

Vitamin B1

Question 13

If you’re worried about refeeding syndrome, how much would you feed someone for the first 24hrs?

Answer 13

5-10 kcals/kg of body weight

Question 14

What might need to be replaced in someone with refeeding syndrome?

Answer 14

Phosphate <0.3mmol/l
Magnesium <0.5mmol/l
Potassium <2.5mmol/l
Thiamine

Question 15

What can happen if someone runs out of thiamine?

Answer 15

Permanent brain damage- condition called Korsakoff psychosis

Question 16

List some conditions which can result in disordered eating.

NOTE this is not the same as an eating disorder.

Answer 16

Crohn’s disease
Coeliac disease
Missing false teeth

Question 17

Describe a binge eating disorder.

Answer 17

Binge on food and then purge- sometimes throwing up to compensate for calories consumed.

Question 18

Which fear drives eating disorders?

Answer 18

Fear of gaining weight

Question 19

What is the result of binge eating disorders on weight?

Answer 19

Often results in gaining weight as purges do not compensate for vast amounts consumed.

Question 20

Describe what happens in bulimia nervosa.

Answer 20

Restriction of food -> binge -> purging (making self sick)

Question 21

What is the weight of those with bulimia like?

Answer 21

Normal or near normal weight.

Question 22

What is anorexia nervosa?

Answer 22

Obsessive fear of gaining weight

Question 23

What will the weight of those with anorexia be like?

Answer 23

Significantly weight loss

Question 24

What will many patients with anorexia develop as a result?

Answer 24

Amenorrhoea- will be unable to menstruate

Question 25

If you realise a patient has an eating disorder, what should you do?

Answer 25

Very dangerous condition, needs special psychiatric help

Question 26

What are some psychological/social reasons someone may vomit?

Answer 26

Sexual abuse
Worry- ay be worried about their diagnosis

Question 27

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.

Answer 27

Anxiety
Depression
Eating disorders