Psychological Aspects of GI DIsease and Eating Disorders Flashcards
What are the psychological problems caused by GI disease?
Conditioning Nausea and vomiting Loss of appetite - weight loss Diarrhoea Sexual problems 'Stress'
What are the psychological problems presenting as GI disease?
Stress Anxiety Depression Somatisation Eating disorders Mental state examination
What drugs can cause GI problems?
Opiates (prescribed/non-prescribed/illicit) Amphetamines Cocaine Anticholinergics Antidepressants (tricycles/SSRI)
What is adapted starvation?
Body gets used to reduced intake of carbohydrates and reduced secretion of insulin
Alternative sources of energy - fat and protein (can’t generate fat to glucose)
Extracellular levels of phosphate may be normal
Lower expenditure of energy (lethargic)
Gut/heart/muscle atrophy
Low micronutrient reserves
What happens with refeeding with carbohydrate?
Rapid rise in insulin
Rapid generation of ATP
Phosphate moves into cells
Hypophosphataemia rapidly develops
What is the criteria for determining people at high risk of developing refeeding problems? (one or more)
BMI < 16 kg/m2
Unintentional weight loss > 15% within 3-6 months
Little/no nutritional intake > 10 days
Low levels of K/phosphate/Mg prior to feeding
What is the criteria for determining people at high risk of developing refeeding problems? (two or more)
BMI < 18.5 kg/m2
Unintentional weight loss > 10% within 3-6 months
Little/no nutritional intake > 5 days
History of alcohol/drug (insulin/chemotherapy/antacids/diuretics) abuse
What is the treatment for refeeding syndrome?
Start slow: correct fluid depletion Thiamine 30 mins before feeding feed at 5-10 kcal/kg over 24 hours Gradual increase to requirement over 1 week
What needs replaced during refeeding syndrome?
Phosphate (IV) below 0.3mmol/l
K < 2.5 mmol/l
Mg < 0.5mmol/l
Thiamine
What is binge eating disorder?
Patient binges then purging
Purging fails to compensate for amount of binging
Patient gains weight?
What is bulimia nervosa?
Patient alternates between restriction and binging + purging
Normal + near normal weight
What is anorexia nervosa?
Significant weight loss (from fear of gaining weight)
Significantly impaired decision making (SIDMA)
Body dysmorphia (seeing themselves different to reality)
Over exercising
Amenorrhoea (no menstrual cycle)
What is the general principle for treating eating disorders?
Firm and consistent approach
Team approach
What does the team approach in dealing with eating disorders consist of?
Dietitian, ward nurses etc Decide on management recommendations as a team Avoid arguments at bedside May need NG feeding Watch for refeeding syndrome
What are the management principles for treating eating disorder?
Listen to patient carefully Treat symptoms seriously Reach a firm diagnosis Explain 'functional' disease Manage underlying disease/s
