Spiseforstyrrelser - Amboss

Question 1

Hva er spiseforstyrrelser (SF)?

Answer 1

Question 2

Hva kjennetegner overspisingslidelse/tvangsspising (“Binge eating disorder”)?

Answer 2

ASCVD; Atherosclerotic vascular disease.

Question 3

Gi en oversikt over anorexia nervose (AN) og bulumia nervosa (BN)?

Answer 3

There is limited evidence to support the use of pharmacotherapy in anorexia nervosa. SSRI is not effective if prescribed solely for the management of anorexia nervosa. SSRIs have not been shown to increase weight gain but they can help manage comorbid psychiatric conditions. Evidence supporting Olanzapine efficacy is limited and adverse effects such as metabolic syndrome and extrapyramidal effects must be considered.

Question 4

Hva er Pica?

Answer 4

Behavioral interventions can be e.g., patient/caregiver education; replace nonfood substances like pebbles with substitutes like Grape Nuts.

Question 5

Hva bør utredes ved anamnese hos en pas. med SF?

Answer 5

Klinisk historie

Vektflutasjoner

Tegn på ernæringssvikt

Tegn på gjentakende oppkast

GI-symptomer

Question 6

Hva bør utredes ved den kliniske historien ved anamnesen for SF?

Answer 6

Changes in eating and/or exercise patterns can be e.g., extreme dietary restrictions, binge eating episodes, inappropriate weight compensatory behaviors.

Question 7

Hva bør utredes ved vektfluktasjoner ved anamnesen ved SF?

Answer 7

These changes can be readily identified on serial measurements plotted on standardized CDC growth charts and BMI percentiles.

Question 8

Hvilke tegn på ernæringssvikt bør utredes ved us. av SF?

Answer 8

Question 9

Hva er tegn på gjentakende oppkast ved SF?

Answer 9

Signs of recurrent vomiting can be seen in individuals with bulimia nervosa and binge-eating subtype of anorexia nervosa.

Question 10

Hva er GI symptomer ved SF?

Answer 10

Question 11

Hva er RED-S?

Answer 11

Question 12

Hva bør avklares ved den første evalueringen av en pas. med mistenkt SF?

Answer 12

Ideally, the assessment should be performed by a psychiatrist. Oligomenorrhea: A type of abnormal uterine bleeding characterized by infrequent menses, with menstrual cycles occurring in intervals > 38 days. The International Federation of Gynecology and Obstetrics recommends the use of the term "infrequent menstrual bleeding" rather than "oligomenorrhea." Amenorrhea; The lack of menses. Can be primary (a failure to begin menstruating by ~ 15 years) or secondary (a lack of menstruation for ≥ 3–6 months in a previously menstruating woman).

Question 13

Hva er karakteristiske lab. abnormaliteter ved SF?

Answer 13

Hypoglycemia due to impaired gluconeogenesis and inadequate glycogen stores. ↑ Serum alpha-amylase; The degree of elevation has been shown to correlate with the frequency of vomiting.

Question 14

Hva er røde flagg ved SF?

Answer 14

Compensatory behaviors; Including purging and behaviors that are refractory to treatment or result in medical complications.

Question 15

Hvilke komplikasjoner kan oppstå på bakgrunn av SF?

Bein og syndrom

Answer 15

Hormonal derangements can include elevated cortisol and low estrogen, testosterone, DHEA, and IGF-1.

Question 16

Hva er anorexia nervose (AN)?

Answer 16

Question 17

Gi en skjematisk oppsummering av hva som kjennetegner AN?

Answer 17

Question 18

Hvordan er epidemiologien til AN?

Answer 18

Onset is rare before puberty or after 25 years of age.

Question 19

Hvilken etiologi har AN?

Answer 19

Many patients report having had traumatic experiences and negative recollections of childhood.

Question 20

Hvilke kliniske kjennetegn (kan) har AN?

Answer 20

Hypothermia; This is thought to be caused by a disorder of the hypothalamic thermoregulatory centers. Seizures as a result of dehydration and electrolyte imbalances. Most patients present with a low BMI (KMI), but patients with atypical AN may present with a normal or elevated BMI. Patients with AN who engage in purging (oppkast) behavior may also exhibit clinical features of bulimia nervosa (BM) such as dental damage, sialadenosis, and Russels sign.

Question 21

Hva er de generelle prinsippene ved diagnostisering av AN?

Answer 21

Ta høyde og vekt for å beregne KMI og ernæringssvikt.

Bestem om pas. oppfyller kravene til diagnosen AN ved hjelp av ICD-10/DSM-5.

Se etter andre komplikasjoner og komorbiditeter, og utelukk mulige organiske etiologier.

Question 22

Hva er de diagnostiske kriteriene for AN jmf. DSM-5?

Answer 22

The DSM-5 does not provide an absolute weight cutoff. The following cutoffs are suggested, but the clinician may determine that a higher threshold is appropriate based on, e.g., the individual's developmental trajectory or weight history.

Question 23

Hvilke subtyper av AN deler man opp i?

Jmf. DSM-5

Answer 23

Question 24

Hvordan behandler man AN?

Answer 24

Question 25

Hvilke diff.diagnoser har man til AN?

Answer 25

Bulumia nervosa:
- Vurder for pas. med anorexia nervosa binge eating/purging type

Avoidant restrictive food intake order

Body dysmorphic disorder

Question 26

Hvordan er prognosen til pas. med AN?

Answer 26

Question 27

Hva er bulimia nervosa (BN)?

Answer 27

Question 28

Fyll inn

Answer 28

Question 29

Hvordan er epidemiologien til BN?

Answer 29

Onset is rare before puberty or in individuals > 40 years of age.

Question 30

Hvilken etiologi har BN?

Answer 30

Question 31

Hva er karakteristiske kliniske kjennetegn ved BN, og hva er BMI til pas.?

Answer 31

Affected individuals may also be slightly underweight. Bulimia nervosa can occur but is uncommon in individuals with BMI ≥ 30 kg/m2. Between episodes of binge eating, individuals typically consume a low-calorie diet.

Question 32

Hva er assosierte tilstander hos pas. med BN?

Answer 32

Seizures; As a result of dehydration and electrolyte imbalances (e.g., hyponatremia). Cardiac arrhythmias; Mainly caused by potassium deficiency. Hypotension; As a result of decreased sympathetic nervous system activity. Severe impairment of the gastrointestinal tract may occur as a long-term effect of frequent vomiting. Swelling of the parotid gland often results in the cheeks appearing unusually round or puffy. Russell sign; As a result of self-induced vomiting, calluses on the knuckles may form due to frequent contact with the upper incisors.

Question 33

Hva er de diagnostiske kriteriene for BN, jmf. ICD-5?

Answer 33

Binge eating episodes can occur during periods of stress or boredom, or after an attempt to lower body weight through dietary restriction. Prescription drug misuse; E.g., misuse of levothyroxine; omission of insulin dose in patients with diabetes.

Question 34

Hvilke lab. us er aktuelle ved mistanke om BN?

Answer 34

Recurrent vomiting causes excessive removal of acid from the body, resulting in metabolic alkalosis. α-Amylase is elevated in patients with recurrent vomiting. The elevation correlates with the frequency of vomiting.

Question 35

Hvordan nærmer man seg behandlingen hos pas. med BN?

Answer 35

Question 36

Hvilken psykoterapi er anbefalt ved BN?
Hvilke farmakologiske muligheter har man?

Answer 36

Question 37

Hvordan er prognosen til BN?

Answer 37

Impulsiveness is a common characteristic of these comorbidities.

Question 38

Hva er Binge eating disorder (BED)?

Answer 38

Question 39

Hvordan er epidemiologien til BED?

Answer 39

Question 40

Hvilken etiologi har BED?

Answer 40

The etiology if BED is multifactorial and not entirely understood. Contributory factors are similar to those associated med AN.

Question 41

Hva er kliniske kjennetegn på BED?

Answer 41

Recurrent binge eating episodes that are not associated with inappropriate weight compensatory behaviors.

Question 42

Hva er de diagnostiske kriteriene for BED, jmf. DSM-5?

Answer 42

Question 43

Hvordan behandler man BED?

Answer 43

Question 44

Hvilke komplikasjoner kan oppstå pga. BED?

Answer 44

Overvekt

Metabolsk syndrom

Question 45

Hva er pica?

Answer 45

Question 46

Hvordan er epidemiologien til pica?

Answer 46

Question 47

Hvilken etiologi har pica?

Answer 47

Ingestion of soil may provide the individual with the missing minerals in individuals with nutritional deficiencies. Pica among pregnant women is more common in developing countries and is strongly associated with underlying iron deficiency. Pica has been suggested to provide temporary comfort to individuals who have experienced emotional trauma.

Question 48

Hva kan være de kliniske tegnene på pica?

Answer 48

Us. er vanligvis normale.

Komplikasjoner pga. av pica kan være tilstede, avhengig av hva som blir konsumert av pas.:
- Tannskade
- GI symptomer

Question 49

Hvordan utreder man videre ved pica?

Answer 49

Pica is known to be associated with pregnancy. Bezoar; A gastrointestinal foreign body formed by accumulated ingested material (e.g., food and plant material, hair, drugs). Can cause gastrointestinal obstruction. Risk factors include gastric dysmotility (e.g., from organic or drug-induced causes) and gastric outlet obstruction.

Question 50

Hva er de diagnostiske kriteriene for pica, jmf. DSM-5?

Answer 50

Mouthing and ingestion of nonnutritive substances is considered normal up to a developmental age of 2 years. The ingestion of inedible substances such as clay and soil (geophagia) is normative in certain cultures, e.g., to aid digestion or suppress hunger, and would not be considered pathological.

Question 51

Hvordan behandler man pica?

Answer 51

Question 52

Hvilke komplikasjoner kan oppstå pga. pica?

Answer 52