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Paediatrics > Thin Teenager > Flashcards

Thin Teenager Flashcards

1
Q

What are the risks of rapid weightloss?

A

Refeeding syndrome
Hypoglycaemia
Risk of infection
Cardiac arrythmia

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2
Q

What conditions can cause rapid weightloss?

A 
Coeliac
T1DM
Hyperthyroidism
Malignancy
Anorexia Nervosa
IBD
Oesophageal problems (achalasia)
Severe depression/OCD/autism
Juvenile arthritis
Addisons
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3
Q

Specifics involved in weight loss history

A

organic cause? - abdo pain, malaena, diarrhoea, joint pains, bloating, fever

Body image, feeling fat, wont eat, vegan, exercising, perfectionist shape

FH of eating disorder/major mental illness. Drugs/alcohol in family

Menstrual history. vomiting, bingeing, laxative use, hiding food, excess exercise

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4
Q

What is Lanugo hair?

A

Thin soft hair
Protective as a foetus
Can appear in extreme weight loss due to loss of insulating effect of fat tissue

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5
Q

What is the best acute measure of liver function?

A

Coagulation Screen

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6
Q

Common themes of blood results in eating disorders

A

Low WCC and liver abnormalities can be caused by weight loss

Check blood film to exclude haematological malignancy
Glandular fever test, Hep A,B,C, coagulation screen (best acute measure of liver function), liver USS

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7
Q

Short term plan for patient with anorexia nervosa

A

PHYSICAL STABILISATION

If weight height ratio is less than 75% - commence thiamine, vitamin B complex and multivitamins

Diet Plan: Aim for 0.5-1kg per week weight gain (initial drop in weight may be noted as body leaves starvation mode)

Monitor bloods, especially phosphate (drop can indicate refeeding syndrome and may precipitate respiratory arrest

Regular ECGs

Discharge when vital signs stable and weight gain occurring

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8
Q

Medium term plan for patient with anorexia nervosa

A

MULTI-DISCIPLINARY TREATMENT PAKAGE IN THE COMMUNITY

Under the care of child psychiatrist - directs treatment for comorbidities (fluoxetine for OCD)

Dietician: gradually increase diet plan, agreed by patient, (aviod supplements)

Therapists work on changing thought process, family therapist look at family dynamic

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9
Q

Long term plan for patient with anorexia nervosa

A

RELAPSE PREVENTION

80% cure long term
cocern due to long term risk of osteopenia and osteoporosis (esp. in girls with amenorrhoea) - dexa to monitoe BMD

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10
Q

Aetiology of Anorexia nervosa

A

Neuro-bilogical, not the patients fault
>90% females

  • Genetic factors (FH of AN or mental illness)
  • Events around puberty
  • Cultural promotion of thinness
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11
Q

What are the 3 main types of eating disorder?

A

AN
Bulimia nervosa
EDNOS (eating disorder not otherwise specified) - outlook better than pure AN

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12
Q

What are the behavioural/psychological factors of AN?

A 
Pre-occupation with food
Feeling fat
Unhappy with body shape - disturbed body image
Won't eat in front of others
Hiding food 
May be a compulsive exerciser
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13
Q

Clinical features of AN

A 
Low weight for height
Amennorhoea
Headaches
Cool peripheries
Constipation
Dry skin
Hair loss 
Fainting/dizziness
lethargy/tiredness
bradycardia
Peripheral oedema
Hypotension
Hypothermia
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14
Q

Common co-morbidities associated with AN

A

OCD

depression

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15
Q

What are the most significant mortality risks in AN?

A

Sudden cardiac death
Suicide
Chronic emaciation and pneumonia

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16
Q

Features of bulimia

A 
Bingeing
Vomiting
Low self worth
Often co-morbid with other forms of self harm e.g cutting
Often normal weight
Poor dentition
Often glucose intolerance
17
Q

Features of EDNOS

A

Fulfils some but not all features of AN

Outlook better than classical AN

18
Q

Effect of anorexia on brain and nerves

A 
Can't think right
Fear of gaining weight
Sad
Irritable 
Bad memory
Fainting 
Changes in brain chemistry
19
Q

Effects of anorexia on hair

A

Hair thins
Brittle hair
Lanugo hair

20
Q

Effects of anorexia on heart

A

Low BP
Slow HR
Palpitations
HF

21
Q

Effects of anorexia on blood

A

Anaemia

Other blood problems

22
Q

Effects of anorexia on muscles and joints

A

Weak muscles
Swollen joints
Fractures
Osteoporosis

23
Q

Effects of anorexia on body fluids

A

Low Potassium
Low Magnesium
Low Sodium

24
Q

Effects of anorexia on intestines

A

Constipation

Bloating

25
Q

Effects of anorexia on hormones

A

Amennorhoea
Growth problems
Difficulty getting pregnant
higher risk of miscarriage and low birthweight

26
Q

Effects of anorexia on skin

A 
Bruise easily
Dry skin
Growth of fine hair all over body
Get cold easily
Jaundice
Nails get brittle

Paediatrics (19 decks)

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