17 - Eating Disorders Flashcards
(38 cards)
What is anorexia nervosa and the epidemiology of this?
Eating disorder characterised by restriction of energy intake resulting in low body weight and an intense fear of weight gain
More common in females
0.1-0.3% prevalence at any time
What are some risk factors for developing anorexia nervosa?
- Female
- Age (young)
- FHx of eating disorders, depression, or substance abuse
- Previous criticism of eating habits and weight
- Increased pressures to be slim (e.g. ballet dancers, models, athletes)
- History of sexual abuse
- Low self-esteem
- Obsessive personality
- Emotionally unstable personality disorder
What are some clinical features of anorexia nervosa?
- Restriction of energy intake
- lanugo hair growth
- Low body weight
- Features of body dysmorphia
- Intense fear of weight gain
- Rapid weight loss
- Aggressive weight-loss techniques (laxatives, diuretics, vomiting)
- Often a lack of insight or denial
- Withdrawal from social settings
- Loss of libido
*physical symptoms such as hair loss, dry skin, loss of muscle strength fainting, dizzy and fatigue
What are some signs you might see of someone with anorexia nervosa?
- Amenorrhea
- Lanugo
- Hypothyroidism
- Hypotension
- Hypokalaemia
- Hypothermia
What are some cardiac complications with anorexia nervosa?
- Arrhythmia
- Cardiac atrophy
- Sudden cardiac death
What is a screening questionnaire you can use for anorexia?
Used in primary care to help refer on, score of 2 or more could mean anorexia or bulimia
SCOFF
- S – Do you make yourself Sick because you feel uncomfortably full?
- C – Do you worry you have lost Control over how much you eat?
- O – Have you recently lost more than One stone (6.35 kg) in a three-month period?
- F – Do you believe yourself to be Fat when others say you are too thin?
- F – Would you say Food dominates your life?
What is the ICD-10 diagnostic criteria for anorexia nervosa?
- Weight <85% expected or BMI<17.5
- Avoidance of fattening foods or compensatory behaviours
- Disordered body image
- Wide spread endocrine disorder e.g amenorrhea
What are some compensatory behaviours in anorexia nervosa?
- Calorie limits
- Avoiding food groups
- Food rules e.g timing, only when others eat
What management plan is used for eating disorders?
MARSIPAN
MARSIPAN (Management of Really Sick Patients with Anorexia Nervosa) is a guideline developed in the UK to help medical professionals manage severely ill patients with eating disorders, particularly Anorexia Nervosa, who require medical admission due to the risk of life-threatening complications.
determines their risk, BMI, HR, BP, blood glucose
assesses if they need an nGT tube or fluid replacement
will admit them and look for refeeding syndrome
offer thiamine, multivitamins
What examinations should you do if you suspect someone to have anorexia nervosa?
- Hydration status
- Height, weight and BMI. Centile chart if <18
- Vital signs: bradycardia, hypothermia and postural blood pressure drop
-
Sit-up, Squat–stand test: tests the patient’s ability to sit up from lying and to squat down and stand back up
SIT UP
What it tests: Proximal muscle strength and overall physical frailty.
How to perform:
Ask the patient to lie flat on a bed and sit up without using their arms.
Interpretation:
Unable to sit up without assistance or using arms → Red flag for severe muscle wasting and medical instability.
SQUAT TEST
What it tests: Lower limb strength and postural stability.
How to perform:
Ask the patient to squat fully down and then stand back up without assistance.
Interpretation:
Inability to do this → indicates severe muscle weakness and deconditioning → consider admission and high refeeding risk.
What investigations should you do for someone with anorexia?
- ECG: bradycardia, prolonged QT interval or arrhythmias
- Blood sugar: hypoglycaemia
- Blood tests: FBC, LFTs, U+Es, TFT, bone profile, magnesium
- Additional: pregnancy test and hormonal panels
How is anorexia nervosa managed in general terms?
- **Talking therapies -> FT-AN family focused therapy 18-20 sessions a year or CBT **
- Supervised weight gain: weight gain of 0.5–1kg/week being wary of refeeding syndrome
- Inpatient: if bradycardia, ECG changes, electrolyte abnormalities, very low BMI, rapid weight loss, dehydration, organ failure, suicide risk)
What talking therapies are used in anorexia nervosa?
CBT-ED, MANTRA, SSCM
- CBT
- Interpersonal
- Supportive
- Family therapy - First line for children (FT-AN)
What is the prognosis with anorexia nervosa?
1⁄3 recover completely, 1⁄3 improve, and 1⁄3 develop a chronic eating disorder
Highest mortality of any mental health illness (5x general population)
Causes of death: cardiovascular complications, infections and suicide
Mortality is higher if: aged 20–29 at presentation, delayed access to treatment, bingeing, and vomiting
What is refeeding syndrome and the pathophysiology of this?
If nutritional intake is resumed too rapidly after a period of relatively low caloric intake
Rapidly increasing insulin levels lead to shifts of potassium, magnesium and phosphate from extracellular to intracellular spaces. Also utilisation of thiamine
This is potentially fatal
What are some risk factors for refeeding syndrome?
What are the features of refeeding syndrome?
- Oedema
- Confusion (Wernicke’s as thiamine stores only last 7 days)
- Tachycardia
- Hypotension
- Seizures
How is refeeding syndrome diagnosed?
HYPOPHOSPHATAEMIA
hypokalemia due to the vomiting - will be seen on the ecg
‘Refeeding’ bloods
- Urea & electrolytes (gives a potassium)
- Bone profile (gives a phosphate)
- Magnesium
- Blood glucose monitoring
- ECG monitoring
What actions are taken to prevent refeeding syndrome?
Before initiation of feeding:
- Electrolyte derangements should be corrected
- Patients started on thiamine or Pabrinex
- ECG to look for QTc and any arrhythmias
Feeding:
- No more than 50% of energy requirements if > 5 days with minimal intake
- Alternatively, aim for 10-20 kcal/kg/day in high-risk patients and increase over 5-7 days as possible with electrolyte correction
- Daily monitoring of refeeding bloods
- ECG monitoring
What is Bulimia Nervosa and the epidemiology of this?
Eating disorder characterised by episodes of binging followed by purging (usually by induced vomiting but laxative abuse is also common)
Often have a normal BMI
0.5-1% prevalence
What is the ICD10 criteria for bulimia?
A. Recurrent episodes of overeating (binges)
B. Persistent preoccupation with eating and a strong desire to eat (craving).
C. The patient attempts to counteract the fattening effects of food by compensatory behaviours
What is a binge and a purge?
- Binge eating: Loss of control, eating enormous amounts with thousands of calories, often in sense of urgency and compulsion
- Purging: binges causes feelings of shame and guilt leading to attempts to ‘undo damage’ vomiting, laxatives, diuretics, can also be exercise
What are some features you may spot in an OSCE or GP with someone with bulimia?
- BMI >17.5
- Dental erosion
- Parotid gland swelling
- Russell’s sign (calluses on knuckles)
- Complaints of reflux or abdo pain
What are some biochemical changes you may see on the bloods of a person with bulimia?
- Hypokalaemia
- Alkalosis on blood gas due to vomiting HCL
