Eating disorder

Question 1

Anorexia nervosa

Answer 1

Underweight

Distorted body image
Intense fear of gaining wt
Reduce caloric intake relative to energy requirements to lose wt

Dieting, exercising, purging

SH: high achieving
Care what people think

-> secondary amenorrhea
decreased bone density and osteoporosis
electrolyte disturbances – hypophosphatemia
depression

Tx: supportive, CBT, counseling

Question 2

Bulimia nervosa

Answer 2

Normal wt

Episodes of binge eating – uncontrollable

Inappropriate, unhealthy, compensatory behavior

• purging – V/D
• caloric restriction/exercise

guilt/disgust after eating

maintain wt w/ in normal range

Russell’s sign – callus/scar/abrasions on back of hand from inducing vomiting
Erosions of tooth enamel
Enlarged parotids

Tx: fluoxetine (SSRI) and psychotherapy

Question 3

Chronic recurrent vomiting electrolyte imbalance

Answer 3

Hypokalemia, hypochloremia, metabolic alkalosis

HCl doesn’t get reabsorbed -> unbuffered HCO3- -> alkalotic serum

Cl- lost to vomiting -> hypochloremia

H/K pumps H into serum to buffer alkalosis and K out of serum -> hypokalemia