Eating Disorders Flashcards
1
Q
What is the definition of Bulimia Nervosa
A
- eating disorder associated with a morbid fear of fatness
- characterised by a period of starvation leading to intense hunger -> out of control binding-> guilt -> purging
- purging can be in the form if vomiting, excess exercise and medication
2
Q
What are physical consequences of Bulimia Nervosa?
A
- Hypokalemia: cardiac arrhythmias
- Hypocalcaemia
- Hypotension
- Decreased red cells
- mouth and esophageal ulcers due to gastric contents and poor dentition
3
Q
What is the prevalence of Bulimia Nervosa?
A
- 1-2% in women aged 15 to 40 years old
- rapid increase seen in 15-24 years old
- more commonly seen in women than men
4
Q
What is a screening tool for Anorexia Nervosa or bulimia nervosa
A
SCOFF
- ‘Do you ever make yourself sick because you feel uncomfortably full?’
- ‘Do you worry that you have lost control over how much you eat?’
- ‘Have you recently lost more than one stone in a 3-month period?’
- ‘Do you believe yourself to be fat when others say you are too thin?’
- ‘Would you say that food dominates your life?’
5
Q
What are focused questions about food intake/weight to ask when assessing the history of presenting a complaint with someone with low body weight
A
- Pattern of weight loss – how much weight lost, over what timeframe
- Intentional or unintentional?
- Change in appetite
- What is their diet like? Do they follow any dietary ‘rules’? (any textures, flavours they prefer/ dislike)
- Purposely restricting intake of food?
- Purging (vomiting, but also laxatives/diuretics/diet pills)
- Any binge eating – how much and how often?
- How much exercise do they do? Has this increased recently?
- Perceptions of body image – do they recognise they are underweight?
- Mental health: do they feel anxious, depressed, stressed?
6
Q
What importants are important to ask about the physical health in someone presenting with low body weight?
A
- How are your energy levels?
- Do you ever have fainting episodes? Dizziness?
- Palpitations?
- Any change in bowel habit?
- Have you noticed any change in hair growth? (rapid weightloss → fine hair growth across arms, back and face)
- Do you have regular periods?
- Don’t forget to screen for differentials…..therefore ask about physical health symptoms:
- increased thirst/polyuria/fatigue/tremor/change in bowels/abdo pain/chronic cough/night sweats
7
Q
What are important points to assess in the examination
A
- Observations – pulse, BP (including L+S), temperature, blood sugars
- BMI
- Hydration state
- Look for muscle wasting and assess muscle strength (SUSS)
- Dental erosion, parotid hypertrophy. Russell’s sign (knuckle calluses from inducing vomiting).
- Assess for alternative causes: this may involve abdominal and thyroid examination.
8
Q
What are red flag symptoms of Anorexia?
A
- Observations – pulse, BP (including L+S), temperature, blood sugars
- BMI
- Hydration state
- Look for muscle wasting and assess muscle strength (SUSS)
- Dental erosion, parotid hypertrophy. Russell’s sign (knuckle calluses from inducing vomiting).
- Assess for alterative causes: this may involve abdominal and thyroid examination.
9
Q
What is the SUSS test?
A
Sit up, Squat and Stand test
- You can measure muscle strength via:
- Scores of 2 or less (especially if scores are falling) on the Sit up–Squat–Stand (SUSS) test are a red flag.
- The sit up test — the person lies flat on a firm surface such as the floor and has to sit up without, if possible, using their hands.
- The squat test — the person is asked to rise from a squatting position without, if possible, using their hands.
10
Q
What are the differentials for weight loss?
A
- GI: coeliac, IBD, peptic ulcer, malignancy
- Drug or alcohol
- Endocrine/metabolic – Diabetes, hyperthyroidism
- Autoimmune conditions
11
Q
What are the differentials with Amenorrhoea?
A
- Pregnancy
- Polycystic ovary syndrome
- Hypothalamic
12
Q
What are other mental health-related conditions associated with a weight loss history?
A
- Depression
- Anxiety
- OCD
- Substance misuse
13
Q
What are the clinical features of anorexia nervosa?
A
- Significantly low body weight (typically BMI <18.5) that is not due to another health condition
- Persistent pattern of behaviours to prevent the restoration of normal weight
- Compensatory behaviours aimed at reducing energy intake (restricted eating), purging behaviours (e.g. self-induced vomiting, misuse of laxatives), and behaviours aimed at increasing energy expenditure (e.g. excessive exercise)
- Intense fear of gaining weight
- Low body weight or shape is central to the person’s self-evaluation or is inaccurately perceived to be normal - may include repeated weighing, measuring and checking in the mirror.
14
Q
What types of eating disorders are there?
A
- Anorexia nervosa
- Bulimia nervosa
- Binge eating disorder (BED)
- Other specified feeding or eating disorders (OSFED): almost half of patients with eating disorders will actually have OSFED. This accounts for a variety of eating disorders that don’t quite fit into diagnostic criteria for the disorders above.
15
Q
What are clinical features of Bulimia Nervosa?
A
- Frequent, recurrent episodes of binge eating (e.g. once a week or more for three months)
- A binge eating episode is a distinct period of time during which the individual experiences a subjective loss of control over eating, eating notably more or differently than usual, and feels unable to stop or limit eating.
- Repeated inappropriate compensatory behaviours aimed at preventing weight gain (e.g. self-induced vomiting, misuse of laxatives or enemas, strenuous exercise, continuing attempts to restrict intake)
- The individual is preoccupied with body shape or weight, which strongly influences self-evaluation.
- There is marked distress about the pattern of binge eating and inappropriate compensatory behaviour or significant impairment in psychosocial function.
- Body weight or BMI may be normal or above average
17
Q
What are physiological complications of eating disorders
A
19
Q
What is re-feeding syndrome?
A
- Occurs 1-5 days after eating is reinstated following period of starvation
- Rapid shifts of electrolytes back into cells from which they had, during starvation, been leached out
- It occurs due to change in metabolism from a catabolic state (breaking down fats/protein) to an anabolic state (metabolising carbohydrates to rebuild tissues).
- This change alters hormone secretions which contribute to the shift in electrolytes. As the body is so in need of nutrients to rebuild cells, it moves electrolytes from the blood to the cells. This causes severe electrolyte disturbances which can have serious consequences.
- Electrolytes affected: phosphate, potassium, magnesium, calcium, thiamine,
22
Q
What is the MARSIPAN checklist?
A
an aide-mémoire for the points that require attention when a severely ill patient with anorexia nervosa is admitted to a medical unit
