1
Q
2 main EDs
A
- anorexia nervosa
- bulimia nervosa
2
Q
clinical features: anorexia
A
UNDER-exia
* Underweight BMI <17.5
* Nervousness about weight and gaining
* Distorted perceptions
* Excessive excercise (vomiting or abusing laxatives can also be used)
* Restricting calories
3
Q
ref flags: anorexia nervosa
A
- BMI <13
- weight loss >1kg/week
- BP <80/50
- pulse <40
- O2 sats <82%
- limbs cold and blue
- muscles - unale to get up without using forearms for leverage
- purpura on skin
- bloods: hyponatraemia <130, hypokalaemia <2.5 and hypophosphataemia <0.5
- ECG long QT and flat T waves
4
Q
SCOFF questionnaire: anorexia nervosa
A
- ever felt so uncomfortably full you have had to make yourself SICK?
- ever worry you have lost CONTROL over how much you eat?
- recently lost or gained more than ONE stone in 3 months?
- do you believe yourself to be FAT when others say you’re too thin?
- would you say that FOOD dominates your life?
score >2 indicates likely anorexia or bulimia
5
Q
complications: anorexia
A
- fatigue
- amenorrhea
- infertility
- osteoporosis
- electrolyte abnormalities
- cardiac arrhythmias
6
Q
epidemiology: anorexia
A
- F:M 4:1
- average age onset 15-16 and >30y is rare
7
Q
def: bulimia nervosa
A
BOWL-emia
* Binge eating
* Offsetting (purging)
* Weekly for 3 months
* Linked to self-esteem
normal/overweight
8
Q
complications: bulimia nervosa
A
- physical injury to mouth, teeth and oesophagus
- kidney damage - dehydration
- electrolyte abnormalities - met alkalosis (loss of stomach acid)
- changes to key hormone levels
- gastric ulcers
- oesophageal rupture (boerhaave symptoms)
9
Q
signs to look for: bulimia nervosa
A
- swollen salivary glands
- erosions of enamel
- injuries on back of knuckles from self-induced vomiting
10
Q
rx: bulimia nervosa
A
- support, food diary
- EDU (eating disorder unit)
- SSRI st line fluoxetine 60mg PO OD
- CBT
Year 4 Psychiatry
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