Eating disorders Flashcards
(29 cards)
What is bulimia?
Episodes of binge eating followed by intentional vomiting / laxative use / excersizing
ICD 10 diagnostic criteria for bulimia?
Binging/overeating or persistent preoccupation with eating. (MAIN SYMPTOM)
Purging behaviours (excessive exercise, vomiting, laxatives, diuretics).
Psychopathology (loss of control, body image distortion, dread of fatness).
* tend to be a normal / increased weight due to the bingin g
Referral pathway name for patient:
- moderate anorexia : (BMI 15-17, no evidence of system failure)
Routine referral CEDS
When managing an anorexic patient need to screen to assess whether they need immediate admission - what to look for?
BMI <13
Weight loss of >1kg/week
Septic signs - cold peripheries
HR <40bpm
Suicide risk
Treatment for child anorexia?
1st line - Family therapy
2nd line - CBT - ED
Bedside test to assess anorexia?
SUSS test:
Sit up and squat stand : assess muscle wasting
- inability to stand up from a chair without using their hands - red flag sign
Do you use watchful waiting for bullimia and when?
Mild bullima?
Moderate bulima?
Severe bulimia
No watchful waiting ever
mild - infrequent binge+purse <2 a week -> monitor 12 weeks
mod - frequent binge + purge >2 a week -> monitor 8 weeks and refer to CEDS if needed
severe - daily purging with electrolyte imbalance -> urgent CEDs referral
Do you use watchful waiting for bullimia and when?
Mild bullima?
Moderate bulima?
Severe bulimia
No watchful waiting ever
mild - infrequent binge+purse <2 a week -> monitor 12 weeks
mod - frequent binge + purge >2 a week -> monitor 8 weeks and refer to CEDS if needed
severe - daily purging with electrolyte imbalance -> urgent CEDs referral
[Anorexia]
What red flag symptoms to look out for?
Postural tachycardia
Hypotension
bradycardia <50
Failed sit up squat stand test
Main complication with treating ED is refeeding syndrome - how to diagnose?
refeeding syndrome: occurs with the sudden reversal of prolonged starvation, leading to large shifts in electrolytes from blood into cells. Leads to extremely low levels in blood, which can cause cardiac arrest, respiratory and organ failure. Typically seen in first 72 hrs of refeeding.
Low potassium, phosphate and magnesium (DEFINED BY LOW PHOSPHATE MAINLY).
Blood test for anorexia? (4 Cs, 2 Gs will be high)
High (4Cs + 2Gs)
- cortisol, cholesterol, CK, carotenaemia
- GH, glands (salivary)
*most other things will be low in this patient)
What disturbances may be seen in anorexia?
- hormones?
- Raised cortisol
- Growth hormone
- Low T3
- FSH / LH / E2 / Testosterone
- Impaired glucose tolerance
- bad stuff is increased such as cortisol, GH
Adult management of anorexia - MANTRA?
(Maudsley Anorexia Nervosa Treatment for Adults
Clinical signs of recurrent vomiting in bulimia?
- erosion of teeth
- russel’s sign (calluses on the knuckles) from self induced vomiting
What is EDNOS?
Eating Disorder Not Otherwise Specified. Most commonly diagnosed eating disorder. Diagnosis that is often received when an individual meets many, but not all, of the criteria for anorexia or bulimia.
Referral pathway name for patient:
- Mild anorexia : (BMI>17, no additional co-morbiditiy)
Monitor + give advice for 8 weeks
BEAT charity support
Referral pathway name for patient:
- severe anorexia : (BMI<15, rapid weight loss, evidence of system failure)
CEDS
Community eating disorder services
Bulimia management for adults vs children?
What is the name of the clinical sign of calluses on knuckles from forced vomiting?
Russel’s sign = bullimia
What will be seen on ECG of a bulimic?
Hypokalaemia due to vomiting -> 1st degree heart block, tall P-waves, flattened T waves
What is binge eating disorder?
Consume excessive amount of food in relatively short period of time.
However, unlike bulimia, there is no compensatory behaviours such as vomiting, laxatives or excessive exercise.
For diagnosis, must occur at least once per week for at least six months.
Features of:
Moderate bulima?
mod - frequent binge + purge >2 a week -> monitor 8 weeks and refer to CEDS if needed
Features of:
Severe bulimia
severe - daily purging with electrolyte imbalance -> urgent CEDs referral
