Eating disorders Flashcards by Emily Ong

Describe some cardiovascular complications in A/N

hypotension
arrythmia
bradycardia
prolonged QT
hypercholesterolaemia (HDL)

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Describe GI complications A/N

Swollen salivary glands
Dental Caries - erosion of enamel
Delayed gastric emptying
bloating
constipation

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Describe metabolic complications A/N

hypothermia
dehydration
electrolyte disturbance - low K+ Mg2+ Ca2+ Po43- 
hypoglycaemia
high LFTs

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Describe MSK complications of A/N

cramp
tetany
weakness
osteoporosis
fracture
high CK due to muscle breakdown

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Describe endocrine complications of A/N

LOW:
-estrogen
-testosterone
-gonadotrophin
-thyroxine
HIGH:
-cortisol

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Describe renal complications of A/N

nocturia
acute renal failure
chronic renal failure
psychogenic polydipsia

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Haematological complications A/N

Anaemia 
decrease WBC count
Thrombocytopenia
iron deficiency
B12 and folate deficiency

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Describe how serotonin systems are affected in A/N

serotonin systems implicated in regulation of feeding and mood
remain altered in A/N even after weight recovery

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What are the five main eating disorders?

anorexia nervosa
bulimia nervosa
EDNOS (eating disorder not otherwise specified - features of ED’s but not in any category)
Binge eating disorder
ARFID (avoidant/restricted food intake disorder- only eat narrow/restricted range of food)

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describe the 4 different areas concerned with the aetiology of eating disorders

Genetic:
-influence of variant genes on control appetite and feeding via hypothalamus (leptin/ghrelin)
-personality type e.g. anorexia and controlling pers.
-10X risk in families with affected individual
Environmental
-in utero nutrition
-childhood adverse experiences
Developmental (puberty)
Brain chemistry

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What are the five diagnostic criteria for Anorexia Nervosa?

BMI of 17.5 or less
Self induced weight loss (strict dieting/vomiting/excessive exercise/medication)
Body image disturbance
Fear of fatness (egosyntonic emaciation)
Amenorrhea (this can occur befor significant weight loss and gonadotropin abnormalities can persist after weight recovery)

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What are the 7 starvation effects on the brain?

loss grey/white matter
increase in compulsive behavior
decrease in social skills
enhanced response to hedonic/nutrostat signals
Focus on food
Poor conc/decision making
New learning stunted

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What are hedonic signals?

Reward/pleasure component of eating

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What are nutrostat signals?

Hunger/satiety

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In an anorexic patient why might their HCT/Na+ be low?

due to water loading

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In an anorexic patient what might be seen on ECG

bradycardia and can get sudden death

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In an anorexic patient what might be shown on DEXA scan

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decrease in bone density even after 1 year amenorrhea

What is the squat test for anorexic patients?

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do they have to use their arms to get up?

Why is checking core temperature important for anorexic patients?

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risk hypothermia

what BMI consitutes low-moderate/moderate/high/v.high risk?

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Low/mod: BMI 16-17.5 - safely managed as outpt
Mod: BMI 15-16 - often independant lives
High: BMI 13-14.9
V. high: BMI <13 - inpatient

Describe the risk assessment for a high risk anorexic patient

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BMI <13, wt loss >1kg a week
Prolonged QT, HR <40, sys BP <80
Core temp. <34
Unable to rise from squat without using arms
Cognitive impairment

What is MARSIPAN?

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Management of really sick patients with anorexia nervosa

RCPsych, RCPhys
aim to decrease mortalitiy of starve pt. with AN

What is the eden unit?

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-Psych ward for medically stable pts. (arranged in advance)

What is the evidence based treatment for AN in adolescents

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Family therapy for adolescents

What is refeeding? How to prevent?

Caused by depletion of already inadequate stores of nutrients which are used up quickly as body tries to repair itself Prevented by frequent blood monitoring and slow pace refeeding.

For Anorexia nervosa what is: - age onset - lifetime prevalence females/males - F:M - mortality

- onset 9-24yrs - lifetime prevalence 1-2.2% females, 0.2-0.3% males - 10:1 F:M - mortality up to 20%, (50% of these due to suicide)

describe the biological, physiological, psychological and social aetiologies of anorexia nervosa

``` Biological -genetic (50-75% heritability, 10Xrisk in affected families) -puberty -wt loss -starvation effects Physiological (improves with refeeding) -decreased memory/attention -brain atrophy -hypothalamic dysfunction Psychological -low self esteem -perfectionist/obsessional -black/white thinking -adolescence -child sexual abuse Social - western culture and expectations -family environment -school (bullying/academic pressure) ```

Describe some clinical signs seen in Anorexia Nervosa

- muscle wasting - hair loss - lanugo hair - cold, blue peripheries - dry skin - hypercarotenaemia - bradycardia/hypotension - bruising

Describe what is involved in the long term treatment of anorexia nervosa

``` family therapy dietician medical monitoring psychological therapies - CBT art/drama therapy ```

What are assoc. co-morbidities of anorexia nervosa

depression OCD substance misuse DM

What is the prognosis for anorexia nervosa?

- the higher the duration and the lower the BMI the worse the prognosis - 80% good recovery - 30% develop binge eating disorder - 20% mortality

What are the 4 diagnostic criteria for bulimia nervosa?

- persistant preoccupation with eating - irresistable craving for food - binges and attempts to counteract them (starvation/vomiting/laxatives) - morbid dread of fatness

what is the age onset and lifetime prevalence Bulminia nervosa

onset - late teens | lifetime prevalence - 1.5-2% females, 0.5% males

Describe the physical, psychological and social aetiologies of bulimia nervosa

physical - genetic/puberty/childhood obesity psychological - impulsive personalities social - cultural factors more relevant/access to large amounts of processed food/wt gain undesirable

Describe the signs seen in patients with bulimia nervosa

russells sign - calluses on knuckles from induced vomiting with fingers parotid gland hypertrophy dental caries - from vomiting

What are the medical complications of bulimia nervosa?

``` oesophageal reflux/tears/ruptures hypokalaemia subconjunctival haemorrhage dehydration siezures - metabolic abnormalities ```

What is the evidence based treatments for bulimia nervosa?

- guided self help - CBT - SSRI

What is the prognosis for bulimia nervosa

- >50% good recovery with treatment - 10-20% symptomatic up to 10years - core cognitive distortions might persist - worse with co-morbid substance misuse

What is binge eating disorder and why is it different from bulimia/anorexia?

- episodes of compulsive overeating - taste and quality food important - no compensatory behavior - body wt/shape is less important to self-esteem than bulimia nervsa

What is the lifetime prevalence of binge eating disorder?

3.5% females, 2%males - increasing prevalence | 1/3 obese patients

Eating disorders Flashcards

(40 cards)