Flashcards in Eating disorders Deck (46):
What is anorexia nervosa?
Eating disorder characterised by deliberate weight loss, intense fear of fatness, distorted body image, endocrine disturbances.
What are the predisposing factors to anorexia nervosa? (Biopsychosocial).
Bio - genetics, family history, female, early menarche.
Psycho - sexual abuse, preoccupation with slimness, dieting behaviour early on, low self-esteem, premorbid anxiety or depression, perfectionism, obsessional/anankastic personality.
Social - Western society, bullying at school about weight, stressful life events.
What are the precipitating factors for anorexia nervosa? (Biopsychosocial).
Bio - adolescence and puberty.
Psycho - criticism about eating, body shape, weight.
Social - occupational or recreational pressure to be slim from media etc.
What are the perpetuating factors of anorexia nervosa? (Biopsychosocial).
Bio - starvation leads to neuroendocrine changes which perpetuate anorexia.
Psycho - perfectionism, obsessional/anankastic personality.
Social - occupation, Western society.
What are the physical features of anorexia nervosa?
Fatigue, bradycardia, arrhythmias, peripheral oedema (hypoalbuminaemia), headaches, lanugo hair.
What are the non-physical features of anorexia nervosa?
Preoccupation with food. Socially isolated, sexually feared. Depression and obsessions.
What are the ICD-10 criteria for diagnosing anorexia nervosa?
Fear of weight gain, endocrine disturbance (amenorrhoea, loss of sexual interest), emaciated BMI <17.5kg/m^2, deliberate weight loss, distorted body image, 3mo + absence of recurrent episodes of binge eating + absence of preoccupation with eating/craving to eat.
What are the metabolic complications of anorexia nervosa?
Hypokalaemia, hypercholesterolaemia, hypoglycaemia, impaired glucose tolerance, deranged LFTs, increased urea and creatinine, low potassium, low phosphate, low magnesium, low albumin, low chloride.
What are the endocrine complications of anorexia nervosa?
High cortisol, high growth hormones, low T3 and T4, low LH, FSH, oestrogens, progesterogens --> amonorrhoea, low testostosterone.
What are the GI complications of anorexia nervosa?
Enlarged salivary glands, pancreatitis, constipation, peptic ulcers, hepatitis.
What are the CVS complications of anorexia nervosa?
Cardiac failure, ECG abnormalities, arrhythmias, hypotension, bradycardia, peripheral oedema.
What are the renal complications of anorexia nervosa?
Renal failure, stones.
What are the neurological complications of anorexia nervosa?
Seizures, peripheral neuropathy, autonomic dysfunction.
What are the haematological complications of anorexia nervosa?
Iron deficiency anaemia, thrombocytopenia, leucopenia.
What are the MSK complications of anorexia nervosa?
Osteoporosis, proximal myopathy.
What are the general complications of anorexia nervosa?
Hypothermia, dry skin, brittle nails, lanugo hair, infections, suicide.
Which points should be covered in a history about anorexia nervosa?
Fear of weight gain, overvalued ideas about weight, deliberate weight loss, amenorrhoea, physical symptoms.
What would the MSE findings be of anorexia nervosa?
Appearance - thin, weak, slow, makeup to disguise emaciation, dry skin, lanugo hair.
Behaviour - anxious.
Speech - slow, slurred, or normal.
Mood - low or euthymic.
Thought - preoccupation with food, overvalued ideas about weight and appereance.
Perception - normal.
Cognition - normal or poor if physically unwell.
Insight - poor.
What are the investigations for anorexia nervosa?
Bloods - FBC for anaemia, thombocytopenia, leukopenia; U+Es for high urea and creatinine; low K, Mg, Cl; TFTs; LFTs for low albumin; lipids - high cholesterol; high cortisol; sex hormones for low LH, FSH, oestrogens and progestogens; low glucose; amylase for pancreatitis is complication.
VBG: metabolic alkalosis from vomiting, metabolic acidosis from laxatives.
DEXA scan for osteoporosis.
ECG for arrhythmias, bradycardia, prolonged QT.
What are the differentials for anorexia nervosa?
Bulimia nervosa but no binge eating; eating disorder not otherwise specified - doesn't meet ICD-10 criteria; depression; OCD; schizophrenia with delusions about food; organic cause - diabetes, hyperthyroidism, malignancy; alcohol or substance misuse.
How is anorexia nervosa managed?
Risk assessment for suicide and medical complications.
Inpatient goal of 0.5-1kg gain/week, outpatient 0.5kg/week. Hospitalisation if BMI <14. SSRIs, treat medical complications. Psychoeducation, CBT, cognitive analytic therapy, interpersonal psychotherapy, family therapy. Voluntary organisations, self-help groups.
What is refeeding syndrome?
Prolonged starvation means when food is eaten, there's a huge insulin surge -> hypokalaemia, hypomagnasaemia, hypophosphataemia, abnormal glucose metabolism.
How is refeeding syndrome managed?
Measure serum electrolytes and monitor refeeding bloods daily.
What is bulimia nervosa?
Eating disorder with repeated episodes of uncontrolled binge eating followed by compensatory weight loss behaviours and overvalued ideas about ideal body shape/weight.
What is the cycle in bulimia?
Sense of compulsion to eat -> binge eating -> fear of fatness -> compensatory weight loss behaviours -> sense of compulsion to eat etc.
What are some compensatory behaviours in bulimia?
Vomiting, laxatives, exercising excessively.
What is the demographic affected by bulimia mostly?
Young women, 15-40 years, 1-2% prevalence in women.
What are the biological predisposing factors for bulimia?
Female, family history, early onset puberty, type 1 diabetes, childhood obesity.
What are the psychological predisposing factors for bulimia?
Abuse, childhood bullying, parental obesity, mental health disorder, preoccupation with slimness, parents with high expectations, low self-esteem. Co-morbid depression, anxiety, deliberate self-harm, EUPD.
What are the precipitating factors for bulimia? (Biopsychosocial).
Bio - early onset puberty/menarche
Psycho - perceived pressure to be thin, criticism about body weight or shape.
Social - environmental stressors, family dieting.
What are the perpetuating factors for bulimia? (Biopsychosocial).
Bio - co-morbid mental health problems.
Psycho - low self-esteem, perfectionism, obsessional personality.
Social - environmental stressors.
What are the clinical features of bulimia?
Normal weight, depression and low self-esteem, irregular periods, signs of dehydration, hypokalaemia.
What is the key electrolyte disturbance in bulimia?
Hypokalaemia due to repeated vomiting.
What are the signs of hypokalaemia?
Muscle weakness, cardiac arrhythmias, renal damage.
How is hypokalaemia managed?
Mild - oral replacement and/or supplements.
Severe - hospitalisation and IV K+ replacement.
What are the ICD-10 criteria for bulimia nervosa?
Compensatory behaviours (vomiting, starvation, drugs, excessive exercise), preoccupation with eating (compulsion leads to binges), fear of fatness, overeating (2/week for 3mo +).
What are the two subtypes of bulimia nervosa?
Purging - self-induced vomiting and other ways of expelling food from the body.
Non-purging - less common, use excessive exercise or fasting after binge.
What are the CVS complications of bulimia?
Arrhythmias, mitral valve prolapse, peripheral oedema.
What are the GI complications of bulimia?
Mallory-Weiss tear, increased size of salivary glands.
What are the metabolic complications of bulimia?
Dehydration, hypokalaemia, renal stones, renal failure.
What are the dental complications of bulimia?
Permanent erosion of enamel.
What are the endocrine complications of bulimia?
Amenorrhoea, irregular menses, hypoglycaemia, osteopenia.
What are the dermatological complications of bulimia?
Russell's signs (calluses on back of hands due to abrasion against teeth).
What are the pulmonary complications of bulimia?
What are the neurological complications of bulimia?
Cognitive impairment, peripheral neuropathy, seizures.