Eating Disorders

Question 1

What does anorexia nervosa literally mean?

Answer 1

Nervous absence of appetite

Question 2

What happens if the onset of anorexia is pre-pubertal?

Answer 2

The sequence of pubertal events is delayed or even arrested (growth stops; in girls the breasts don’t develop and there is primary amenorrhoea; in boys the genitals remain juvenile

Question 3

What happens to pubertal events after recovery?

Answer 3

Puberty is often completed normally, but the menarche is late.

Question 4

What % of weight below that of normal is classified as anorexia?

Answer 4

15%

Question 5

The weight loss is ____ _______ by avoidance of ‘fattening foods’

Answer 5

Self - induced

Question 6

What leads to a self-imposed low weight threshold?

Answer 6

A self perception of being too fat
+
Intrusive dread of fatness

Question 7

Outline the 4 main areas of anorexia.

Answer 7

1. Weight loss
2. Self induced by avoidance
3. Self perception of being fat + dread of fatness
4. Widespread endocrine disorder

Question 8

What is AN characterised by?

Answer 8

Distorted body image and excessive dieting that leads to severe weight loss, with a pathological fear of becoming fat

Question 9

What are the 2 subtypes of AN?

Answer 9

• Restricting.

* Binge-eating/purging

Question 10

Outline the key features of AN.

Answer 10

• Persistent restriction of energy intake leading to significantly low body weight (in context of what is minimally expected for age, sex, developmental trajectory, and physical health)
• Either an intense fear of gaining weight, or of becoming fat, or persistent behaviour that interferes with weight gain (even though significantly low weight)
• Disturbance in the way one’s body weight or shape is experienced, undue influence of body shape and weight on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight

Question 11

Outline the ICD-10 criteria for anorexia.

Answer 11

1. BMI <17.5 or less
2. Self induced weight loss
3. Body image disturbance
4. Fear of fatness
5. Amenorrhoea

Question 12

List the things that should be considered during a physical examination of someone with AN.

Answer 12

Muscle wasting
Hair loss
Lanugo hair (baby hairs)
Cold, blue peripheries
Dry skin
Hypercarotenaemia
Bradycardia, hypotension
Bruising

Question 13

What co-morbid conditions are often associated with AN?

Answer 13

Depression
ODC
Substance misuse
Diabetes mellitus

Question 14

How can people with DM control their weight?

Answer 14

By not taking insulin

Question 15

List those who are classified as ‘high risk’ in AN.

Answer 15

BMI <13 
Weight loss >1kg per week
Prolonged QT, HR<40 or systolic BP <80
Core temperature <34
Unable to rise from squat without using arms for leverage
Cognitive impairment

Question 16

Scott Test - what is this?

Answer 16

Get patient to lie on floor and sit up without using their hands

Question 17

Outline the scores for Scott test.

Answer 17

0- Unable
1- Only able when using hands
2-

Question 18

What 4 investigations should always be done in someone who presents with AN?

Answer 18

FBC – usually maintained
Biochemistry – U+E’s
ECG
DXA

Question 19

Why is a DXA done?

Answer 19

Bone scan - to look for osteoporosis

Question 20

Why is an ECG done?

Answer 20

To look for bradycardia and QT prolongation

Question 21

What 4 things should be looked for in blood tests?

Answer 21

GGT
ALT
Protein
Albumin

Question 22

Describe ‘re-feeding syndrome’.

Answer 22

Caused by depletion of already inadequate stores of nutrients e.g Mg, K, phosphate which are quickly used up as body starts to repair itself

Question 23

How can re-feeding syndrome be prevented?

Answer 23

Prevent by frequent blood monitoring and slow pace of initial refeeding

Question 24

MAESIPAN stands for?

Answer 24

Management of really sick patients with anorexia

Question 25

What is the aim of MAESIPAN?

Answer 25

Aim to reduce mortality of starved patients admitted to medical wards

Question 26

Outline some physiological managements of a patient with AN.

Answer 26

``` CBT Dietician Medical monitoring Art therapy/ drama therapy Family therapy Inpatient treatment for high risk (MHA) ```

Question 27

If someone is refusing, or not consenting to artificial feeding, you can start in an emergency under the mental health act but this only lasts a few days

Answer 27

TRUE

Question 28

What 4 things does the Mental Health Act encompass?

Answer 28

Capacity Risk Reciprocity Artificial feeding

Question 29

Outline the ICD-10 criteria for bulimia nervosa.

Answer 29

1. Persistent preoccupation with eating 2. Irreversible craving of food 3. Binges 4. Affects to counter the effects of binging 5. Morbid dread of fatness

Question 30

How might someone counter the effects of binging?

Answer 30

Starvation Vomiting Laxatives Drug misuse

Question 31

What should be looked for on examination of a patient with Bulimia?

Answer 31

Parotid hypertrophy Dental caries U+E’s Russel's sign

Question 32

What is Russels sign?

Answer 32

Abrasions of the hand from the patients teeth rubbing when they stick their fingers down their throat

Question 33

What should be included in a physiological assessment of someone with an eating disorder?

Answer 33

Depression Self harm Substance misuse Impulsive personality

Question 34

List some medical complications of eating disorders.

Answer 34

``` Oesophageal reflux Oesophageal tears/ruptures Hypokalaemia Subconjunctival haemorrhage Dehydration Seizures – metabolic abnormalities ```

Question 35

Outline the management of someone with Bulimia.

Answer 35

Guided self help – manuals CBT SSRI