Eating Disorders Flashcards

Question

NOTE from lecture: common myth is that if you binge and vomit you must have bulimia but in fact you could have binge purge AN. It's about BMI and other endocrine disturbances (based on current ICD-10 criteria)

Answer 1

* **Potentially life-threatening** condition defined by **severe electrolyte and fluid shifts** as a result of a r**apid reintroduction of nutrition** after a period of **inadequate nutritional intake.** * Route of nutrition does not affect risk * Biochemical features: * **Hypophosphataemia** * Hypomagnesaemia * Hypokalaemmia * Fluid shifts/abnormalities in fluid balance *\*High carboydrate feeding is most risky!*

Answer 2

* In starvation, secretion of insulin is decreased because there is reduced intake of carbohydrates * In starvation, body uses fat & protein stores to produce energy * During prolonged starvation several intracellular minerals become depleted however plasma concentrations often remain normal (as most of minerals intracellular). * When re-introduce food, glycaemia causes insulin surge and you get a sudden shift from fat catabolism to carbohydrate catabolism * Insulin stimulates glycogen, fat & protein synthesis; all of which requier minerals such as phosphate, magnesium & co-factors such as thiamine * Phosphate, magnesium & potassium are taken up by cells and water follows by osmosis * Decreases plasma concentration of phosphate, magnesium & potassium * Furthemore, the change in carbohydrate metabolism causes an increase in Na+ and water retention so if you hydrate pt with aim of achieving normal fluid output they will become quickly fluid overloaded

Answer 3

* Fatigue * Weakness * Confusion * Arrhythmias * Difficulty breathing * Hypertension * Oedema * Heart failure

Answer 4

Phosphate depletion causes reduction in cardiac muscle activity which can lead to cardiac failure

Answer 5

* Identify risk (use MUST screening tool) * Measure serum electrolytes prior to feeding (phosphate, magnesium, potassium, calcium) * If low, replace orally or IV. Consider replacement of thiamine and other vitamins. *\*NOTE: latest guidance says you can correct fluids, electrolytes and vitamins as you start feeding- don't have to correct before as this prolongs malnourishment* * Slow initial feed rate/low calorie intake and gradually increase every 5 days * Monitor bloods * Monitor for clinical features of refeeding syndrome e.g. hypertension, oedema, tachycardia

Answer 6

* Slow done rate of feeding/decrease calories * Replenish electrolytes & vitamins

Answer 7

* Cardiac failure * Seizures * Respiratory failure * Renal failure * Death

Answer 8

* Recovery * Soruces vary from 25% to 46% (NICE) making full recovery * 34% partial recovery * 20% chronic anorexia nervosa * Relapse is common (30%) and is most likely in first year * Mortality rates are \>5x higher for people with anorexia nervosa

Answer 9

Ego-systonic *(it feels right so people don't want to stop)* Other factors include: * AN helps them manage their emotions * Helps them control relationships (e.g. might fear partner will leave if get better but won't leave an ill person) * Helps them communicate (if they get better people will think they are okay but they aren't) * Self-esteem (being really good at losing weight increases their self-esteem)

Answer 10

Eating disorder characterised by **repeated episodes**of **uncontrolled binge eating** followed by **compensatory weight loss behaviours** and **overvalued ideas regarding ideal body shape/weight.**

Answer 11

* Adolescence- young adult (age of presentation of BN is slightly later than AN) * More common in females (male:female, 1:10) * Equal socioeconomic class distribution unlike AN which is more common in higher classes * BN could develop as sequel to persistent AN pts (e.g. start to recover but then become BN) and vice versa

Answer 12

*\*NOTE: role of genetics in BN is unclear but in AN there is clear genetic link*

Answer 13

* Get strong cravings * Binge eat * Then feel guilty about binge eating * Then do compensatory behaviours e.g. self-induced vomitting, exercising excessively, laxative abuse or alternate binge eating with prolonged periods of starvation

Answer 14

* **Purging type:** pt uses self-induced vomiting and other ways of expelling food from body (e.g. laxatives, enemas, diuretics) * **Non-purging type:** pt used excessive exercise or fasting after a binge. Purging types may also exercise and fast but this is not the main form of weight control for them * \*PURGING type is most common*

Answer 15

* **Behaviours to prevent weight gain to compensate for binge eating** * **Preoccupation with eating** *(a sense of compulsion/craving to eat which leads to bingeing. Bingeing typically followed by regret or shame)* * **Fear of fatness *(****pt sets themselves sharply defined weight threshold, well below the premorbid weight that constitutes the optimum or healthy weight in the opinion of the physician)* * **Overeating** *(rule of thumb should be at least 2 episodes per week over a period of 3 months but ICD-10 does not specify this)*

Answer 16

* **Normal weight:** *usually potential for weight gain from bingeing is counteracted by weight loss behaviours* * **Depression and low self-esteem** * **Irregular periods** * **Signs of dehydration** *(decreased BP, dry mucous membranes, increased cap refill time, decreased skin turgor, sunken eye* * **Often a history of AN** *(AN may not have been fully expressed/just seen as minor episode)*

Answer 17

* Self-induced vomiting * Alternating periods of starvation * Drugs * Laxatives * Apetite supressants * Thyroxine * Amphetamines * Diuretics * Excessive exercise * Omit or reduce insulin if diabetic (diabulimia)

Answer 18

* Depression * Anxiety * DSH * Substance misuse * EUPD

Answer 19

* \<3.5mmol/L * See image for clinical features * ECG: * Flattened/inverted T * Prominent U wave * Increase P wave amplitude * Prolonged PR * Management: * Mild (3-3.4): oral replacement e.g. K+ rich foods and/or oral supplements (Sando-K) * Severe (\<2.5): IV K+ replacement

Answer 20

_Bedside_ * ECG: *check for arrhythmias as consequence of hypolakaemia* * VBG: *check electrolytes quickly, may show metabolic akalosis from vomiting* * Plasma glucose _Bloods_ * FBC: *may be anaemic* * U&Es: *check for hypokalaemia, urea may be raised if dehydration* * LFTs: *drug overdose or excessive exercise may elevate* * CK: *drug overdose or excessive exercise may elevate* * Magnesium: *may be low* * Phosphate: *may be low* * Calcium: *may be low* _Imaging/other_ * ?dexa scan

Answer 21

* Anorexia nervosa with bulimic symptoms * EDNOS * Depression * OCD * Organic causes of vomiting e.g. gastric outlet obstruction

Answer 22

* Dehydration * Pancreatitis * Hypokalaemia * Oesophageal rupture * Tooth erosion * Irregular periods

Answer 23

_First line:_ * **CBT- BN** *(CBT specifically designed for BN)* * or **family therapy** *(children)* * **Nutrition counselling** by trained dietician * **Meal support** (therapist can give techniques to avoid binge eating e.g. eating in comppany, distractions, manageing triggers) * **Support groups** _Other options if above doesn't work:_ * SSRIs (fluoxetine 60mg) BUT less effective than CBT * Other psychotherapies e.g. interpersonal therapy

Answer 24

* Risk assessment * Monitoring of electrolytes

Answer 25

* Better recovery rates & lower mortality than anorexia nervosa * 30-60% make full recovery * Nature of illness is often relapsing & remitting

Answer 26

Recurrent episodes of binge eating withouth compensatory behaviours

Answer 27

1/3, could be: * Atypical AN * Atypical BN * Binge eating disorders * Others which defy classification *\*Idea that can think of as on a spectrum and may not completely fit into one diagnosis*

Answer 28

* Wants to change but not progressing with outpatient treatment * Immediate danger * No adequete treatment locally

Answer 29

* Pt has motivation to change * Short duration of illness * Level of severity/mild * Onset in adolescence * Good family function * Lack of comorbid conditions

Eating Disorders Flashcards

(65 cards)