Eating Disorders

Question 1

What is the criteria for Diagnosing Anorexia Nervosa?

Answer 1

• BMI <17.5
• SELF-INDUCED WGT loss (strict dieting, vomiting, excessive exercise,meds)
• body image disturbance
• fear of FATNESS
• amenorrhoea for MORE than 3 Months

Question 2

What should be considered when diagnosing a pt with an eating disorder?

Answer 2

-a pt may come in WITHOUT falling into the criteria of anorexia nervosa, BUT they may well be EXPERIENCING an eating d.o ( starving themselves, may still be plump)

Question 3

What is the importance of not dxing a pt with an eating disorder without solely looking at their BMI?

Answer 3

• anorexia nervosa is a SECRETIVE condition

- recognizing that it is an eating disorder allow medical intervention to occur well before the BMI drops really low

Question 4

WHat makes some individuals more vulnerable to Anorexia Nervosa than others?

Answer 4

• some are genetically inclined

- some have VULNERABLE to environmental triggers

Question 5

What are the physical features of Anorexia Nervosa?

Answer 5

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

Question 6

What shoudl you search for during psychological assessment of anorexia nervosa?

Answer 6

• Depression
• OCD
• SUBSTANCE MISUSE
• DM

Question 7

What are the benchmarks for those at HIGH risk?

Answer 7

• BMI< 13
• wgt loss >1kg/week
• prolonged QT, HR <40
• systolic BP <80
• core temp. <34*C
• cognitive impairment

Question 8

What is one test that can be performed for assessing the severity of Anorexia Nervosa?

Answer 8

• ask pt to rise from SQUAT
  (without using arms for leverage)

3: ABLE, no difficulty.
2: ABLE, with some DIFF.
1: able only USING HANDS

Question 9

What investigations can be performed on an Anoxieria nervosa patient?

Answer 9

• hematology
• biochem.
• ECG
• DXA (bone density)

Question 10

What lab abnormalities would be seen in anorexia nervosa?

Answer 10

• • hypoglycemia
• Leukopenia
• elevated liver enzymes
• EUTHYROID sick syndrome (Low TSH, normal T3 and T4)

Question 11

What is refeeding syndrome?

Answer 11

-the FATAL shifts in FLUIDS and ELECTROLYTES that may occur in MALNOURISHED patients after artificial feeding

Question 12

How does the refeeding $ develop?

Answer 12

• shift from FAT to carbohydrate metabolism
• > glucose load will evoke a INSULIN release; triggers incr. CELLULAR uptake of glucose, K, PO-, Mg. ( further depletion of INADEQUATE stores of nutrients)

Question 13

How to prevent refeeding $?

Answer 13

• by frequent BLOOD monitoring
• freq. ECG monitoring to avoid fatal arrhythmias
• slow pace of initial feeding

Question 14

What are the risks of refeeding syndrome?

Answer 14

• body-fluid imbalances, vit. deficiency, electrolyte disturbances> FATAL CARDIOPULMONARY dysfxn

Question 15

What specific management is set up for those with Anorexia Nervosa?

Answer 15

• MARSIPAN (managem. of really SICK pts with anorexia nervosa)
• RCPsych, RCPhysicians
• AIM: TO REDUCE the mortality of starved pts

Question 16

What psychological forms of management is available for AN pt??

Answer 16

• CBT
• dietitian
• medical monitoring
• art therapy
• family therapy
• InPATIENT rx

Question 17

How is Bulimia Nervosa diff?

Answer 17

• persistent preoccupation with eating
• IRRESISTIBLE craving for food
• BINGES
• attempts to COUNTER effects of binges (staarving, vomiting, laxatives, drug misuse)
• MORBID DREAD of fatness
• body dysmorphic $

Question 18

What is seen on physical assessment?

Answer 18

• calluses on knuckles (from forcing fingers down the throat)
• parotid HYPERTROPHY (excessive salivation post every vomitting sesh)
• dental caries (ENAMEL erosion)
• • cardiomegaly
• U &Es

Question 19

What should BN pts be screened for?

Answer 19

• depression
• self harm
• substance misuse
• impulsive personality

Question 20

What are medical complications of BN?

Answer 20

• esophageal reflux/ tears/ ruptures
• hypokalaemia
• subconjunctical hemorrhage
• dehydration
• seizures (metabolic imbalance)

Question 21

How to manage BN?

Answer 21

• guided self help
• CBT
• SSRI

Question 22

What ECG findings are seen with anorexia nervosa and bulimia nervosa?

Answer 22

• LOW voltage
• Prolonged QT interval
• Brady cardia

Question 23

What lab abnormalities are seen with BULIMIA NERVOSA?

Answer 23

• hypochloremic
• hypokalemic
• metabolic acidosis (from LAXATIVES and DIURETICS)
• elevated salivary AMYLASE (also seen in the purging subtype of ANOREXIA nervosa)

Question 24

What is seen from medical HX of bulimic pt?

Answer 24

• bloating
• fullness
• GERD
• lethargy
• abdominal pain
• sore throat