Eating disorders Flashcards
ICD-10 diagnosis of bulimia nervosa?
binge eating-persistent preoccupation with eating and irresistible food craving
counteracting weight gain (compensatory behaviours)-vomiting, laxatives, exercise, appetite suppressants, thyroxine, diuretics, insulin omission
overvalued idea-fear of fatness, low target weight
There is often, but not always, a history of an earlier episode of anorexia nervosa, the interval ranging from a few months to several years.
how do anorexia and bulimic patients differ in their appearance?
bulimic patients often of normal weight, so not always obvious to others that they are unwell
anorexia-patients appear thin
ICD-10 diagnostic criteria for anorexia nervosa?
all 4 of the following to be present: low body weight (weight maintained at least 15% below expected weight, or BMI less than 17.5) intentional weight loss-dieting, excessive exercise, self induced vomiting-often without the preceding overeating seen in bulimia nervosa, or use of laxatives-purging and diuretics to achieve weight loss, and use of appetite suppressants e.g. chewing gum and cigarettes body image distortion-overvalued idea- worry of getting fat-intense fear, low target weight, believe they are overweight even when they know they are not endocrine disturbance (amenorrhoea, raised GH and cortisol, decrease T3)
4 features that occur with repeated vomiting in an eating disorder?
calluses on the back of the hands-russell’s sign
eroded dental enamel
salivary gland enlargement
oesophageal tears-mallory-weiss-haematemesis
physical complications of an eating disorder?
osteoporosis liver failure anorexic hepatitis arrhythmias hypotension bradycardia heart failure-in severe AN as loss of muscle mass, including heart muscle peripheral oedema seizures depression cold intolerance amenorrhea and infertility dry, yellow coloured skin dizziness muscle weakness abdominal pain constipation BM suppression-decrease Hb, WCC, PLT extreme irritability peripheral neuropathy
features in the history of an eating disorder which suggest medical risk?
excess exercise with low weight
blood in vomit
inadequate fluid intake combined with poor eating
rapid weight loss
factors which disrupt ritualised eating habits e.g. journey, holiday, exam.
how can medical risk be screened for in patients with an eating disorder?
examination of muscle strength pulse BP peripheral circulation core temperature
types of anorexia nervosa as split using DSM-IV criteria?
restricting-patients maintain a low body weight only by restricting their dietary intake
purging- pts can lower their body weight by self induced vomiting, or using laxatives and diuretics
what behaviour associated with eating might anorexic patients display?
food avoidence order to eating own plate and cutlery separation of food on plate slow eating eating alone setting daily calorie limits
what is atypical anorexia nervosa?
Disorders that fulfil some of the features of anorexia nervosa but in which the overall clinical picture does not justify that diagnosis. For instance, one of the key symptoms, such as amenorrhoea or marked dread of being fat, may be absent in the presence of marked weight loss and weight-reducing behaviour. This diagnosis should not be made in the presence of known physical disorders associated with weight loss.
problems assoc with chronic laxative abuse in anorexia nervosa?
chronic constipation
disruption to magnesium levels, producing an atonic bowel
core psychopathology in anorexia nervosa?
disturbance of body image, believes they are overweight despite all evidence to the contrary
fear of fatness
valuation of self-worth as a function of weight and body shape, rather than usual values of society
what blood test results may be found in an anorexic patient?
FBC: low Hb, MCV may be raised, low WCC, low PLT
low glucose
low albumin
Us and Es: raised urea, low Na+, low K+
LFTs: raised bilirubin, ALT/AST, ALP and GGT
when might the MHA be required in the tment of anorexia nervosa?
Under the New MCA (2005) people lacking capacity may be treated if it is in their best interest, if it is the least restrictive option, if it is not depriving them of their liberty and there is no advanced refusal or objection by a donee or court of protection.
Treatment of people with severe anorexia nervosa who are not consenting to treatment for their mental disorder will in most cases require use of the MHA as it involves deprivation of liberty and compulsory refeeding. Treatment under the Mental Health Act can be given
under Section 2 or 3, if they meet the legal criteria (see Code of Practice) whether or not they lack capacity. If after three months from the start of their detention they either lack capacity or object to treatment, SOAD authorisation is required-second opinion authorised doctor.
management of physical aspects of eating disorders?
Where laxative abuse is present, patients should be advised to gradually reduce laxative use and informed that laxative use does not significantly reduce calorie absorption.
Treatment of both subthreshold and clinical cases of an eating disorder in people with diabetes is essential because of the greatly increased physical risk in this group.
People with type 1 diabetes and an eating disorder should have intensive regular physical monitoring because they are at high risk of retinopathy and other complications.
Pregnant women with eating disorders require careful monitoring throughout the pregnancy and in the postpartum period.
Patients with an eating disorder who are vomiting should
have regular dental reviews.
Patients with an eating disorder who are vomiting should be given appropriate advice on dental hygiene, which should include:
avoiding brushing after vomiting; rinsing with a non-acid
mouthwash after vomiting; and reducing an acid oral
environment (for example, limiting acidic foods).
Healthcare professionals should advise people with eating disorders and osteoporosis or related bone disorders to refrain from physical activities that significantly increase their falls risk.
