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Pediatric Eating

Pediatric Eating Disorders

QuestionAnswer
What are the DSM-IV-TR classifications for eating disorders? Anorexia Nervosa (AN), Bulimia Nervosa (BN), eating disorder not otherweise specified
True or False? 62% of girls and 29% of boys said they were trying to lose weight True
What are the risk factors for eating disorders Affective disorder, anxiety disorder, activities that emphasize a lean physique, childhood sexual/physical abuse, depression, dissatisfaction with body image, early onset of menses, low self-esteem, obsessive behaviors
How can you detect eating disorders? Rarely present with an admitted ED, may be referred by a concerned parent, friend or coach, fatigue, dizziness, HA, constipation, heartburn, amenorrhea, growth chart
What are some screening tools that can be used? how much would you like to weigh? how do you feel about your present weight? are you or anyone else concerned about your present eating or exercise habits?
What are the DSM-IV criteria for AN Refusal to maintain body weight at or above normal, intense fear of gaining weight, disturbed body image, amenorrhea in postmenarchal females
What are some critical red flags for AN ritualistic eating habits, refusal to eat in front of others, suddenly becoming a vegetarian, choosing to eat only low-fat, no-fat or lo cal food, continual exercising, hypersentivity to cold
What are the two types of anorexia restricting and binge-eating/purge
What is BN The hunger of an ox, binge-eating is the cetnral feature, usually don't fall below 85% of IBW
What is the DSM-IV criteria for BN recurrent episodes of binge eating (eating more than most people and a sense of lack of control over eating during the episode). Recurrent inappropriate compensatory behavior to prevent weight gain, occur at least 2x/wk, undul influenced by body image
What are some of the inappropriate compensatory behaviors exhibited by pts with BN laxatives, diuretics, enemas, fasting, excessive exercise
what are some clinical red flags for BN Frequent excuses to go to the bathroom after meals, mood swings, hoarding food, unusal swelling around the jaw, laxatives or diuretic wrappers found in trash cans
What are some similarities between AN and BN Preoccupation w/food and body wt, disturbed body image, poor self-esteem, fear of loss of control, high prevalence of depression, may alternate between illnesses
What are some differences between AN and BN anorexic's emaciation often leads others to bring them to medical attn, BN are aware that their behavior is abnormal
What are osme medical complications of AN loss of fat sotres and lean muscles mass, brgotr puberty, growth/development/sexual maturation stops, compensatory slowing of metabolism, medaites by thyroid hormone. Purging pts suffer additional consquences
What are the clinical presentations of AN Denial of illness is the hallmark, AN should be suspected in any pt with unexplained wt loss
What are some common complaints of pt with AN post prandial bloating, constiptation, cold intolerance, amenorrhea
What would you expect on ROS and PE Endocrine, Hematologic, Derm, Immunologic Endocrine: amenorrhea, fertility issues, Thyroid (low T4, LowT3 normal TSh), Heme: anemia, leukopenia, thromobocytopenia, Derm: Russell's sign, lanugo, hair loss, dry skin. Immu: incr suscept to infections
What are cardiac, GI, renal signs on ROS and PE Card: dystrhytmia, cardiomyopathy, orthostatic changes in BP, bradycardia, murmur, MVP, GI: loss of tooth enamel, dental caries, swelling of salivary glands, GERD, mallory-weis (upper GI bleeding), esophageal rupture, constipation. Renal failure.
what are Neuro and MS clinical presnetation of AN Neuro: Sz, myopathy, peripheral neuropathy. MS osteoporosis, pitting edema, cold extremities, acrocyanosis, stress fractures
What are complications of BN chronic vomiting, laxative abuse, diuretic abuse
What are complications of chronic vomiting gastric & sophagel irritation and bleeding, volume depletion, hypochloremic metabolic acidosis, hypokalemia, reversible painles parotid gland swelling, irreversible dental errosion, ipecac complicatins (myopathy, cardiomyopathy)
What are complications of laxative abuse transient wt loss, watery diarrhea, volume depletion, electrolyte loss, gi bleeding or rectal prolapse
What are the consequences of diuretic abuse hypochoremic metabolic alkalosis, hypokalemia, volume depletion, dilutional hyponatremia
What are some clues to BN preoccupation w wt & food, frequent wt fluctuations, dizziness, syncope, muscle cramps, weakness, paresthesias, heartburn, constipation, rectal bleeding
What are signs specific to BN Russell's sign, dental caries, loss of enamel, gum disorders, parotid hypertophy, mallory weiss tears, esophageal rupture
What are the lab findings with BN Metabolic alkalosis, Hyperchloremic metabolic acidosis, hypokalemia, hypomagnesemia, hyperphsophatemia, hypophosphatemia, hyponatremia
what are the goals of treatment for BN normalizing body wt, addressing medical complications, reducing symptoms through cognitive & behavioral therapy, nutrition education, management & counseling, individual & family therapy
what is the duration of treatment for AN & BN An: long term Rx required, BN: short term Rx can be very effective
What is the management for AN/BN Labs: CBC, CMP, magnesium, TSH, prolactin & serum HCG if amenorrhea or irregular menses, Bone density testing, 12 lead EKG, transthoracic echo, regular wt check, psych, dietitian, activity/ex plan constip oral GERD Lg edema hypoka osteop wt gain
What is the refeeding syndrome characterized by CV collapse, cardiac arrest and/or delirum. Can result from feeding high caloric nutrients too soon to malnourished pts
What medications are appropriate for AN/BN antidepressants (Fluoxtine 60 mg/day), Anxiolytics (Xanax), HRT/OCP: Rx for osteoporosis
When should you hospitalize an AN/BN when there are serious physical or metabolic complications: BP<90/5-, HR <40, renal failure, sev anemia, sz, LOC, dehydration, CP or heart failure, muscle spasm, UO < 40cc/day, pre/syncope, sev electrolyte imb
Other criteria for possible hospitalization need for nourishment, inability to control binging/purging after 3 months of outpt Rx, cognitive impairment that interferes w judgement
what are some comorbid conditions that may be criteria for possible hospitatlization Depression, bipolar, OCD, PTSD, substance abuse.
What is the female athlete triad disordered eating, amneorrhea osteoporosis
Who are at risk for male eating disorders? gay or bisexual men, models and actors, sports, most have a h/o premorbid obesity, substance abuse common, poore prognosis than women
What is the prognosis for AN AN: 50% achieve complete recovery, 21% intermediate outcome, 26% poor outcome overal mortality rate 9.8%,
What is the prognois for BN? 50% full recovery, 30% occasional relapse, 20% maintained full criteria for BN
What is the differential diagnosis for AN/BN malignancy, IBD (inflammatory bowel disease), malabsorption, celiac dise, DM, hyp/hyperthyrodism, Addison's disease, depression, HIV, chornic illness
Created by: lknightly