Bulimia

Bulimia

    * Introduction
    * Diagnosis
    * Treatment
For centuries people have consumed too much food when they were available. Practice vomiting caused by overnutrition also dates back hundreds of years ago. Definition of abnormal eating problems only appeared 20 years ago. Bulimia nervosa was first described in 1979 as a disorder that involves episodes of overnutrition and inappropriate behavior to avoid weight yield.
Diagnostic criteria for bulimia include the concern of consuming large amounts of food in short periods. This abnormal behavior is followed by the desire to lose weight as much, especially with vomiting caused. Other weight loss methods include the use of laxatives and diuretics. Bulimia is a disease that affects a large segment of the population, especially women and virtually nonexistent in industrialized countries.
Characteristic cycle of eating and vomiting affects multiple organ systems. Gastrointestinal system may be affected by overnutrition associated with episodes of abnormal behavior. This can stretch the stomach or delay gastric emptying. Esophageal rupture cause vomiting or esophagitis. Pancreatitis is a condition that can also trigger. Electrolyte abnormalities may include hypokalemia and hypochloraemic. Cardiovascular abnormalities can lead to arrhythmias, cardiac arrest, cardiac rupture or pneumomediastinum. The system can be affected by lung aspiration of gastric contents from vomiting.
Death is relatively unusual for bulimia. Approximately 3% of women with the disease die from complications of the disease. The main cause of death among patients with eating disorders is suicide. Other factors associated with suicide are drug abuse, alcohol and smoking.
Bulimia is a disease of long duration, with an evolution that varies over time, episodes and events precipitated by emotional crises. Diagnosis may not be stable over time. Short-term studies show an improvement in 50% of patients. The most important principle of treating psychiatric comorbidities is the effect of starvation and food recognition irregular in diagnosis and treatment response. There are no data on the differential effectiveness of medication, a combination of medication and counseling or psychiatric treatment for bulimia nervosa only by groups of age, race, etinie, sex.
Pathogenesis Among the identified metabolic disorder bulimia include low levels of plasma C peptide, thyroid hormones, glucose. Increased free fatty acids and beta-hydroxybutyrate are also observed. Studies show abnormal dexamethasone suppression in perosanele with anorexia nervosa, bulimia suggesting that status may be associated with pseudo-Cushing. These data are more evident in people with starvation diets. Episodes of amenorrhea may occur in more than 50% of women with bulimia. Half of women with bulimia have anovulatory cycles. It shows low estradiol and progesterone.
Causes and Risk Factors Bulimia nervosa is a complex disease that appears in the problems of social integration, psychological and family. There is no definite single cause of bulimia. Several factors are thought to play a role in the development of bulimia.
Chemical factors: There are several hypotheses that suggest abnormalities of specific chemical in the body associated with bulimia. Serotonin is a neurotransmitter with multiple functions in the body. These functions serotonin is involved in the development of satiety. High levels of serotonin are associated with decreased food intake. Serotonin is believed to increase postprandial satiety than directly decrease appetite. One hypothesis involves abnormalities in the development of bulimia serotoninoergica function. Because serotonin is involved in the development of satiety, contributions to the persistence of these disorders are abnormal eating behavior. Another hypothesis suggests that the answer can serotoninoergic unusual contributions to the extension of periods of rapid food intake. Diet has been associated with altered serotonin function, especially in women than in men.
Another suggested pathophysiology involves increased levels of peptides and their association to mediate appetite. Increased PYY peptide known to increase appetite was detected in some patients with bulimia food after a period of stability. This suggests that these patients have an increased appetite when they have a normal diet.
Psychiatric factors: Premorbid psychiatric disorders are often associated with the development of bulimia. These disorders may include active, anxiety and substance abuse. Many patients with bulimia and depression shows.
Environmental and social factors: The strongest risk factor in the development of bulimia is weight loss diet. Many patients report onset of abnormal behavior after food diet. Many have continued to restrict caloric intake. Cultural factors play an important role in eating disorders. Most cases of bulimia occur in industrialized countries where food is plentiful and there is concern for poor women.
Family factors: Family problems are associated with the development of bulimia. Sexual abuse in patient history is a risk factor. The existence of family members increases the risk of supply problems to the pediatric patient bulimia up to 20 times.
Activities practiced: Some athletes are more prone to developing bulimia. They include balerinii, cheerleaders, gymnasts, models.
Signs and symptoms Bulimia nervosa is an eating disorder characterized by episodes of excessive food consumption followed by efforts to get rid of extra calories by vomiting, laxative or diuretic administration, after prolonged or excessive physical effort. Fear of weight gain leads to characteristic behavior, but bulimia nervosa is centered practice of excessive consumption of food. Most patients have normal weight or obese. Although some patients with anorexia nervosa also show such behavior, it is characterized by starvation.
Eating disorders develop in adolescence, but approximately 5% of people develop when they provided over 25 years. The top of onset of bulimia is 18 years. Abnormal feeding behavior may precede disease onset. Development of bulimic symptoms at a younger age can mean a more severe disease.
Bulimia nervosa can be classified as type 1 by inducing vomiting, they induce vomiting if the patient regularly with use of emetics, laxatives, diuretics. Bulimia nervosa may be a 2 if the patient has vomiting induced only after prolonged and excessive physical effort, without administration of laxatives, emetics, or diuretics.
Patient's main accusations include: muscle weakness, cramps, dizziness, twitching carpopedale, haematemesis, abdominal pain, chest pain, heartburn, menstrual irregularity. Life-threatening tonsillar hyperplasia was reported in asoiere with bulimia. Sialoadenita may be a sign of bulimia debut because of excessive activity in the salivary glands associated with repeated vomiting. Bulimia nervosa is associated with unrecognized perioperative cardiac arrhythmias. Half of women with bulimia have irregular cycles or amenorrhea.
Skin Signs include hair loss, nail dystrophy, self-inflicted trauma, acne, xerozis. Other signs include nonspecific but suggestive of bradycardia, hypothermia, hypotension, leg edema, especially in people who abuse diuretics and are malnourished with hypoalbuminemia.
Patients usually deny inducing vomiting or using laxatives, diuretics may permit the use of peripheral edema due to this. Caffeine, pseudonefrina, thyroid replacement preparations can be used to increase the rate and loss of calories metabiolica. Other substances used to increase metabolism, decrease appetite or weight loss include bitter orange, green tea extract, guarana, sesame, pepper, flaxseed oil. Laxatives used may include: bisacodil, Cascara, senna and fiber supplements.
Patient history is essential when bulimia is suggested, it includes the following: Problem-denial by the patient -Patient has followed several diets and weight loss is considered fat and unpretty Self-esteem is closely linked to body shape and weight -Diabetic patients can not have you administer insulin -Patients become vegetarians -Shows the history of the use of slimming pills, laxatives, Ipecac or thyroid medication Aliemente privately-consumed in large quantities and short intro Overnutrition, followed by episodes of inappropriate behavior by inducing vomiting.
Physical Exam: The diagnosis of bulimia is not conditioned by the discovery of characteristic physical features, these may include the following: Normal-weight or body may be decreased / increased -Hypothermia, hypotension Dentre erosion with decalcification of tooth surfaces exposed to vomit Palate, trauma, painful enlargement of the parotid glands -Bradycardia, arthritic pain frequently broadcast on palpation Metacarpal-phalange bruises, calluses, scars, abrasions, sign Russell -Edema by abuse of laxatives and diuretics Proximal muscle weakness, if the patient is abusing ipecac.
Complications of the disease: -Seizures, cardiac arrhythmias by hypokalemia, cardiac arrest, cardiac rupture, secondary cardiomyopathy ipecac abuse Vomiting, pulmonary aspiration, pneumomediastinum -Rupture of the esophagus, esophagitis, delayed gastric emptying, pancreatitis -Muscle weakness secondary to ipecac and potassium imbalances, tetany -Impaired renal function -Depression, suicidal intent, substance abuse.
Disease progression: Bulimia is a disease with long-term evolution towards cachexia. The mortality rate is not known. Comorbid medical and psychological conditions associated with bulimia nervosa include irritable bowel, fibromyalgia, mood disorders, personality disorders, anxiety, substance abuse and adverse events related to poor control of aggression or impulsivity. Rates of major depression in bulimia is 38-63%. Rates of substance abuse is high among people with bulimia who have family history of alcoholism. Among patients with symptoms of bulimia, substance abuse was associated with increased incidence of suicide attempts, theft and promiscuity. Some studies show 67% risk of kleptomania patients with food issues.