Sunday, 1 December 2013

Eating Disorders: Bulimia nervosa - The Affects and Consequences

 Bulimia nervosa is defined as a medical condition of  consuming a large amount of food in a short amount of time or one setting (binge eating), followed by self induced vomiting, taking a laxative or diuretic and/or excessive exercise, etc. to compensate for the binge. Bulimia nervosa also effects almost 90% of female. Unlike anorexia nervosa, people suffering from bulimia nervosa are usually normal or slightly over weight.

IV. Effects and consequences of bulimia nervosa (BN)
A. Psychological effects
1. Mood disorders and suicidality
Onset of bulimia nervosa (BN) typically occurs in adolescence and is frequently accompanied by medical and psychiatric sequelae that may have detrimental effects on adolescent development. Potentially serious medical consequences and high comorbid rates of mood disorders and suicidality underscore the need for early recognition and effective treatments(14)

2. Substance abuse
In the study to examine the significance of a past history of substance abuse on treatment outcome for bulimia nervosa, showed that Although patients with a history of substance abuse reported higher levels of anxiety and depression at presentation for treatment than patients without such histories, the two groups reported a similar age of onset of their bulimia nervosa and similar severity of eating pathology with regards to binge and vomit frequencies and measures of concern about body shape and weight. On all outcome measures, the improvement of the substance abuse group was equal to or greater than that in the group without a history of substance abuse(15).

3. Etc.

A.2. Physical consequences
1. Acute gastric dilation
There are a report of a  case of a young woman with bulimia nervosa who developed acute gastric dilation that was diagnosed by computerized tomography. The patient had no history of factors associated with delayed gastric emptying. The treatment course is reviewed, as is the pathophysiology of acute gastric dilation(16).

2. Electrolyte imbalances
Dr. Olson AF., in the study of Outpatient management of electrolyte imbalances associated with anorexia nervosa and bulimia nervosa, said "Bulimia nervosa and anorexia nervosa are eating disorders with significant morbidity that often go undetected. Nurses and primary care providers are encouraged to recognize the early signs and symptoms of these disorders and to intervene appropriately. Several case reports in this article describe patients with these disorders and various related electrolyte abnormalities. Understanding electrolyte imbalances associated with both disorders may lead to earlier effective intervention and overall improved health outcomes"(17).

2. Arrhythmias
In the examination of signal-averaged electrocardiography (SAECG). on 48 female ED patients [21 with anorexia nervosa (AN) and 27 with bulimia nervosa (BN)] and on 20 healthy women. An LP was judged positive if two or more of the following criteria were fulfilled: QRS duration >120 ms, root-mean-square voltage <20 microV, and a high-frequency, low-amplitude duration >38 ms. that indicated BN patients with a history of AN had significantly more SAECG abnormalities(18).

3. Oesophageal and gastric motor activity
In the study of esophageal and gastric motor activity in patients with bulimia nervosa, found that (i) bulimic behaviour can obscure symptoms of oesophageal motor disorders and (ii) gastric emptying is frequently delayed in bulimia nervosa(19).

4.  Pancreatitis
There is a report of a 19-year-old woman with bulimia nervosa who died of acute hemorrhagic pancreatitis. The symptoms of both conditions are very similar, the pre-existence of an eating disorder should not distract physicians from the possibility that potentially lethal acute pancreatitis may coexist(20).

5. Absence of period
Some researchers suggested that amenorrhea is one of diagnostic criteria of bulimia nervosa(21)

6. Visceral fat and increased adrenal gland volumes (AGV)
BN patients had significantly more visceral adipose tissue (VAT) (HC, 1589.3 +/- 967.6 ml versus 927.2 +/- 428.4 ml, p < .05) and an increased relative AGV (0.068% of body volume versus 0.048% of body volume, p < .05) compared with HC, although waist circumference and BMI did not differ. Although the VAT part in the upper abdomen was increased, especially the VAT of lower abdomen along with the pelvis or any subcutaneous fat compartment was not increased(22).

7. Sleep disturbance
Sleep disturbances are highly associated with anorexia nervosa (AN), buLimia nervosa (BN) and non-specified eating disorders (ED-NOS)(23)

8. Other physical effects 
Dt, Mitchell JE and Crow S. at the University of North Dakota School of Medicine and the Neuropsychiatric Research Institute, in the study of Medical complications of anorexia nervosa and bulimia nervosa, showed that the frequently cited risk of premature death in those with anorexia nervosa. A plethora of dermatologic changes have been described, some signaling serious underlying pathophysiology, such as purpura, which indicates a bleeding diathesis. Much of the literature continues to delineate the fact that diabetic patients with eating disorders are at high risk of developing diabetic complications. Gastrointestinal complications can be serious, including gastric dilatation and severe liver dysfunction. Acrocyanosis is common, and patients with anorexia nervosa are at risk of various arrhythmias. Low-weight patients are at high risk for osteopenia/osteoporosis. Nutritional abnormalities are also common, including sodium depletion and hypovolemia, hypophosphatemia and hypomagnesemia. Resting energy expenditure, although very low in low-weight patients, increases dramatically early in refeeding(24).

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