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قديم 10-02-2012, 08:07 PM
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تاريخ التسجيل: Sep 2012
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Bulimia nervosa
Bulimia nervosa is characterized by recurrent episodes of binge eating and a feeling of lack of control over eating behavior during these episodes, with associated inappropriate methods to prevent weight gain, including self-induced vomiting, excessive use of laxatives, diuretics, fasting, or excessive exercise. These episodes occur at least twice per week for 3 months. Self-image is significantly influenced by body weight and shape.

 Signs and symptoms:
• The course of the disease may be chronic or intermittent during many years.
• Weight is usually maintained within **rmal range or may be significantly elevated or decreased.
• Binge eating may be followed by inappropriate compensatory mechanisms, including self-induced vomiting, self-induced diarrhea through the use of laxatives or cathartics, the use of diuretics, excessive fasting, and excessive exercise.
• Physical signs may include calluses or skin changes on hands and fingers, loss of dental enamel, swollen lymph
**des, and bad breath or mouthwash smell on breath because of self-induced vomiting.
• Endocrine changes, such as ame**rrhea, may be present.

Medical complication:
• Fluid and electrolyte disturbances, particularly hypokalemia, metabolic alkalosis, and associated cardiac dysrhythmias.
• Obesity or a**rexia nervosa.
• Dental erosion.
• Esophageal tear or gastric rupture.
Natural history:
• Bulimia typically begins in adolescence or young adulthood in individuals consciously trying to stay slim. Some report a history of A**rexia Nervosa and others report a history of obesity. The onset often follows changes in living situations such as leaving home, starting college, changing jobs, or becoming involved in new relationships.
Differential diag**sis:
• Serum chemistry for electrolytes, , and creatinine, and bicarbonate—may be ab**rmal, indicating fluid and electrolyte imbalances.
• Additional tests may include thyroid function tests , estrogen, and electrocardiogram to determine effects of bulimia on body.

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