Internal Medicine

0521779407-B02 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:52

Buerger’s Disease Bulimia Nervosa 263

specific therapy

■Vasodilators, anticoagulants, prostaglandins are not beneficial

■Surgical bypass and sympathectomy are not useful

follow-up

■Close followup of any gangrene is needed to determine later need

for subsequent amputation

complications and prognosis

■Limb Loss

➣50% of those who keep smoking

■Other vascular beds

➣Buerger’s disease rarely affects coronary arteries or other areas

Bulimia Nervosa.....................................

JOSE R. MALDONADO, MD

history & physical

History

■Lifetime prevalence: 1%–3% in females, 0.1%–0.3% in men

■Females >> males (90% occurs in females)

■Repeated episodes of binge eating, followed by compensatory

inappropriate methods to prevent weight gain (purging & dietary

restrictions)

■At least twice a week for 3 months

■Dissatisfaction about body weight and shape

■Fear of weight gain

■A sense of lack of control over eating patterns

■Binges: usually high-calorie foods, usually until person feels uncom-

fortable or develops abdominal pain

■Secrecy: patients are usually ashamed of their eating patterns and

attempt to hide their symptoms

■Binges are often preceded by dysphoria and/or anxiety induced by

daily stress, interpersonal stressors, intense hunger caused by dietary

restrictions

■Binges are usually followed by feelings of guilt and depressed mood

■Purging:

➣Seen in 80–90% of bulimia cases

➣Provides relief from physical discomfort and reduces the fear of

gaining weight following a binge episode