Internal Medicine

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

266 Bulimia Nervosa Bullous Pemphigoid

➣Modify distorted patterns of thinking about weight and shape

➣Dealing with ongoing problems of living

■Family therapy recommended for children and adolescents

complications and prognosis

Complications

■Menstrual irregularities (25%)

■Hypokalemia

■GI problems related to self-induced emesis: chronic hoarseness,

esophageal tears and gastric rupture, GERD

■GI problems associated with chronic laxative use: physiologic adap-

tation of colon leading to slowed GI motility, an enlarged colon, and

constipation

Prognosis

■Usually begins in late adolescence with dieting and binge eating

preceding the onset of purging by several months

■Usually a chronic, sometimes episodic, course

Bullous Pemphigoid..................................

DANIEL J SHEEHAN, MD; ROBERT SWERLICK, MD; and

JEFFREY P. CALLEN, MD

history & physical

■Highest incidence in elderly

■Severe pruritus

■Urticarial papules and plaques with tense vesicles

■Mucosal lesions in < 1/3 of patients

tests

Basic Blood Tests:

■Eosinophilia

Specific Diagnostic Tests

■Skin biopsy: subepidermal bullae

■Direct immunofluorescence (DIF): IgG and C3 deposits at the base-

ment membrane zone (BMZ)

■Indirect immunofluorescence (IIF): anti-basement membrane IgG

antibodies