Eating Disorders 4

From a GI standpoint; they get chipmunk cheeks. When you see adolescents who have anorexia nervosa, yet their cheeks look fairly broad – they look like they have mumps – it’s when you vomit a lot either through anorexia with purging or bulimia with purging, you get parotid hypertrophy. They are non-tender. And sometimes after purging, if they stop, their salivary glands are so used to producing they can get huge cheeks. They really do look like they have mumps. Their amylase is up. The loss of dental enamel; where do they have it? What part of their teeth? The lingual aspect. The inner aspect, because when you vomit the acid etches the inside of the teeth. Constipation; nothing going in, nothing going out. Bloody diarrhea is a complication of laxatives or cathartics, and constipation can also come from the use of laxatives and cathartics because they get a cathartic colon. They get intestinal atony. That also can come from hypokalemia or hypophosphatemia. Most patients with bulimia have delayed gastric emptying, as do patients with anorexia. So when they are re-fed they feel full all the time. And they really do feel full.

You can get esophagitis from acid going up, Mallory-Weiss tears from vomiting too often. You get streaks of blood. So a patient who all of a sudden has streaks of blood in their saliva from vomiting, think of bulimia. A perforation rupture of the stomach; almost unheard of, but that’s from eating too much. Fatty infiltration, focal necrosis of the liver. This can be really difficult because if you get really low weight your liver doesn’t work very well, it gets fat in it, your cholesterol goes up. You do a cholesterol on an anorectic and they see that the cholesterol is 210 but they haven’t looked at fat in a decade. It can be very disturbing. They even cut down more on fat. Acute pancreatitis but you should subdivide the amylase and do a lipase to make sure it’s not from the parotids. Superior mesenteric artery syndrome; what’s that? That’s when you are so thin when you lie down your superior mesenteric artery occludes your duodenum and you have vomiting. So every time they lie down they have vomiting. And gall stones.

Acrocyanosis just means cold hands and feet. Doesn’t necessarily mean warm heart. Yellow, dry skin. They look like a baby who is eating too many yellow vegetables. They don’t process carotene very well. So a thin patient who comes in, who is yellow but has normal liver function tests, think of anorexia. Brittle hair and nails, lanugo, just like a newborn baby, it’s to maintain temperature. Hair loss is often after they are gaining weight because they have antigen effluvium where they’ve shocked their head, and as they are gaining weight they lose hair and they are really pissed off at you because, “Hey you are making me gain weight and my hair is falling out.” Russell’s sign: Dr. Russell described it as calluses over the knuckles from sticking your finger down your throat. Pitting edema; once again, if your aldosterone system is turned on you take too much free water, it goes into the vessels and then into the periphery.

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