Patients with bulimia nervosa who purge by vomiting may develop swelling of salivary glands, which is not seen in patients who abuse laxatives. Patients with anorexia nervosa may develop parotid gland swelling (sialadenosis) if they become malnourished (see above).


General clinical features:

(1) Bulimia usually occurs in young women, but also may occur in young male athletes or actors.

(2) The person is obsessed with weight control and being thin.

(3) The patient has episodes of binge eating followed by vomiting, which may be strongly denied.

(4) Anxiety and depression may be present.

(5) Teeth may show erosions with loss of enamel caused by gastric acid.

(6) Patients may have electrolyte abnormalities due to loss of gastric juice, with hypokalemia, hypochloremia and metabolic alkalosis.


Salivary gland findings:

(1) The salivary glands affected are usually the parotid and submandibular glands.

(2) The swelling is usually bilateral.

(3) The affected salivary glands are diffusely enlarged with the size increase proportional to the frequency of vomiting.

(4) The salivary gland swelling is painless and asymptomatic.

(5) The swelling is initially intermittent but eventually becomes persistent.

(6) Saliva flow is normal.

(7) Sialography of the parotid duct shows a normal duct.

(8) Inflammatory and autoimmune conditions must be excluded.


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