Bulimia nervosa is an eating disorder. If you have this disorder, you eat larger amounts of food than most people would eat in a short time, then you may purge by making yourself vomit or using laxatives. Purging is meant to make up for binging. You may also cut back on eating or exercise too much to make up for binging.

Most bulimics have a normal weight but feel they cannot control their eating. Some people swing back and forth between anorexia and bulimia. Anorexia is an eating problem that occurs when people are so afraid of becoming overweight that they eat as little as possible. They may starve to death.

Although the disorder can affect men, most people with bulimia are young women.

How does it occur?

The exact cause of this disorder is not known. It may be related to problems with the chemicals in the brain that regulate mood and appetite.

If you have bulimia nervosa you may:

• have a family history of bulimia or other eating disorders
• have a family or personal history of mood disorders, such as depression, anxiety, or bipolar disorder.

What are the symptoms?

Signs and symptoms of bulimia include:

• eating large amounts of food in short periods of time without being able to stop
• making frequent trips to the bathroom after eating
• vomiting, or using laxatives, diuretics, or enemas to purge food
• dieting or fasting
• exercising a lot after eating
• repeatedly losing or gaining more than 10 pounds
• feeling weak, depressed, or guilty after binge eating
• having heartburn or reflux from stomach acid injuring the esophagus or damaged teeth from stomach acid contained in vomit
• having swollen cheeks from repeated vomiting
• having scratches or scars on the back of fingers or hands from self-induced vomiting
• constantly thinking about being thin and feeling that weight is tied to self-esteem
• having menstrual problems.

Bulimia is especially dangerous when vomiting or laxatives are used to remove food from the body. Either habit can cause an electrolyte imbalance that can lead to irregular heartbeats and possibly heart failure and death.

How is it diagnosed?

Your health care provider takes a medical history and does a physical exam. He or she will ask about your eating patterns, looking for such behavior as:

• repeated episodes of binge eating followed by purging
• binging and fasting
• secret eating and binging
• exercising too much to prevent weight gain.

How is it treated?

If you have bulimia, you must recognize that you are suffering from a dangerous disorder. Treatment involves getting your eating habits back to normal. Your health care provider may suggest that you meet with a dietician to create a healthy eating plan. You may also benefit from psychotherapy or family counseling. Psychotherapy, either individual or group therapy, is very important. You may also need medicine used for mood disorders, such as antidepressants, antianxiety medicines, or mood stabilizers.

How long will the effects last?

You may stay preoccupied with eating for many years. You may need to continue taking medicine or having therapy for many months. Being under a lot of stress can cause a relapse. The earlier you seek treatment, the more successful it is likely to be.

How can I take care of myself?

• Eat healthy meals.
• Schedule regular meals. Avoid irregular eating habits and avoid fasting.
• Take vitamin and mineral supplements, if recommended by your health care provider.
• Avoid drinking too much caffeine.
• Do not drink alcohol.
• Do not use laxatives and diuretics. These can have serious side effects.
• Seek professional help if you need to lose weight. It is best to lose weight slowly and in a healthy way.
• Limit your exercise program as advised by your treatment team.

What is liver cancer?

Liver cancer is an abnormal growth of cells in the liver. Often the abnormal growth is called a tumor.

The liver is one of the largest organs of the body and a very important part of the body.

• It helps the body get rid of harmful substances.
• It produces bile, which helps your body digest fats.
• It stores sugar, which the body uses for energy.
• It makes many proteins, which are the building blocks for all cells in the body.

There are 2 types of liver cancer: primary and secondary. Primary liver cancer starts from cells in the liver. The 2 most common forms of primary liver cancer are:

• hepatoma, which is often associated with cirrhosis and hepatitis B or C infections
• cholangiocarcinoma, a rare tumor developing in bile duct cells.

Liver cancer is called secondary when a cancer starts in another part of the body and spreads to the liver. The secondary type is much more common in the US than primary liver cancer. The most common body areas where cancer starts and then spreads to the liver are the lungs, breasts, and large intestine.

How does it occur?

Liver cancer is often the secondary type and caused by the spread of cancer from another part of the body.

The exact cause of cancer that starts in the liver (primary cancer) is not known. Medical problems that seem to increase the risk of primary liver cancer are:

• chronic hepatitis B and C infections
• scarring of the liver (cirrhosis), which most often results from alcohol abuse and less often by having too much iron in the body, as in a disease called hemochromatosis.

Also, long-term use of anabolic steroids can slightly increase the risk of liver cancer. Exposure to vinyl chloride and arsenic is rare but these chemicals can increase your risk.

What are the symptoms?

Symptoms of liver cancer are:

• pain or discomfort on the right side, especially in the upper belly or around the right shoulder blade
• a hard lump on the right side just below the rib cage
• unexplained weight loss
• loss of appetite
• jaundice (yellowing of the skin and whites of the eyes).

How is it diagnosed?

To diagnose liver cancer, your health care provider will ask about your symptoms and health history. You will have a physical exam.

Your provider may also order these tests:

• blood tests, including tests that check how well the liver is working
• ultrasound, radionuclide, or CT scan of the liver
• laparoscopy (a surgical procedure to look at the organs inside the belly)
• liver biopsy (the removal of cells or tissues for testing, which may be done during a laparoscopy or with a needle inserted through your skin and into the liver).

How is it treated?

The treatment depends on if the cancer is primary or secondary and how much it has grown or spread.

Possible treatments are:

• surgery to remove part or all of the tumor, which may mean that part of the liver is also removed
• chemotherapy, which uses anticancer drugs to kill cancer cells and shrink tumors
• high-energy radio waves (radio frequency ablation)
• freezing with a cold probe
• injecting alcohol or drugs into the tumor to destroy the tumor
• liver transplant if the cancer is a hepatoma.

How long will the effects last?

The effects of liver cancer depend on how long the tumor has been growing and when it was found and when treatment started. How old you are and if you have other health problems are also important. If a liver tumor (hepatoma) is found at an early stage, surgery may cure it. However, surgery may not be a good option if the tumor is large, your liver is not working well, or you have cirrhosis.

The more the cancer has spread before it is found, the less chance for cure. Survival after diagnosis is often only several months but may be longer.

How can I take care of myself?

• Be sure you understand the treatments your health care provider recommends. Ask questions and talk about your concerns with the provider.
• Take the suggested medicines for nausea and vomiting to help with possible side effects of cancer-fighting treatments.
• If possible, join a support group for cancer patients to help you during your illness.
• Contact national and local self-help organizations such as:
  • American Cancer Society, Inc.
    Phone: 800-ACS-2345 (800-227-2345)
    Web site: http://www.cancer.org
  • AMC Cancer Research Center and Foundation
    Phone: 800-525-3777
    Web site: http://www.amc.org
  • Cancer Information Service
    Phone: 800-4-CANCER (800-422-6237)
    Web site: http://cis.nci.nih.gov
• Maintain a hopeful and positive outlook throughout your treatment and recovery.

What can be done to help prevent liver cancer from spreading or recurring?

You may be able to reduce the likelihood of spread or recurrence of liver cancer by following these guidelines:

• See your health care provider right away if you notice a return of any previous symptoms or develop any new ones.
• Avoid alcohol.
• Eat small, frequent, well-balanced meals throughout the day. Take vitamin and mineral supplements with iron, folic acid, and thiamine, if recommended by your provider.
• Make sure that restaurants and grocery stores where you buy food, and areas where you prepare food, are safe and clean.
• Exercise according to your health care provider’s recommendations.
• Do not use illegal drugs.

What is a small bowel obstruction?

A small bowel obstruction is a blockage of the small intestine. The small intestine begins at the end of the stomach and ends where the colon (large intestine) starts. The blockage makes it hard for the contents of the bowel to pass through and out of the body.

How does it occur?

The small bowel may become blocked when it is trapped inside the abdominal cavity in scar tissue or outside the abdominal cavity in a hernia.

• Adhesions are the major cause of small bowel obstruction. Adhesions are bands of scar tissue that form after surgery. The adhesions grow between sections of the bowel and may trap loops of bowel.
• A hernia is a weakness in the wall of the abdomen through which the bowel may protrude and become trapped.

Other causes include:

• inflammatory bowel disease, such as Crohn’s disease
• inflammation from other abdominal problems, such as diverticulitis
• intussusception, which is the intestine folding into itself, cutting off normal flow of partly digested food and eventually cutting off blood flow to the tissues
• a twisted or knotted bowel
• a narrowing of the bowel that has been present since birth
• cancer.

Sometimes the blockage cuts off blood flow to part of the bowel. When this happens, the bowel is said to be strangulated. The lack of blood flow can cause death of some of the tissue (gangrene) and can be life threatening.

What are the symptoms?

The symptoms of a blocked small bowel may include:

• a cramping pain in the abdomen that comes and goes
• a tender and swollen abdomen
• vomiting
• diarrhea or trouble passing gas or stools
• severe, constant pain if the blood supply has been cut off.

How is it diagnosed?

Your health care provider will review your symptoms, take your medical history, and examine you. Your provider will ask about previous surgeries, bowel blockages, and hernias. You may have the following tests:

• blood tests
• x-rays of the chest and abdomen
• x-rays of the bowel after a barium enema.

How is it treated?

The blockage will need to be treated at the hospital. A tube may be passed through your nose and into your stomach to decrease the pressure of bowel gas. Usually surgery is performed as soon as possible unless the symptoms go away and your bowels quickly start working again.

If you need an operation, the surgeon will make a cut through the wall of your abdomen and relieve the blockage. The surgeon may remove a portion of bowel. Sometimes this can be done with a laparoscope. (A laparoscope is a thin tube with a light and tiny camera that can be put into your abdomen through a small cut.)

You will need IV fluids to replace fluids from vomiting and diarrhea. You may need to take antibiotics for infection.

How long will the effects last?

How long the effects last depends on what caused the blockage and whether the bowel has been strangulated.

How can I take care of myself?

• Follow your health care provider’s instructions.
• If you have surgery, get up and walk as soon after surgery as is reasonable. Walking helps get the bowel to start moving again.

How can I help prevent small bowel obstruction?

You may have little control over preventing an obstruction. Scar tissue may form in the abdomen from surgery, injury (such as penetrating wounds or auto accidents), and infections (such as appendicitis). Being active after any surgery or bowel injury may help prevent adhesions. If you have a hernia in the abdominal wall or groin, ask your health care provider if repair of the hernia would help prevent a bowel obstruction.