Exhaustion: diagnosis, treatment, prognosis

Weight loss of more than 20%, which provokes disorders in the work of human organs and systems, is called exhaustion. About the symptomatology of the pathological condition, methods of correction – you will learn from the article.

Contents:

1. General information.
2. Triggers of patholog.
3. Rare causes.
4. Diagnosis.
5. Treatment.
6. Before diagnosis.
7. Conservative therapy.
8. Surgical intervention.
9. Prognosis.

General Information

Wasting is a pathological reduction of subcutaneous fat with progressive reduction of lipid, muscle and connective tissue masses below normal. The extreme manifestation of emaciation is cachexia. There are no statistics on the prevalence of this pathology, because one of the causes of emaciation is dieting, and it is simply impossible to collect reliable information on how many people today are into newfangled ways of weight correction. Doctors, as a rule, meet already with the consequences of exhaustion.

Triggers of pathology

The causes of exhaustion are many and varied.

The main triggers include:

1. Anorexia of nervous genesis is the prerogative of young women. The reason is dissatisfaction with their appearance and body. Girls limit themselves in everything about food, sit on exhausting diets that allow you to lose up to 15% of body weight, and sometimes do not hesitate to provoke vomiting after eating. On such an unhealthy background comes rapid exhaustion, changing the appearance, shape, skin becomes dry, going into folds, hair begins to fall out, broken nail plates, a person experiences weakness, chronic fatigue. However, girls consider themselves fat and continue to lose weight by dieting. Progressive weight loss is associated with a concentration of leptin in the blood, which controls human eating behavior. Exhaustion provokes dysfunction of all internal organs, suggesting that exhaustion transforms into cachexia. The loss of extra kilograms reaches a third, complete refusal of food intake is possible. Against this background, subcutaneous fat disappears, all the ribs, pelvic bones, clavicles, spine are well contoured. In addition, there is a dysfunction of metabolic processes, there is pastosity, amenorrhea, disappearance of sexual desire. The occurrence of such signs requires an immediate visit to a specialist.
2. Esophageal stenosis prevents food from moving into the stomach. These are post-traumatic causes of the debilitation: stricture, tumor. At first, food partially overcomes the block and the weight loss is no more than 5%. However, the progression of esophageal constriction aggravates the emaciation, eating ends in vomiting, which forces patients to consciously reject food. Pasticity and ascites accompany this condition.
3. Diseases of the digestive system are formed on the background of dyspepsia: heaviness in the abdomen after meals, diarrhea, vomiting. The essence is malabsorption syndrome. Patients begin to minimize portions, which impoverishes food with proteins and vitamins. The person loses weight quickly, the skin becomes flabby, hyprepigmentation is noted, menstruation is disturbed, potency decreases, alopecia develops, and the nails are broken. All this is triggered by triggers such as intestinal, pancreatic and liver pathologies, infections, celiac disease, post-operative conditions in the gastrointestinal tract.
4. Internal intoxication is the result of cumulation of toxins and metabolic products of bacteria. Visually, there is weight loss against the background of lack of appetite, sharp deterioration of the dermis and hair, decreased erectile function, potency. Subfebrile symptoms, hyperhidrosis, pallor of the skin are present in the clinic. Emotional instability appears, and neurosis is formed. Most often it is a consequence of chronic infections, abscesses, sepsis.
5. Tumors of any localization as a result of severe intoxication provoke tissue disintegration, breakdown of substances. As a result, patients lose more than 29% of their weight in a short time, which guarantees loss of ability to work and a characteristic appearance: absence of hypodermis, flabby skin, hair loss, splitting nails. If the tumor occurs in the gastrointestinal tract, cachexia develops faster. This is explained by the formation of obstructions to the passage of food and impaired absorption of nutrients.
6. Dysfunction of the hypothalamic-pituitary system manifests itself by weight loss of up to 6 kg monthly on the background of general exhaustion. Weight loss is uniform, body proportions are preserved, the skin thins, becomes dry, angidrosis and alopecia are formed. Dystrophy is manifested by hypotonia, amenorrhea, constipation. Such symptoms resemble postpartum exhaustion in women as a result of Sheehan syndrome.
7. Cardiovascular pathologies provoke exhaustion in the third stage of cardiac insufficiency. Myocardial dystrophy, first of all, and changes in all muscle mass, lesion of small intestine mucosa become a trigger. At first the weight does not change, as the stage of edema and ascites comes, but then the patient loses 15% of the norm at once, there is weakness, adynamy, the face is drained and the abdomen is huge, leg edema.
8. Amyloidosis – abnormal deposition of protein in the intestine with impaired digestion and absorption of food because the small intestine fails to perform its functions. The patient loses weight against a background of constant diarrhea and lack of appetite. If the liver is involved, then in addition to pain on the right side of the subcostal area after each meal, bile vomiting appears. Wasting can accompany amyloidosis of the kidneys.
9. AIDS is visualized by dramatic weight loss due to secondary infection, with weight loss as high as 25% of normal and exacerbated in the presence of purulent lesions and diarrhea. Menstruation, libido, apathy, nervous breakdowns, and cognitive deterioration occur.

Rare causes

These should include:

• hereditary enzymopathies;
• collagenoses, including systemic ones;
• involuntary starvation;
• endocrine disorders;
• acantholytic vesicular disease;
• poisoning with salts of heavy metals;
• avitaminosis such as scurvy or pellagra.

Diagnosis

In order to make the correct diagnosis, a comprehensive examination of the patient with an assessment of his or her psychoneurological status is necessary.

Of greatest importance here are:

1. Ultrasound of the abdomen with sonography, which allows to see signs of inflammation and dystrophy, stenoses and tumors. Gastric and intestinal motility are assessed at the same time.
2. Ultrasound of the thyroid gland and adrenal glands, mammary glands, which can rule out malignant neoplasms.
3. A series of X-rays with contrast to estimate the speed of movement of the food lump.
4. X-ray of the Turkish saddle to rule out pituitary lesion.
5. Endoscopy allows for a detailed examination of structures and tumors in the upper part of the digestive tube. Methylene blue test to detect metaplasia, and biopsy of suspicious masses to rule out oncology.
6. OAC and biochemistry provide an opportunity to assess the level of protein in the bloodstream, the concentration of products of nitrogenous metabolism, basic electrolytes, the level of tropic hormones of the pituitary gland, liberins and hypothalamic statins.
7. Assessment of neurological status helps identify signs of nervous and physical exhaustion. They look at the level of consciousness and cognitive functions, muscle tone, coordination of movements. Cerebral CT and MRI scans, EEG are used for this purpose.

If symptoms of exhaustion accompany symptoms of intoxication, blood should be checked for cancer markers. All patients are screened for HIV. If mental disorders are suspected, a psychiatrist should be consulted.

Treatment

Medical care consists of several steps.

Help before diagnosis

The triggers that provoke exhaustion are so serious that it is almost impossible to correct them on your own. In most cases, emergency intervention is needed to rule out irreversible changes in internal organs. If the signs of the pathology are formed on the background of anorexia nervosa, while the patient does not consider himself ill, relatives can consult a specialist of the right profile.

Conservative therapy

The main goal of treatment is to replenish nutrients. A mild degree of depletion allows a gradual increase in the caloric content of the diet. The diet contains an optimal amount of protein, complex carbohydrates and vitamins. In severe cases, feeding through a tube and parenteral administration of corrective solutions of amino acids and fat emulsions are used. At anorexia psychotherapy is connected: individually or as part of correction groups.

Etiotropic therapy of exhaustion involves inclusion in the therapeutic scheme:

1. Enzymes, which are necessary for the normalization of digestive processes in chronic enteritis and pancreatitis. They replace thyroid function, and probiotics balance the microflora, preventing the development of SIBR – bacterial overgrowth syndrome in the small intestine.
2. Antibiotics are used for chronic infections that provoke intoxication and tissue and substance breakdown reactions. In combination with antimicrobials, antibacterial agents are used for opportunistic infections in AIDS.
3. Hormones are connected in case of endocrine genesis of the pathology, using them as substitution therapy. These are glucocorticoids, levothyroxine and sex hormones, in case of panhypopituitarism sometimes tropic pituitary hormones are used.
4. Cytostatics are indicated for severe pathologies of connective tissue, tumors, amyloidosis. The dosage is selected individually, taking into account the localization of the pathological process and the presence of metastases.

Surgical intervention

When a tumor is detected as a trigger of exhaustion, radical intervention is needed to remove the primary focus along with the affected tissue and lymph nodes. In cancers up to stage 2, the method of correction is organ-preserving surgery. In neglected cases, extended techniques. For treatment of debilitating esophageal obstruction, stenting of the affected area is used. If necessary, esophagoplasty with gastric or intestinal grafts is performed.