Alimentary dystrophy

Alimentary dystrophy is a kind of dystrophy (Greek dystrophe - an eating disorder of tissues, organs or the body as a whole).

Dystrophy is considered as "a violation of the natural process of assimilation of proteins, carbohydrates, fats, which the body must absorb with food."

But the alimentary (latin alimentum - content) in this context means that the dystrophic condition develops as a consequence of a prolonged lack of nutrition (that is, hunger) or malnutrition. In medicine this term appeared during the siege of Leningrad. Obviously, in the statistical reports on the number of people who died of hunger in the besieged city, the word "death came due to alimentary dystrophy" did not look so ominous ...

In both cases, the normal functioning of all organs and systems of the body is disrupted due to protein and energy deficiency.

[1], [2], [3], [4], [5],

Causes of the alimentary dystrophy

According to the United Nations Standing Committee on Nutrition (SCN), diseases and malnutrition are closely related, and globally, alimentary dystrophy is one of the main causes of health problems.

According to the World Food Program, alimentary dystrophy at an early age leads to a decrease in the physical and mental development of children. To date, in developing countries, there are at least 147 million children with growth retardation due to constant malnutrition. Signs of food dystrophy have 14.3% of adults. Moreover, alimentary dystrophy is the cause of 45% of deaths of children under the age of five: 2.6 million children die each year from malnutrition in Asia and Africa.

The main causes of alimentary dystrophy are associated with a deficiency in the diet of proteins and other essential nutrients, or - with their complete absence ...

In a word, this pathology occurs when a person goes hungry or consumes something that does not cover the energy costs of the body in any way.

[6], [7], [8], [9], [10], [11]

Symptoms of the alimentary dystrophy

The appearance of characteristic symptoms of alimentary dystrophy is due to the fact that, without getting adequate replenishment of nutrients that provide a general metabolism, the body begins to consume fats and carbohydrates from its "storages". And when they run out, the process of dissimilation (disintegration) of tissue proteins, protein structures of enzymes and hormones starts.

This is due to the oxidation of amino acids in the blood - to obtain the missing energy, since the amino acids that are formed when digesting food proteins and enter the cells are sorely lacking.

Then the rapid loss of proteins begins (more than 125 g per day). As a result, the metabolism and balance of blood proteins and tissue proteins are disturbed, atrophic degenerative changes in skeletal muscles occur with loss of muscle mass and loss of muscle functions; in blood sharply reduced the level of sugar and cholesterol; the glycogen content in the liver parenchyma and muscle tissues is also reduced. In general, there are all the signs of cachexia (dr.-Greek - bad state) - the syndrome of extreme exhaustion of the body.

The key clinical symptoms of alimentary dystrophy are as follows:

• agonizing (insatiable) hunger;
• pallor and yellowness of the skin, the skin is dry and wrinkled;
• thinness (significant weight loss);
• general weakness, dizziness;
• decrease in body temperature (hypothermia) to + 35.5-36 ° C;
• reduction in muscle and subcutaneous tissue (atrophy);
• numbness (paresthesia) and muscle pain;
• reduction of arterial and venous pressure and blood flow velocity;
• disorders of the heart rhythm (bradycardia and tachycardia);
• digestive disorders and intestinal atony (dyspepsia, flatulence, constipation);
• anemia  (hypochromic or hyperchromic);
• decreased functions of the sexual glands (amenorrhea, impotence);
• increased irritability and excitability at the onset of the disease; apathy, drowsiness and inhibition - at later stages.

In terms of severity, it is common to distinguish three degrees of alimentary dystrophy: 1st degree (mild) - weakness and weight loss without muscle atrophy; 2nd degree (middle) - a sharp deterioration in the general condition, the presence of a cachexic syndrome; 3rd degree (severe) - complete absence of subcutaneous fat and atrophy of skeletal muscles, decreased functions of organs and systems.

In addition, distinguish between edematous and dry varieties of alimentary dystrophy. Cachexia edema can be accompanied by an increase in the daily excretion of urine (polyuria) and fluid congestion in the cavities. And dry dystrophy - with all other manifestations - differs more pronounced muscular atrophy and the presence of brown atrophy of the myocardium (a decrease in the size of the heart and the thinning of its muscle fibers).

[12]

Diagnostics of the alimentary dystrophy

Diagnosis of alimentary dystrophy for clinical medicine does not represent complications, although, as specialists note, this pathological condition should be distinguished from:

• oncological diseases (oncological cachexia),
• chronic dysentery,
• long-term intoxication of the body with tuberculosis or brucellosis,
• syndrome of digestion and absorption of food (chronic enterocolitis and other diseases),
• intoxication with purulent inflammation (abscesses, osteomyelitis, sepsis),
• diencephalic-pituitary cachexia (Simmonds syndrome),
• metabolic disorders in diseases of the thyroid gland,
• chronic hypokorticism (dysfunction of the adrenal cortex or Addison's disease),
• psychogenic anorexia.

[13], [14], [15], [16]

Treatment of the alimentary dystrophy

Treatment of alimentary dystrophy consists, first of all, in providing the patient with high-grade nutrition (3000-4000 kcal per day) with an increased content of easily digestible proteins, vitamins, macro- and microelements. Number of meals - small amounts - at least six times a day. If there is diarrhea, the food should be homogeneous. At the same time, consumption of table salt should be limited (maximum 10 g per day), and the recommended amount of liquid to be drunk is 1000-1500 ml during the day.

Patients undergoing treatment for alimentary dystrophy, it is extremely important to observe physical rest and psychoemotional balance.

In the treatment of alimentary dystrophy of the 2nd and 3rd degree of severity, a strict bed rest is shown in a hospital. Power can be conducted using a probe. In addition, intravenous glucose injections, as well as metered-dose transfusions of blood plasma or blood-substituting formulations are prescribed. With digestive disorders, heart rhythm disorders, anemia and other symptoms, drug-induced symptomatic therapy with the use of appropriate drugs is performed.

For example, patients with dyspepsia take enzyme preparations: gastric juice, hydrochloric acid with pepsin, as well as pancreatin, abomin, panzinorm-forte, etc. The main means against anemia are vitamin B12, folic acid and iron-containing preparations (parenteral-ferrum-lek, ferbitol inside - gemostimulin, ferroplex, etc.).

With a severe form of alimentary dystrophy, there is a high likelihood of developing comatose conditions, in which urgent medical attention is needed. Among the main points of the instruction for its conduct:

• warm the patient by applying heaters;
• intravenously inject 40% glucose solution (40 ml every three hours), 33% alcohol (10 ml), 10% solution of calcium chloride (5-10 ml);
• to stimulate respiration - intramuscularly or intravenously inject 1% solution of lobeline hydrochloride (1 ml); do subcutaneous injections of a 10% solution of sodium caffeine-benzoate (1 ml) and 0.1% solution of adrenaline (1 ml).
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Prevention

Prevention of alimentary dystrophy is a full-fledged diet that ensures the timely replenishment of the energy inputs of the body.

[17], [18], [19], [20],

Forecast

The prognosis of alimentary dystrophy - recovery, transition to a chronic condition or a lethal outcome - directly depends on the degree of exhaustion of the body. In the case of the 1 st and 2 nd degree of severity (mild and moderate), the prognosis is favorable. An unfavorable prognosis is the third degree of pathology, as they aggravate the state of complication of alimentary dystrophy in the form of such incidental diseases as dysentery, pneumonia and tuberculosis.

The great doctor of antiquity Hippocrates said that with the "disappearance of the flesh" (that is, weight loss in chronic malnutrition, that is, a condition we call alimentary dystrophy), "the shoulders, collarbone, chest, fingers seem to melt. This state is the face of death. "

[21], [22]