Alimentary dystrophy

Alimentary dystrophy is a type of dystrophy (Greek dystrophe - a disorder of the nutrition of tissues, organs or the organism as a whole).

Dystrophy is considered as a “disruption of the natural process of assimilation of proteins, carbohydrates, and fats that the body must absorb with food.”

But alimentary (Latin alimentum - maintenance) in this context means that the dystrophic condition develops as a result of a prolonged lack of nutrition (i.e. hunger) or malnutrition. In medicine, this term appeared during the siege of Leningrad. Apparently, in statistical reports on the number of residents of the besieged city who died of hunger, the formulation "death occurred 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.

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Causes alimentary dystrophy

According to the UN Standing Committee on Nutrition (SCN), disease and malnutrition are closely linked, and malnutrition is a major cause of health problems worldwide.

According to the World Food Programme, early malnutrition leads to decreased physical and mental development of children. Today, there are at least 147 million children with growth retardation due to chronic malnutrition in developing countries. Signs of malnutrition are found in 14.3% of adults. Moreover, malnutrition is the cause of 45% of deaths in children under five: in Asia and Africa, 2.6 million children die annually from malnutrition.

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

In a word, this pathology occurs when a person goes hungry or eats food that in no way covers the body’s energy expenditure.

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Symptoms alimentary dystrophy

The appearance of characteristic symptoms of alimentary dystrophy is due to the fact that, not receiving an adequate replenishment of nutrients that ensure general metabolism, the body begins to consume fats and carbohydrates from its "reserves". And when they are exhausted, the process of dissimilation (breakdown) of tissue proteins, protein structures of enzymes and hormones is launched.

This occurs during the oxidation of amino acids in the blood - to obtain the missing energy, since the amino acids that are formed during the digestion of food proteins and enter the cells are sorely lacking.

Then a rapid loss of proteins begins (more than 125 g per day). As a result, metabolism and the balance of blood proteins and tissue proteins are disrupted, atrophic degenerative changes in the skeletal muscles occur with a loss of muscle mass and loss of muscle function; the level of sugar and cholesterol in the blood drops sharply; the content of glycogen in the liver parenchyma and muscle tissues also decreases. In general, all the signs of cachexia (ancient Greek - poor condition) are present - a syndrome of extreme exhaustion of the body.

The key clinical symptoms of alimentary dystrophy are the following:

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

According to severity, three degrees of alimentary dystrophy are distinguished: 1st degree (mild) - weakness and weight loss without muscle atrophy; 2nd degree (moderate) - a sharp deterioration in the general condition, the presence of cachexic syndrome; 3rd degree (severe) - a complete absence of subcutaneous fat and atrophy of skeletal muscles, decreased function of organs and systems.

In addition, a distinction is made between edematous and dry varieties of alimentary dystrophy. Cachexic edemas may be accompanied by an increase in daily urine output (polyuria) and fluid stagnation in the cavities. And dry dystrophy - with all other manifestations - is distinguished by more pronounced muscle atrophy and the presence of brown myocardial atrophy (a decrease in the size of the heart and thinning of its muscle fibers).

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Diagnostics alimentary dystrophy

Diagnosis of alimentary dystrophy for clinical medicine does not present any difficulties, although, as experts note, this pathological condition should be distinguished from:

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

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Treatment alimentary dystrophy

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

For patients undergoing treatment for alimentary dystrophy, it is extremely important to maintain physical rest and psycho-emotional balance.

In the treatment of alimentary dystrophy of the 2nd and 3rd degree of severity, strict bed rest in a hospital setting is indicated. Nutrition can be carried out using a tube. In addition, intravenous glucose infusions are prescribed, as well as dosed transfusions of blood plasma or blood substitutes. In case of digestive disorders, heart rhythm disturbances, anemia and other symptoms, symptomatic drug therapy is carried out using appropriate drugs.

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

In severe forms of alimentary dystrophy, there is a high probability of developing comatose states, which require emergency medical care. Among the main points of the instructions for its implementation:

• warm the patient by placing heating pads on him;
• intravenously administer a 40% glucose solution (40 ml every three hours), 33% alcohol (10 ml), 10% calcium chloride solution (5-10 ml);
• to stimulate breathing - administer a 1% solution of lobeline hydrochloride (1 ml) intramuscularly or intravenously; make subcutaneous injections of a 10% solution of caffeine-sodium benzoate (1 ml) and a 0.1% solution of adrenaline (1 ml).

Prevention

Prevention of alimentary dystrophy is a complete diet that ensures timely replenishment of the body's energy expenditure.

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Forecast

The prognosis of alimentary dystrophy - recovery, transition to a chronic condition or death - directly depends on the degree of exhaustion of the body. In the case of 1st and 2nd degree of severity (mild and moderate), the prognosis is favorable. The 3rd degree of pathology has an unfavorable prognosis, since the condition is aggravated by complications of alimentary dystrophy in the form of such concomitant diseases as dysentery, pneumonia and tuberculosis.

The great ancient physician Hippocrates said that when the "flesh disappears" (that is, weight loss due to chronic malnutrition, a condition we call alimentary dystrophy), "the shoulders, collarbones, chest, fingers seem to melt. This condition is the face of death."

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