Cachexia

The degree of complete exhaustion of the human body denotes the medical term cachexia. This condition, when the body of the patient sharply loses weight, the vital tone decreases, the vital tone decreases, all the physiological processes are slowed down, a change takes place on the mental level.

[1], [2], [3], [4], [5], [6]

Causes of Cachexia

This disease reverses the patient beyond recognition. In memory, images of documentary films about the Second World War, concerning concentration camps, are emerging. In modern life, the causes of cachexia are due to a wide range of factors.

• Diseases of the esophagus (stenosis), in which it is difficult to get food into the patient's stomach.
• Fasting for a long period of time.
• Severe form of heart failure.
• Chronic forms of brucellosis and tuberculosis, in which the patient's body is exposed to prolonged intoxication.
• Ultrasonic polyarthritis.
• Purulent processes in the body (progressive osteomyelitis and abscesses, suppurated bronchiectasis).
• Cancerous tumors.
• Diseases of the gastrointestinal tract, the consequences of which is the failure of the functions of digesting food and absorption of its mucous (gastrectomy, enterocolitis, the effects of resection of the stomach (celiac disease), and so on).
• Amyloidosis.
• Failure in the work of the endocrine system, the violation of metabolic processes (pathology of the adrenal gland and the work of the thyroid gland).
• Psychogenic anorexia.
• Prolonged reception of psychostimulants.
• Malnutrition.
• Diseases of connective tissues of a diffuse nature.
• Hypotrophy in small patients.
• Syndrome of acquired immune deficiency (AIDS).

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

Symptoms of cachexia

The course of the disease, the predicted outcome, and, accordingly, the symptoms of cachexia largely depends on the nature of the disease that caused it. But the main symptomatology is this:

• Rapid weight loss (a severe degree of cachexia shows a loss of half the normal weight of a person).
• Loss of capacity for work.
• Decreased general vitality.
• Dangerous loss of body fluid, its accumulation in the serous cavities of the body - a consequence of malfunction of blood circulation and lymph flow (transudate).
• Loss of fat cells.
• General weakness.
• Avitaminosis.
• Protein-free edema.
• Skin flabby, wrinkled, color unnaturally pale, gray - green.
• Increased brittleness of hair and nails.
• Stomatitis.
• Dysbacteriosis.
• Constipation.
• Loss of teeth.
• Decreased immunity.
• Amenorrhea in women (absence of menstruation during several menstrual cycles).
• Deterioration of potency in men.
• Failure in the work of intestinal peristalsis.
• Blood pressure is low.
• Constant feeling of cold.
• Reduction of glomerular filtration in the kidneys.
• Reduction of the volume of circulating blood.

Mental disorders are common:

• Asthenia.
• Sub-depressive mood.
• Tearfulness.
• Dullness of consciousness.
• Apathetic stupor.
• Less common is a psycho-organic syndrome.

Degrees of cachexia

Physicians distinguish three degrees of cachexia:

Hypothalamic form of the disease. It is characterized by complete or partial cessation of peptide synthesis in human plasma. The consequences of this failure:

• Inhibition of the production of protein kinases (phosphotransferases) involved in the modification of many proteins.
• Blocking of lipogenesis process, including digestion, digestion and absorption of lipids of the digestive tract, transportation of fats from the intestine, exchange transformations of triacylglycerols, cholesterols and phospholipids.
• Decrease in the activity of endothelial lipoprotein lipase (regulates lipid levels in the blood, which is essential for atherosclerosis).
• There is suppression of anabolism (metabolic processes).
• Transport of fats is slowing down.
• There is an intensification of catabolism (energy metabolism).

Kahehtinovaya form of the disease. It is accompanied by increased production of kahehtin, as a result of which:

• Frequent and lasting emotional failures.
• Loss of appetite.
• Imbalance of the synthesis of neuropeptides (protein molecules formed in the central or peripheral nervous system and regulating the physiological functions of the human body).
• Rapid development of anorexia (pathological weight loss).

Anorexic form of the disease. It is represented by malabsorption (a violation of the absorption of substances in the small intestine):

• The increase in the number of new formations, such as necrotic alpha tumors in the blood plasma.
• Deficiency of hormones of the thymus.
• Hypocorticism (pathological changes caused by hypofunction of the adrenal cortex).
• Hypoinsulinism (endocrine disease, characterized by attacks of significant reduction in blood sugar).

All this leads to a rapid loss of body weight.

[12], [13], [14], [15], [16], [17],

Classification of cachexia

Depending on the etiology of the disease classification of cachexia passes in several directions:

Exhaustion of the organism, connected with exogenous factors (influence of the surrounding, external environment):

• Lack of food.
• Fasting (of a religious nature or a maniacal desire to lose weight).

Endogenous causes (internal failures):

• Chronic stage of radiation sickness.
• A violation of the adrenal glands.
• The age-old involution of the body.
• The presence of a malignant tumor.
• Violation of the endocrine glands.
• Myxedema (insufficient provision of organs and tissues of the body with thyroid hormones).
• Consequences of trauma.
• Terminal (dystrophic) form of chronic heart failure.
• Postoperative hypothyroidism (long, persistent deficiency of thyroid hormones).
• Significant decrease in mental activity.

[18], [19], [20], [21]

Pituitary cachexia

Violation of the integrity of the functioning of the anterior lobe of the pituitary gland and the centers of the hypothalamus, manifested in the insufficient development or total absence of production of triple hormones of adenohypophysis, leads to hypocorticism (adrenal gland dysfunction), hypothyroidism (hypothyroidism) and hypogonadism (decrease in the number of male sex hormones - androgens). All these failures lead to the development of pituitary cachexia in the patient's body.

The cause of this pathology can be:

• Injury.
• Inflammatory process, taking place in the pituitary gland.
• Malignant or benign tumor.
• Bleeding and collapse in childbirth followed by ischemia or thrombosis of the vessels in the hypothalamic-pituitary system.
• Spasm and thrombosis of the arteries, supplying blood to the anterior part and pituitary foot, cause necrosis of adenohypophysis.

Cerebral cachexia

Cerebral cachexia is diagnosed with pathological changes in the hypothalamus. Often the disease affects not only the areas of the pituitary gland, but also inflammatory, dystrophic processes affect the intermediate brain. When such a pathology dominates the pituitary, with a sharp weight loss, doctors diagnose the cerebral form of the disease.

There are cases of sudden weight loss, while the studies did not reveal any deviations in the endocrine system. Often, these patients in history have a trauma of a psychological nature (shock, fright). Anorexia of this nature occurs quite often and leads to the onset and progression of the cerebral form of the disease. Treatment of the disease of this etiology is very difficult, because the medicine does not fully understand all the processes taking place in the brain.

[22]

Alimentary cachexia

If the cause of anorexia is long-term malnutrition, malnutrition, voluntary or induced starvation, the general exhaustion of the organism develops, physicians refer this pathology to alimentary cachexia.

With this pathology, all metabolic processes in the body fail, the degeneration of organs and tissues progresses, disrupting their functioning. A person's physical activity decreases, changes in the psychological perception of the surrounding society are manifested.

Massive social status is acquired by the alimentary form of the disease during natural disasters (food loss during floods and earthquakes ...) and social conflicts (war, artificial famine).

During a period of prolonged malnutrition, the body does not receive the necessary nutrients, vitamins and microelements, which are a source of energy, for normal functioning. This leads to a reduction in energy costs, loss of psychological, intellectual and physical ability to work. There is a redistribution of the necessary substances, which contributes to a mismatch in the work and trophism of various systems and organs. The hormonal background is undergoing reorganization (failure of the thyroid gland, glands of the reproductive system, adrenal glands). Restriction of protein foods provokes hypoproteinemia, which is manifested by protein puffiness.

Gradually, there is an atrophy of the muscles of the skeletal framework, the patient loses subcutaneous fat. When carrying out studies of such patients, a decrease in liver size in 2 - 2.5 times, and other organs are atrophied.

[23], [24], [25], [26], [27], [28]

Malignant cachexia

Malignant cachexia is more often manifested in patients suffering from a rapid decomposition of the tumor conglomerate, but the size of the tumor does not matter.

Causes of exhaustion:

• Intoxication of an organism with toxins of cancer cells or "products of vital activity" of accompanying complications.
• Accumulation of an excess amount of lactic acid, which is detrimental to the condition and functioning of the liver. The organism of the patient counteracts it by the splitting of sugar in the blood, mobilizing its carbon stock. Fill the same losses can not.

Most often, malignant form of the disease is a companion of cancer of the gastrointestinal tract, respiratory tract. Due to diseases of the digestive system, there is aversion to many foods. As a result, the body does not receive a lot of nutrients necessary for normal functioning.

However, cases are frequent (for example, skyrr is a type of stomach cancer - a sharply deforming organ that disrupts its motor function and secretory work) when cachexia does not occur. While small tumors are capable of provoking its rapid progression. Therefore, it is impossible to single out the cause of the pathological deviation to date.

Cardiac cachexia

As a result of a shortage of nutrients, myocardium is also affected pathologically. The heart gradually loses its pumping ability to pump blood in the volume necessary for the normal functioning of the body. To a similar result lead vices and ischemic heart disease. As a result, a person acquires a heart failure. In severe forms of chronic heart failure, significant weight loss is observed. This pathology is classified as cardiac cachexia.

Until the end, the mechanism of appearance and development of cachexia is not clear, but it is definitely composed of multiple factors. The main for the heart form of the disease are:

• Hepatomegaly, which is caused by stagnation of blood in the venous system.
• Persistent feeling of fullness of the stomach.
• An increase in the number of inflammatory cytokines.
• Violation of intestinal peristalsis.

It is very difficult to diagnose the cachexia of this etiology, but the prognosis for recovery is quite favorable.

[29], [30], [31], [32], [33], [34], [35], [36], [37]

Old cachexia

A person grows old, because his body is aging. There is a slowdown in metabolic processes, skin regeneration is slower, and so on, but the old man's organism can not be depleted to the norm. Often after 50 years, there is a significant reduction in muscle mass, while the amount of fat increases. These are the consequences of a sedentary lifestyle, sedentary work, a restriction in nutrition.

The body ages, there are various diseases that can lead to a strong exhaustion of the body, which falls under the category of senile cachexia.

Treatment of cachexia

Sharp exhaustion is already a consequence of external factors or some diseases that affect the body. Therefore, cachexia treatment is reduced to eliminating, above all, the causes that led to progressive weight loss. If depletion is a consequence of the disease, therefore, the patient must undergo a full course of treatment. If cachexia was provoked by external factors, it is necessary, respectively, to minimize their effects and undergo restorative therapy.

But the obligatory point in the normalization of the patient's condition is the systematic restoration of a balanced diet, careful care for him. Obligatory order in the diet is introduced easily digestible proteins, vitamins, fats, foods rich in microelements. If the patient looks at the symptoms of a malfunction in the digestive tract and the suction system, the doctor ascribes polyenzyme medications, for example pancreatin.

• Pancreatin

The amount of the medicinal product is dependent on the age of the patient and the degree of shortage of enzymes produced by the pancreas. The drug is taken before meals or along with food, washed down with a large amount of water or, preferably, an alkaline liquid (fruit juice).

The average daily dosage of the drug, divided into three to six receptions, is 0.25-0.5 grams. In case of complete deficiency of the secretory function, the dosage is increased to 0.75 gram daily. For children under the age of 18 months, the starting dose is 0.1 grams, for older children - 0.2 grams.

The duration of the treatment course depends on the severity of the disease and varies from several days to months and years.

Contraindications of a remedy include:

• Individual intolerance to one or more of the components that make up the drug.
• Acute or chronic pancreatitis at the stage of exacerbation.

When taking medication, side effects can occur:

• Inflammation of the pancreas.
• Allergic reactions.
• With prolonged use - hyperuricosuria (urine analysis shows an increased amount of lactic acid).

If the patient is in serious condition, parenterally (bypassing the intestine - injections intramuscularly or intravenously), inject glucose, amino acid mixtures, vitamins, protein hydrolysates. If necessary, the doctor connects anabolic steroids (eg, andriol).

With cachexia of psychogenic nature, the psychiatrist and the neurologist give their prescriptions (for example, drugs that increase appetite: periaktin, primobolan-depot).

• Glucose

The drug is administered either orally, intravenously, or by intramuscular injection. Dosage of a single dose is 0.5 - 1 g.

Subcutaneously or in a vein, glucose is supplied with a solution of 4.5 - 5% in an amount of 300-350 ml. In the form of enemas - up to two liters per day.

With a large volume of the drug being administered, a water-salt imbalance, an increase in fluid, and thrombosis may occur in the patient's body.

The only contraindication to the use of glucose can be diabetes, which is available in the patient.

• Andriol

The necessary dose is attributed by the attending physician especially individually, depending on the clinical picture. The recommended initial daily amount is 120-160 mg for two to three weeks, with a subsequent reduction in dosage to 40-120 mg daily. The capsule of the drug is drunk after eating, if necessary with a small amount of liquid. Capsule can not be chewed and not opened, swallowing whole. The daily dosage is divided into two doses: morning and evening. If the daily amount is an odd number of capsules - a greater dosage is taken in the morning.

The drug is contraindicated for use in patients who have a history of verified prostate or breast carcinoma.

• Periactin

The drug is attributed to the doctor to raise the patient's appetite. The adult dosage is:

• tablets - 0.5 - 1 piece three - four times a day.
• syrup - one - two teaspoons three - four meals a day.

Babies age from two to six years - the maximum daily dose is two tablets or two tablespoons of syrup.

Children from 6 to 14 years - the maximum daily amount of the drug is three tablets or three tablespoons of syrup.

The drug is contraindicated with increased intraocular pressure, asthma, stomach ulcer, elderly people.

• Primobolan Depot

The drug is administered intramuscularly:

• adults one ampoule once every two weeks, then 1 ampoule every three weeks.
• children dosage is introduced at the rate of 1 mg per kilogram of the weight of the baby once every two weeks.

The drug is contraindicated for men suffering from prostate cancer and pregnant women.

Catering for cachexia

The diagnosis of depletion is made to a person if his weight deviates significantly from the norm. As for obese people there is a problem to lose weight, so for very thin is the real problem to gain weight and bring it to normal. In addition to medical means, normalizing the patient's weight is also capable of feeding with cachexia.

In such patients, there is often no appetite, and feeding them is problematic enough. Therefore, it is worth starting with small but high-calorie portions. The body should gradually "get used to" food. The maximum effect is achieved if the meal is divided into five to six approaches and is subject to the schedule. Food at the same time makes us stimulate the digestive system of the patient. The dishes should be tasty and aesthetically attractive - this is another stimulus for exciting the appetite. Forcing a person to eat through strength - you can achieve the opposite result.

Food should be varied, balanced, stimulating the desire to eat more. Nutritionists advise:

• The first dishes on a rich broth or a strong broth filled with sour cream, cream or yolks.
• Smoked fish.
• Peppered sauces.
• Spices.
• Fruit and vegetable freshly squeezed juices.
• Dessert.

If there are no medical contraindications, then you can eat everything. You just need to remember that they should be high-calorie. Cooking dishes are also necessary with the use of vegetable and cream oils, cream. In the diet of such a patient necessarily includes:

• Baking.
• Drinks containing large amounts of fat.
• High-calorie desserts.

Pieces of meat and fish better bake with vegetables or fry in vegetable oil. Fatty varieties of meat will perfectly go with sour and sharp gravies and seasonings (hot sauce, horseradish, adzhika, lemon, mustard).

Consumed salads should contain:

• Boiled vegetables with butter.
• Vegetables fried and stewed.
• The ideal seasoning is mayonnaise.

The garnish in this case is suitable:

• Porridge from cereals, seasoned with oil.
• Pasta.
• Boiled potatoes with butter.
• French fries.
• Potatoes - puree with milk, cream or sour cream.
• Potatoes baked with fat.

Dessert can be taken not only at lunchtime, but with a different meal:

• Cottage cheese casseroles, from pasta and cereals.
• Pies and kulebyaki.
• Puddings.
• Desserts can be not only sweet, but also salty.

Dieticians advise to avoid monotony.

[38], [39], [40]

Prognosis for cachexia

Any prediction depends on the nature of the disease, the severity of its course. The prognosis for cachexia directly depends on the factors and the disease of its provoked. Cachexia, provoked by a cancerous tumor, speaks of the advanced stage of the disease being launched and gives an unfavorable prognosis for recovery. If severe exhaustion is caused by other causes, then there is a chance of recovering from such a patient, but on condition that adequate effective treatment is performed, with observance of the diet and correction of the patient's lifestyle.

In nature, everything is harmonious and deviation, both towards the great weight, and its sharp loss leads to serious illnesses, the end of which can be fatal.

Cachexia is not a sentence (excluding oncological diseases) and it can be fought with, but it is necessary to do it only under the vigilant supervision of a graduate. Self-activity in this case is inappropriate, because your life is at stake!

ICD-10 code

According to the International Medical Classification, μB 10 cachexia belongs to the XVIII class of diseases. To the category R50 - R69 common symptoms and signs. In hospital sheets, cachexia is coded as R64.

Read also:

• Cancer cachexia