Cachexia - causes, symptoms, stages of the disease, diagnosis and treatment methods

The result of serious pathologies can be a sharp and significant loss of body weight. This condition is called cachexia and is accompanied by a pronounced deterioration in well-being, requiring urgent medical attention. The most unfavorable prognosis in the absence of treatment is death. Therapy of the disease should be dealt with only by a specialist of the appropriate profile, since there is a high risk of developing concomitant complications.

What is cachexia

A condition characterized by an extreme degree of depletion of the body and arising as a result of serious disturbances in physiological processes is called cachexia. This term is used to refer to deviations from normal values ​​detected in clinical or laboratory studies. In the International Classification of Diseases (ICD-10), cachexia is encoded by the symbol R64 and is included in category R50-R69 "General symptoms and signs."

Manifestations of cachexia are highly specific - the patient’s appearance varies greatly, the mental state worsens, and vitality decreases. The etiology of the condition is associated with a wide range of pathologies, including oncological diseases and acquired immunodeficiency syndrome (AIDS). In some cases, the patient can independently provoke the disease by consciously refusing to eat (due to religious beliefs or due to a pathologically critical attitude to his body).

Causes

Depending on the factor provoking the disease, cachexia is characterized by various signs. It is not reliably determined what effect the causative pathologies have on the pathogenesis of the disease, but a number of specific causes of depletion have been identified. These include:

  • the birth process complicated by massive bleeding (in a newborn child, postpartum pituitary infarction is formed, leading to the development of Sheehan's syndrome);
  • a decrease in the diameter (stenosis) of the esophagus, which prevents food from entering the stomach;
  • violation of the processes of digestion of food and absorption of nutrients (occurs in diseases such as enterocolitis, celiac disease, malnutrition in children);
  • poisoning the body with toxins as a result of a long course of infectious diseases (brucellosis, tuberculosis) or purulent processes (abscesses, progressive osteomyelitis);
  • psychogenically caused syndrome of complete lack of appetite (anorexia) or forced starvation;
  • insufficiency of endocrine glands (adrenal glands, thyroid) or hypothalamic-pituitary system;
  • severe heart failure;
  • uncontrolled use of psychostimulants;
  • disorders of protein metabolism (amyloidosis);
  • oncopathology;
  • AIDS;
  • secondary respiratory diseases developing against a background of chronic infections (bronchiectasis);
  • systemic diseases of the connective tissue of a diffuse nature (lupus erythematosus, scleroderma, polymyositis).

Symptoms

Manifestations of cachexia vary depending on the type of disease provoking it, but a common and constant sign is a rapid decrease in body weight (up to 50% of the original). Other common symptoms that have a history of the disease are:

  • asthenia (general weakness, weakness, irritability);
  • subdepressive state (mood decline, apathy, demotivated behavior);
  • low blood pressure;
  • muscle hypotension (decreased muscle tone);
  • protein-free edema (due to a violation of the lymphatic flow, fluid is removed from the tissues and its accumulation in serous cavities);
  • a decrease in glomerular filtration rate in the kidneys (fluid passing through the renal vessels);
  • keratinization and draining of the skin (the skin becomes flabby and acquires an unnatural color, wrinkles appear);
  • crumbling, tooth loss;
  • frequent dizziness;
  • a feeling of cold in the limbs without fever (occurs due to a decrease in the volume of circulating blood);
  • the appearance of ulcerative formations in the mouth (stomatitis);
  • brittle nails, hair loss;
  • strong and prolonged constipation;
  • decreased potency in men, amenorrhea (absence of menstruation for 3 or more months) - in women;
  • violation of intestinal microflora, manifested in the form of worsening peristalsis (dysbiosis).

In most cases, all or most of the listed symptoms are present, less often the clinical picture is supplemented by atypical phenomena. Severe forms of a disease provoking cachexia or a period of exacerbation may be accompanied by the following conditions joining the main symptoms:

  • amentia (temporary clouding of consciousness, expressed in the incoherence of speech and movements);
  • severe or rudimentary forms of delirium (a mental disorder accompanied by hallucinations and delirium);
  • pseudo-paralysis (unreasonably elevated mood, carelessness, committing ridiculous acts).

Degrees

The nature of the pathological changes that occur in the body during exhaustion determines the division of the disease into 3 degrees. The feasibility of determining the specificity of the disease process is due to differences in treatment regimens. Signs of degrees of cachexia are specific manifestations, which include:

Power

Hypothalamic

Cachectin

Anorexia

Characteristic changes in the body

The synthesis of protein kinases (a subclass of phosphotransferases), enzymes that modify most proteins, is inhibited.

Increased production of cachectin (tumor necrosis factor) - a specific protein that has a cytotoxic effect on tumor cells.

Decrease in the production of adrenal cortex, thymus or pancreas by biologically active hormones.

Consequences of Changes

The process of breakdown, digestion and absorption of proteins in the digestive tract is inhibited. The activity of the lipoprotein lipase enzyme, which regulates lipid levels, decreases, which leads to a slowdown in metabolic processes and inhibition of fat transport.

Violation of the synthesis of neuropeptides - protein molecules produced by the nervous system and regulating physiological processes.

The formation of neoplasms in blood plasma or an increase in the number of available. Violation of the processes of absorption of nutrients (malabsorption).

Manifestations

Progressive weight loss.

Emotional imbalance, nervous breakdowns, a complete lack of appetite with an objective need for food, a sharp reduction in adipose and muscle tissue.

Diarrhea, steatorrhea (increased excretion of fats and feces from the body), abdominal pain, anemia, asthenia.

Classification

Structures damaged due to the development of the primary disease determine the scenario of the pathological depletion of the body. The main classification sign of cachexia is its etiology. The disease is classified as exogenous depletion (nutritional deficiency or deliberate refusal of food) and endogenous (developing against the background of internal malfunctions). Such forms of pathology are distinguished:

  • Cancer cachexia - diagnosed in patients with malignant tumors of any size. The cause of exhaustion is the poisoning of the body by the decay products of tumor formations or an excessive accumulation of lactic acid and its salts (lactates). With oncological diseases, cachexia does not develop in all patients (even in the presence of large tumors) and the cause of this phenomenon has not yet been determined.
  • Alimentary cachexia - occurs due to a violation of all metabolic processes in the body. This condition can occur due to a prolonged lack of necessary nutrients during fasting. The result is muscle atrophy, hormonal disruptions, impaired intellectual activity and the psyche.
  • Senile depletion - is associated with diseases developing during the aging of the body. The natural process of muscle contraction (occurring after 50-55 years) does not apply to pathological exhaustion.
  • Cardiac cachexia - disturbances in the functioning of the heart muscle (myocardium) lead to a deterioration in the blood supply to organs, resulting in stagnation of blood. If this process progresses and becomes severe, further changes occur (an increase in the size of the liver and the number of inflammatory cytokines) that provoke weight loss.
  • Cerebral cachexia - develops due to damage to the structures of the brain (hypothalamus, diencephalon). This is the most difficult to treat type of disease characterized by the presence in the history of patients with psychological trauma.
  • Pituitary depletion - the causes of development are congenital or acquired pathologies associated with hormonal failure, expressed in dysfunction of the pituitary gland (front part) and hypothalamus (central part). The consequence of violations is the reduction or complete cessation of the production of hormones of the adenohypophysis (somatotropin, prolactin, gonadotropin, lutropin, etc.)

Complications

In the absence of timely measures taken to normalize metabolic processes, exhaustion reaches an extreme degree and can entail negative consequences. The most dangerous possible complications of progressive weight loss include:

  • dehydration (dehydration) of the body;
  • internal bleeding (with peptic ulcer of the stomach or intestines);
  • irreversible stupefaction;
  • mental disorders (apathetic stupor, chronic asthenia);
  • aggravation of the primary disease;
  • sepsis (blood poisoning);
  • hypo- and vitamin deficiencies;
  • development of renal and heart failure;
  • coma.

Diagnostics

It is not difficult to determine the presence of exhaustion in the patient, but a number of diagnostic measures are carried out to determine the cause of cachexia and its severity. After the initial examination, including a physical examination and questioning of the patient, the doctor may order one or more of the following types of diagnostic procedures:

  • ultrasound examination of the abdominal organs;
  • blood donation for laboratory tests (general, biochemical, hormonal);
  • magnetic resonance imaging (MRI) of the brain;
  • general urine analysis;
  • bacteriological inoculation (bacterial inoculation) of the biomaterial to detect signs of sepsis;
  • chest x-ray;
  • endoscopic examinations (colonoscopy, hysteroscopy, gastroscopy, esophagogastroduodenoscopy, etc.)

After receiving and deciphering the results of the tests, the specialist determines the treatment tactics. Often, doctors of several specializations take part in the preparation of the treatment program, which is due to the multifactorial etiopathogenesis of the disease. Specialists with qualifications in the following areas of medicine can consult on treatment areas:

  • neurology;
  • psychiatry;
  • endocrinology;
  • oncology;
  • Surgery
  • gastroenterology.

Cachexia treatment

Depletion of the body is a consequence of exogenous or endogenous factors, therefore, in the treatment of pathology, the main attention is paid to eliminating the causes of the disease state. A mandatory measure of the therapeutic course is the restoration of good nutrition, which should occur gradually and systematically. To normalize the appetite and digestive system during cachexia, the following groups of drugs can be prescribed:

Pharmacological group

Preparations

Release form

Appointment

Enzyme products

Pancreatin, Pancitrat, Pancreon

Jelly beans

Normalization of the secretory function of the endocrine glands.

Rehydrated

Glucose, Dextrose

Solution for infusion, tablets

Replenishment of water deficiency, improvement of metabolic processes, detoxification effect.

Antihistamines

Periactin, Peritol, Cyprodin

Pills syrup

Increased secretion of pancreatic juice (helps increase appetite), the elimination of serous puffiness.

Hormonal drugs

Andriol, Testosterone Caprinate

Capsules, tablets

Replenishment of hormone deficiency (endogenous testosterone), regulation of protein-nitrogen-phosphorus metabolism.

Forecast

A full recovery with the depletion of the body can be achieved only if you get rid of the factors provoking its development. The most unfavorable prognosis in cancer patients is that in more than 30% of cases, a fatal outcome is recorded. It is not cachexia itself that causes the death of patients, but the complications accompanying it (skeletal muscle atrophy, disappearance of the fat layer, inhibition of metabolism, etc.).

Timely measures taken to stabilize the state of an exhausted patient reduce the effect of pathology on life expectancy. The suppressed psycho-emotional state (subdepression) in the initial stage does not lead to critical psychiatric deviations, and the patient is able to independently seek medical help. To increase the chances of a complete cure, you should follow all the recommendations of doctors, eat well and observe the daily regimen.

Attention! The information presented in the article is for guidance only. Materials of the article do not call for independent treatment. Only a qualified doctor can make a diagnosis and give recommendations for treatment based on the individual characteristics of a particular patient.

Watch the video: What is cancer cachexia What causes it ? Find Health Questions (February 2020).