Alimentary dystrophy is the depletion of the body due to the insufficient number of nutrients, in other words, a disease of malnutrition. In fact, it is a condition where the body spends more resources (growth, development, physical and mental activity) than it gets from food.
The term suggested that therapists who worked in Leningrad during the siege in 1941-1942.
The main causes that can lead to malnutrition is:
- prolonged fasting;
- inadequate nutrition that does not provide the necessary amount of calories and nutrients, which are not covered by the energy consumption of the body.
In turn, the causes of these factors can be a huge amount.
Prolonged fasting can develop in the following circumstances:
- social disadvantage – the person does not have material resources to buy food, or he is in terms that do not allow you to eat normally – in the zone of war or natural disaster, forced confinement, lost in the wild and so on;
- diseases of the gastrointestinal tract, which hampered a full meal – first of all, it is some diseases of the esophagus (burns, congenital narrowing, foreign body, tumor), pathology with severe nausea and vomiting and so on;
- a fundamental failure of a healthy person from eating animal products (vegetarianism), which is fraught with alimentary dystrophy in that case failed to establish the compensatory replenishment of nutrients (primarily proteins) at the expense of plant foods;
- conscious denial of a healthy person from food for the sake of standards of beauty;
- mental illness in which a person may refuse food without any explanations – schizophrenia, depression, anxiety, eating (phobia).
Obsessive fear (phobia) of eating a particular food – a separate group of causes of prolonged starvation, which can lead to malnutrition. Distinguish a number of food phobias. The most common are:
- amyotonia – fear carbohydrate intake;
- carnophobia – fear of meat and offal;
- cibophobia – fear of drinking any kind of food.
Food phobia that lead to malnutrition (as with phobias in General) are still not understood, they can appear in a person suddenly. In most cases, they are preceded by:
- strong single-step stress (death of a loved one);
- not too pronounced, but the constant stress (dissatisfaction with life situation, a difficult situation at work);
- difficult experiences in childhood, when a child is forced to take a particular food;
- obsessive attitudes – for example, associated with the statement that there is sweetness – 100% harm with no exceptions.
In the case of food consumption, which does not provide the necessary amount of calories and nutrients, alimentary dystrophy develops not so quickly as fasting, but its consequences no less severe.
Highlighted a number of factors that directly to malnutrition do not result, but in the presence of the above factors contribute to its development. In the first place is:
- cold – in particular, long stay in a natural environment with sub-zero temperatures of the environment;
- constant heavy physical activity;
emotional stress. Has a value though not too pronounced, but the long-term (chronic) emotional exhaustion (burnout).
Emotional stress may be associated not only with negative but also often positive emotions that overload the brain centers, and this, in turn, leads to failure of the nervous regulation of the digestive processes in the body.
- long-term current chronic illness (on the part not only of the gastrointestinal tract, but other organs and systems);
- heavy operations;
- pregnancies with severe course and complications.
The pathogenesis (development) of alimentary dystrophy is complex. Before, figuratively speaking, to give up the body in conditions of degraded or inadequate nutrition for a long time tries to maintain the proper level of energy for their physiological processes. The mechanisms of such “self-help” — “multi-pass” in the course of the implementation, the body can be reconstructed more than once.
With inadequate supply of nutrients the body’s response in the first place, is the inventory issue:
- fat (mainly involving the subcutaneous fat and adipose tissue of the abdominal cavity);
- glycogen – polysaccharide formed by residues of glucose (its main strategic reserves are in the liver and muscles).
At first the reserves as the main protein building the body’s reserve remain intact and to replenish the energy expenditure used in the expenditure of up to 30-50% fat and glukagonovykh stocks. As squirrels when broken down into amino acids do not emit that quantity of energy which is released when the breakdown of fats and carbohydrates in energy they spent more than fats and carbohydrates. For peptide (protein) loss atrophy of all structures of the body, primarily affects:
- muscular system;
- internal organs;
- the endocrine gland.
And wasted protein is not only muscle arrays, but muscle fibers, which are part of:
- the vascular wall
and so on.
Sooner or later the energy robbing organs and tissues that cease to fully perform the functions assigned to them by nature. Particularly affected are structures for which it is important to fully the amount of protein is:
- propulsion muscle (equally upper and lower extremities, chest and abdominal cavity);
- endocrine system;
- the autonomic nervous system;
- the Central nervous system.
Gradually developing a functional failure of virtually all organs and systems in the later stages of malnutrition, she poured in more serious developments – multi-organ failure.
The symptoms of malnutrition
Clinical manifestations of malnutrition is very diverse, as it affects all the organs and tissues of organisms.
With alimentary insufficiency, patients complain of such symptoms as:
- constantly tormented by the hunger;
- a significant increase in appetite (“the ravenous appetite”). With the protracted process possible paradoxical decrease (due to the fact that due to the lack of nutrients is disturbed regulates the work of the brain center responsible for hunger and saturation with nutrients);
- chilliness, even at high ambient temperatures;
- pain in muscle areas. Primarily they appear in the muscles of the lower extremities and back, then join the discomfort in other muscle groups;
- almost at the same time developing weakening of hearing, vision and smell;
- burning or tingling in the tongue;
- a feeling of heaviness in the upper abdomen;
- flatulence (bloating);
- violation of bowel movement. First, patients suffer from constipation due to reduced bowel tone. Further, the constipation is replaced by diarrhea;
- frequent urination. In later stages observed increased amount of urine, the prevalence of night urination in the daytime, sometimes with urinary incontinence;
- reduced sexual activity, in case of serious pathology – loss of interest in the opposite sex. In women develops frigidity, in men, reduced sexual potency;
- the decline of fertility (ability to procreate). Women stop menstruation, occurs earlier menopause, in men it impairs the ability to fertilize;
- increasing weakness;
- paresthesia (a disorder of cutaneous sensation), numbness, tingling and “running ants”.
Indicative of the complaint, signaling that suffers from the Central nervous system. Patients can experience such signs as:
- the deterioration of intellectual activity;
- decreased performance;
- too fatigue;
- daytime sleepiness and insomnia at night;
- loss of interest in things that previously attracted the attention and aroused the interest – in other words, was a vital outlet for a hobby (collecting, music, travel and so on);
- possible seizures.
Also these patients suffer psyche:
- for the initial stage of alimentary dystrophy is characterized nervousness, irritability and aggressive behavior;
- with the development of pathology occur lethargy and indifference to what is happening;
- often observed acute psychosis with hallucinations.
The clinical course of the disease can be:
- sharp – and more young people;
The most common complications of alimentary dystrophy is:
- tuberculosis is the most common complication;
- collapse – a sharp deterioration in cardiovascular activities;
- coma. Coma develops as a result of malnutrition, characterized by a reduction in the frequency and depth of breathing and a decreased heart rate. Often there is a specific type of breathing – the so-called respiration of Biota type (normal respiratory movements alternating with respiratory pauses lasting up to half a minute) and Cheyne-Stokes (patient is breathing shallow, and rarely, further, the breathing quickens and deepens, 5-7 breaths/exhalations again and the surface becomes rare, then there is a respiratory pause, and so repeat);
- pustular disease.
Data of physical examination (inspection, feelings fabrics, listening to individual bodies) with alimentary dystrophy is characterized by high information content. Objective changes develop from almost all organs and systems.
A common important change is:
- progressive weight loss – up to 50%. The following regularity is observed: even after the start of treatment the patient still some time continuing to lose weight;
- lowering the body temperature to 35-36 degrees Celsius.
During the examination of patients with alimentary dystrophy revealed the following characteristics:
- language similar to the painted surface because of smooth (atrophied) papillae;
- pale skin (in severe malnutrition – earthy) with a yellowish tinge, cracked, wrinkled, abundantly scaly. There is often increased pigmentation, which indicates endocrine changes;
- muscles are atrophic, unable to hold its normal shape, so it seems that they are almost sagging;
- with the development of pathology of the eye like a sink, around the eyes, there are dark circles (a result of increased pigmentation);
- in the later stages some patients may develop visible swelling (because of the breakdown of proteins).
Palpation (feeling) States the following:
- the skin is dry (like parchment), turgor (elasticity) is reduced;
- in the later stages of muscle tone is not defined exactly, often the muscles flabby, sometimes even similar to an amorphous mass. With the continued development of the pathology muscle atrophy occurs, they are in a literal understanding of the thinning were half the normal for a person’s muscular volume or less.
Auscultation (listening with stethoscope) detect the inhibition of the activity of internal organs – in particular:
- (the colours are muted or deaf);
- lungs (breathing weakened);
- the small and large intestine (peristalsis weakened, in the later stages listen attentively to the rare peristaltic noises).
Additional signs observed changes:
- blood pressure.
At the initial stage there is bradycardia (heart rate lower than normal – less than 60 beats per minute), the development of alimentary dystrophy is observed tachycardia. Noted the following specific feature: even the slightest physical stress (for example, elemental movement of the hand or foot) can cause increased heart rate.
Arterial and venous pressure is lowered.
On the severity there are three degrees of malnutrition:
- easy – deterioration of food is expressed, but the overall condition is normal, the muscle atrophy is not observed;
- moderate severity – General condition is deteriorating, manifested above described symptoms on the part of all organs and systems;
- severe – the patient in the literal sense can be described as “skin and bones” as subcutaneous fat is almost entirely disappears, there is an extreme degree of atrophy of the muscles. There is a complete loss of working capacity and ability for action (including ability to serve himself).
According to clinical features distinguish these forms of malnutrition, such as:
- bestacne – also called dry or kahectina.
- edematous for more benign than bezotvetnoi form.
Often, swelling develops and increases previously combined with polyuria (increased amount of urine). Prolonged cachexia oedema – persistent and difficult to drug impact, while in the cavities (pleural and peritoneal) fluid can build up, this form of malnutrition is called ascites.
Instrumental and laboratory methods of diagnosis
The history, complaints and results of physical examination are enough to diagnose malnutrition. The data of laboratory and instrumental methods of research complement the overall diagnostic picture.
Instrumental methods studies reveal anatomical and physiological oppression on the part of all organs and systems. Almost any method, widely used in the diagnosis will be informative – namely:
- fluoroscopy of the chest – when it detect the deterioration of trips (respiratory movements) of the lung;
- fibrogastroduodenoscopy and colonoscopy – both methods allow to detect the smoothness of the mucous membrane of both stomach and intestines, reduction of peristalsis;
- Ultrasound of internal organs – when it is determined degenerative changes of the heart, liver, pancreas, rarely of the kidney;
- ECG demonstrates the weakening of the electric potentials of the heart, captures a different kind of arrhythmia
and so on.
Revealing are the data of laboratory methods of research. In particular, in the diagnosis of alimentary dystrophy use such methods as:
- General analysis of blood – it identifies anemia (reduction in red blood cell count and hemoglobin), leukopenia (decreased leukocyte count), thrombocytopenia (reduced platelet count);
- biochemical blood test is determined by the decrease of the blood serum protein and lipid fractions and cholesterol;
- blood sugar blood glucose level reduced;
- analysis of gastric juice – demonstrates the reduction of gastric secretion.
Treatment of alimentary dystrophy
Mild as therapeutic measures quite high diet in the outpatient setting.
At average and heavy severity patient should be hospitalized in a therapeutic hospital with a well-heated chambers.
Principles of nutrition in malnutrition:
- the diet should be rich in all kinds of food, but with a predominance of protein foods – soups, porridge, meat (in large quantities, in powdered form), fish, dairy products, vegetables, fruits, berries, chocolate (in limited quantities);
- eating at least 6 times a day;
- with diarrhea adhere to the principle of mechanical wagenia the digestive tract – food in the diet should be rough and solid;
- daily calorie intake should be from 3500 to 4000 kcal;
- limit the consumption of salt (5-10 grams. per day) and carbohydrates (bread, rolls, cakes, candies, jams, preserves), but instead received intravenous infusion of glucose solution;
- if there edematous form, limit fluid intake – up to 1200-1600 ml per day.
- strict bed rest with a warm body warmers;
- to improve gastric digestion designate hydrochloric acid, intestinal – enzyme preparations. With this objective in practice the use of table wine at 30-50 ml 1-3 times daily immediately before meal;
- important purpose of vitamin C and b vitamins – oral (through the mouth) and injecting;
- dystrophy average and heavy degree is carried out transfusion of blood and its components – in the first case a transfusion with whole blood, the second drive plasma, as well as krovezamenauschie infusion drugs.
In the case of severe malnutrition, use:
- feeding via nasogastric (nosology) probe;
- sulfa or antibiotics.
If it is a coma, in an emergency carry out activities such as:
- the total rewarming (the patient overlaid with warm warmers);
- the introduction of glucose solution in small doses (40 ml) every 3 hours intravenously (repetition to the point when the patient will emerge from a coma);
- the introduction of a solution of calcium chloride intravenously (particularly in convulsions);
- inside through a nasogastric tube – hot wine (preferably red), hot sweet tea or coffee;
- with shallow breathing – medications that stimulate the respiratory center, hormonal (epinephrine).
The only way of preventing malnutrition – nutrition with the use of products that provide a normal intake of sufficient amount of protein (primarily), fat, and carbohydrates.
If the person is thin, and there are preconditions to the emergence of malnutrition, in addition to establishing a power recommended:
- light duty work;
- increasing the period of rest and sleep;
- supervision from a local therapist.
If the person has got in conditions of impaired nutrition, which do not depend on it (war, natural disaster) and is fraught with the deterioration of food should be sent all forces on the consumption of normal amounts of protein is with the purpose of the diet is introduced:
- soy products;
Forecast alimentary dystrophy complex. Pathology can result in:
- the transition to the recurrent (repeated) or long-form;
The prognosis depends on:
- the degree of exhaustion;
- opportunities for improving nutrition.
The prognosis is unfavorable in cases of severe disease – people slowly dying, this process is accelerated by acceding infections. Critical changes in the body, leading to death, may occur:
- acceleration (when joining other pathologies);
- suddenly (observed immediate cardiac arrest without any heralding sign of her).
If joined complications, the disease takes a prolonged shape, which is difficult to therapy, the prognosis worsens. If therapy is successful, it should be borne in mind that the apparent recovery may not correspond to biological.
The prognosis is more favorable for:
- young people;
- patients with asthenic body type.
Kovtonyuk O. V., medical columnist, surgeon, consultant physician