Alimentary dystrophy – the disease which is characterized heavy proteinaceous is also more often more expressed power insufficiency. Manifestations can be the most various, the main - loss of body weight more than 20% (or IMT less than 16), dryness and flabbiness of skin, fragility of hair and nails, slackness, drowsiness and weakness, the increased appetite. Diagnostics is based generally on the anamnesis, a combination of objective and subjective signs, and also on an exception of other diseases. Treatment is complex, consists in adjustment of food and restoration of reserves of nutrients, vitamins and minerals in an organism.
Alimentary dystrophy (alimentary marasmus) is a social disease which can develop as a result of the compelled or conscious starvation. Today alimentary marasmus people not only in developing countries have, during wars and accidents – and it is more than half a million people. Many are ready to starve themselves consciously in a pursuit of a beautiful figure and to please to the complexes. However the disease can have serious consequences, up to a lethal outcome. At long starvation, lack of intake of irreplaceable substances in an organism there can be irreversible changes of metabolic processes. In the developed countries even more often it is possible to hear about anorexia cases - and it is the same alimentary dystrophy of heavy degree.
Reasons of alimentary dystrophy
As the reason of alimentary marasmus serves long starvation during which the insufficient amount of nutrients and energy comes to an organism. At the same time also their relative insufficiency is considered: when receipt of calories does not correspond to their expense. Starvation can come for various reasons (war, ecological disaster and other cases when the person it is forcedly long does not receive food; diets; narrowing and hems of a gullet and other), however aggravation of process is provoked by hard physical work, overcooling.
It is necessary to notice that development of dystrophy is possible only at long power starvation. At the same time in an organism at first stocks of a glycogen and fats are completely exhausted, then for ensuring the main exchange reserves of interstitial protein are used. First of all processes of dystrophy begin in skin, muscles, then internals, in the latest turn – vital are involved (heart, kidneys and a brain). At some point processes of a catabolism take such form that the lethal outcome becomes inevitable even at the beginning of full treatment.
At the last stages of a disease in an organism reserves of vitamins and minerals are exhausted, the immune system ceases to function. The lethal outcome usually comes or from heart failure, or from the joined infection against the background of considerable oppression of immunity.
Classification of alimentary dystrophy
In gastroenterology it is accepted to divide alimentary dystrophy both in forms, and on weight. The disease is divided by a form on kakhektichesky (dry) and edematous. The Kakhektichesky form has more adverse current. The edematous form is characterized by development of widespread hypostases including internal (ascites, perikardit also pleurisy), this form will better respond to treatment.
On disease severity distinguish three stages. At the first stage insignificant decrease in body weight, preservation of working capacity along with emergence of complaints to more frequent urinations, thirst and increase in appetite, a chill and weakness is noted. At the second stage the considerable iskhudaniye with working capacity loss is noted. Such patients still can serve themselves, but are practically not capable of any work. There can be hypostases, protein level considerably decreases, often there are episodes of lowering of the level of glucose of blood. At the third stage patients cannot independently move and get out of a bed any more, are sharply exhausted. At emergence of a hungry coma even at the patient who kept working capacity before, speak about the third stage of a disease.
Symptoms of alimentary dystrophy
Alimentary dystrophy develops gradually, quite often the patient can not realize that he has this illness. Usually the first signs of a kakheksiya are shown only after long restriction of receipt in an organism not only of calories, but also protein, fats, irreplaceable amino acids and vitamins (is more often than fat-soluble). The first symptoms can be not noticed or are not regarded as dangerous: increase of an urination, polyuria (increase in daily volume of urine), weakness and irritability, decrease in working capacity, constant drowsiness. Often thirst, the increased appetite disturbs. One of specific symptoms – tendency to salt eating.
If food is not adjusted, the disease progresses and passes into the following stage. At the same time skin becomes very flabby and dry, sags folds, reminds parchment. It becomes very heavy to perform any physical activity, the general state suffers rather strongly. There are first symptoms of dystrophy and violation of functioning of internals (locks and other dispepsichesky manifestations, violations of work of heart, endocrine violations – at women vanish periods, there comes infertility). Tendency to fall of temperature is noted. Heartbeat urezhatsya, pressure low. There can be changes in mentality.
The last stage of a disease is characterized by bright manifestation of fading of all function of an organism. The hypodermic and fatty layer is absent, muscles become very thin and flabby. Independently the person at the third stage is not capable to move any more. Decrease in level of all blood cells (erythrocytes, leukocytes, platelets) is noted, immunity is oppressed. In blood very low level of protein, tendency to decrease in level of glucose is noted. Reserves of vitamins and minerals are completely exhausted, bones become fragile. As the organism starts a catabolism (destruction) of own proteins, in blood poisonous products of their disintegration begin to collect. It leads to a bigger deterioration in a state, emergence of the expressed mental disorders (result of action of products of disintegration on a brain). Usually at the last stages of a disease even the initiation of treatment and food cannot prevent a sad outcome.
The most serious condition which develops at the last stages of alimentary dystrophy – a hungry coma. There is it because of considerable decrease in level of glucose in blood and impossibility to provide a brain with necessary amount of energy. Clinic of this state rather bright: sudden loss of consciousness, pallor and coldness of skin, pupils wide. Body temperature is considerably lowered. Breath is superficial, can be rare and spasmodic. Muscles without tone, can develop spasms. Pulse is practically not defined, weak, pressure low. If not to give timely help, death will come from a stop of warm activity and breath.
Also the course of alimentary dystrophy can be complicated by accession of various infections (intestinal, tuberculosis, pneumonia, sepsis). Quite often death comes from an embolism of a pulmonary artery blood clots (TELA), at an overstrain during physical activities.
Diagnosis of alimentary dystrophy
The diagnosis can be exposed on the basis of careful collecting the anamnesis and survey of the patient. If in the anamnesis there are instructions on long starvation, then there is a symptomatology, characteristic of alimentary dystrophy, and laboratory indicators (developed clinical and biochemical blood tests, symptoms of dystrophy of internals on ultrasonography, KT or MPT), and also excluded other diseases, the diagnosis does not represent difficulties.
It is necessary to differentiate alimentary dystrophy with other diseases which can lead to organism exhaustion: oncological processes (first of all cancer of a stomach and intestines), tuberculosis, diabetes, hypophysial frustration and thyrotoxicosis. Alimentary dystrophy from other diseases is distinguished by the expressed strengthening of thirst and appetite, hunger, very severe exhaustion of muscles and change of skin, bradycardia and decrease in body temperature, violation of work of all endocrine glands.
Treatment of alimentary dystrophy
Treatment of this disease at any stage is begun with normalization of a day regimen, food, rest and a dream. Such patients are placed in the warm aired chamber, without allowing contact with infectious patients. At the first stage of a disease begin fractional food with easily acquired food. At the second and third stage food is carried out as enteralno (enpita – special nutritious mixes), and parenterally by introduction of solutions of glucose and other nutrients intravenously.
Caloric content has to make to start about 3000 kcal/days, gradually bringing to 4500 kcal/days. The diet surely joins animal protein, the total of protein has to make 2 g/kg/days. It is necessary to fill not only nutrients, but also liquid by infusion of various solutions. At the third stage transfusions of medicines of blood (erythrocytes and plasma, albumine) are surely carried out. The acid-base condition of an organism is corrected.
For treatment of infectious complications enter antibiotics (according to sensitivity). Also correction of the immune status, dysbacteriosis is made. Treatment of an alimentary coma consists in introduction of solution of 40% of glucose intravenously before restoration of consciousness or level of glucose in blood; warming, vitamin and hormonal therapy; knocking over of spasms. In time and after the termination of a course of treatment such patients demand powerful mental and physical rehabilitation which can last before half a year after an extract from a hospital therefore treatment is carried out in common by the gastroenterologist and the psychotherapist.
Forecast and prevention
Usually the disease without due treatment leads to a lethal outcome within no more than 3-5 years. At in due time begun treatment the outer effect can be reached quickly enough, however restoration of function of internals can drag on for years. Prevention is promotion of a healthy lifestyle and healthy nutrition.