CACHEXIA (grech, kachexia bad condition, morbidity) — the disease state connected with insufficient receipt in an organism of nutrients or disturbance of their assimilation. The concept «cachexia» is often closed with the concept «exhaustion» though seldom or never To. can proceed without exhaustion. It is observed at various hron, diseases, hron, intoxications, defective food and is followed by sharp emaciation, disturbance homeostasis (see), volemichesky disturbances (see. Oligemiya ), physical weakness, phenomena of the general adynamy. The weight of internals decreases (splankhnomikriya), in them dystrophic and atrophic changes are observed (see. Atrophy ), deposits lipofuscin (see). Fat in an epicardium, retroperitoneal, pararenal cellulose disappears, is exposed to a serous atrophy. Are in some cases noted the diffusion decalcification of bones accompanied with pains, the phenomena osteoporosis (see) and development in hard cases osteomalacy (see).
Depending on etiol, the moments which caused development To., it is possible to allocate two groups: To., connected with the exogenous reasons, and To. endogenous origin.
The most frequent reasons exogenous To. are insufficient food in the quantitative or qualitative relation (see. Nutritional dystrophy ), hron, malnutrition at starvation (see) — To. alimentary. Treats exogenous also To., resulting hron, poisonings with drugs of arsenic, lead, mercury, fluorine.
Treat the same group To., observed at various avitaminosis — beriberi (see), to a spr (see), to a pellagra (see), rickets (see), and also so-called beam To., developing in hron, stages radial illness (see).
To. an endogenous origin develops at hron, infectious and parasitic diseases — tuberculosis, especially mesenteric limf, nodes, syphilis, hron, malaria, a kala azar, an amebiasis, trypanosomic diseases, etc., and also at some diseases of a digestive tract (a spasm and a stricture of a gullet, pyloric stenoses of various etiology, cirrhoses of a liver, diseases of a pancreas). Heavy degree To. it is observed at malignant new growths — cancer To. At localization of a tumor in a gullet, a stomach, intestines, a liver, a pancreas there are also disturbances of food coming to To. alimentary origin. However they meet not always even at a carcinoma of the stomach and a gullet (according to L. M. Shabad, To. at a carcinoma of the stomach makes 15,8%, at cancer of a gullet — 16,2%). To development of this look To. intoxication products of metabolism and disintegration of a tumor, and according to some authors promotes, it develops owing to accession of consecutive infection in the field of tumoral disintegration. However, apparently, the main role in development To. at a tumor belongs to the nonspecific systemic action of a tumor which is in details tracked by V. S. Shapot. He established that the tumor is a trap of glucose. Constant and irreversible withdrawal from an organism leads it to a condition of a hypoglycemia, to-ruyu an organism shall compensate by a gluconeogenesis due to not carbohydrate connections, including amino acids that leads to loss of nitrogen. Besides, nitrogen is spent by an organism also for creation of the tumor. These non-recoverable losses lead to heavy disturbances of a homeostasis and exchange with development of dystrophic and atrophic changes. Obviously, disturbance of a homeostasis is the cornerstone cancer To., and though at the same time often there is no exhaustion, all other manifestations are typical, i.e. it is possible to speak about To. without exhaustion; in separate exceptional cases even obesity, napr is observed, at a breast cancer, a uterus, an ovary, arising as a result of hormonal disturbances. K K. an endogenous origin also wound exhaustion or wound belongs To. at persons with it is long diapyetic extensive wounds of soft tissues and bones (see. Traumatic exhaustion ). Development wound To. it is connected with a resorption of products of unsterile fabric disintegration and massive loss of protein with wound separated. Distinctive feature wound To. existence widespread necrobiotic (in cross-striped muscles) and autoinfektsionny defeats (in lungs, intestines) along with atrophic changes is. It is purulent - resorptive exhaustion is inherent not only to a traumatic wound process, but also another is long to the proceeding purulent processes with loss of protein and absorption of decomposition products, e.g. hron, to empyemas of a pleura. Process is followed by heavy disturbances of a homeostasis, the volemichesky status, an atrophy of bodies, loss of ability to assimilation of food stuffs at enteral introduction owing to an atrophy of digestive glands. To. it can also be observed at serious heart diseases — cordial To. at patients with dekompensirovanny heart diseases and muscat cirrhosis, with a cardiovascular decompensation after the postponed myocardial infarctions. At patients after brain strokes in some cases K. Chasto K. develops is a consequence of dysfunction of closed glands (mono - or multiglandular insufficiency) or defeats of diencephalic area, napr, pituitary To., a marantic form of a bazedovy disease, To. at a myxedema, including postoperative (kachexia thyreopriva), at an addisonovy disease, in hard cases of a diabetes mellitus, at neuroendocrinal multiglandular defeats.
In most cases patients have no hypodermic fatty tissue, the atrophy and flabbiness of skeletal muscles is noted, the stomach is pulled in, the eyes which sank down, hair dry, drop out, nails fragile, teeth are loosened and often drop out, skin dry, flabby, is deprived of turgor, folded or, on the contrary, is tense, as at a mummy, pale or an earthy shade. The xanthopathy, hemorrhages, a furunculosis are often observed, the razrykhlennost of gums, the phenomena of stomatitis, a cataract, etc. can take place. Sometimes emaciation reaches such degree that patients remind the skeleton fitted by skin; in some cases hypostases and dropsy of cavities are observed. To. usually is followed by the general hypotonia of both skeletal muscles, and vascular system, indifference to surrounding and own fate, a condition of prostration, catalepsy, decline of mental capacities. Patients lie, the movements at the same time sluggish, slow move hardly. Sexual function sharply falls or absolutely disappears, at women the amenorrhea is observed. The oliguria or, on the contrary, a polyuria (is often noted at an edematous form), an anemization of various degree of manifestation.
Mental frustration and at To. are very various. In an initial stage To. the adynamy develops (see. Asthenic syndrome ) with dominance of the phenomena of irritable weakness, and with deterioration in the general state apathy begins to prevail (see. Apathetic syndrome ). On this background there are pictures of stupefaction in the form of a delirium (see. Delirious syndrome ), amentias (see. Amental syndrome ), a twilight state (see. Twilight stupefaction ). The heaviest and predictively adverse mental disorders at To. alarming and sad states, an apathetic stupor are and apallichesky syndrome (see). At a favorable outcome of the basic disease which caused To., there can be a resistant adynamy which is quite often combined with decrease in level of the personality.
In some cases at improvement of a mental state the pseudoparalytic syndrome develops (see. Psychoorganic syndromes ).
At the former deported prisoners of war who were in Nazi concentration camps and transferred a nutritional dystrophy in combination with physical. and mental injuries, as the remote effects, as a rule, are often observed a resistant adynamy, regarding cases with a paroxysmal, emotional ekmneziya (ecmnesia), during attacks a cut the last affective shock experiences connected with stay in camps, a premature postareniye are reproduced.
At To. with mental disorders persistent sleeplessness, anorexia are observed, bulimia, a gipomimiya, sometimes hypersalivation, a hypomyotonia is more rare, rigidity, oculomotor frustration, a dysarthtia, subcrustal hyperkinesias, a reflex of a skhvatyvaniye, disturbance of functions of pelvic bodies is more rare. Bystry development of an apathetic stupor is more often observed at a pellagra, dominance of an alarming depression — at tuberculosis.
At wound To. trevozhnodepressivny, apathetic and hallucinatory paranoid states are described. The Apallichesky syndrome most often meets in end-stages To., arising in the course of the diseases of presenile and senile age leading to weak-mindedness.
Treatment and the forecast
In a complex to lay down. actions at To. in all cases the measures directed to elimination of changes of the main homeostatic and metabolic indicators (normalization of an electrolytic and water balance, elimination of a hypoproteinemia, anemia, a lack of vitamins etc.) join.
An outcome To. it is connected with a current and an outcome of the basic patol, process or with intensity and duration of action of the exogenous factor which caused K. Rezhe's development an outcome To. it can be connected with efficiency to lay down. actions (e.g., replacement hormonal therapy at some endocrinopathies).
Bibliography Davydovsky I. V. General pathology of the person, page 175, etc., M., 1969; To yuchukovm. ides of p. Anorexia and cachexia, Nevrol., psikhyat. and psycho-hir. (Sofia), t. 13, No. 1, page 43, 1974; Lukomsky G. I. Nonspecific empyemas of a pleura, M., 1976; With N of e of N of e of Sunday to and y A. V. O late symptomatic psychoses, Trudy Nauch. - issled, in-that psikhiat. of Gannushkin, century 5, page 156, M., 1940; Sh and p about V. S t. Biochemical aspects of tumoral growth, page 107, M., 1975.
A. M. Vikhert; M. V. Korkina, V. M. Morozov (psikhiat.).