Emaciation refers to weight loss due to illness or other factors, exceeding 10% of standard body weight, or a body mass index (BMI) below 18.5. It is characterized by rough, inelastic skin, muscle atrophy, reduced subcutaneous fat, and visible bones.
symptom
Typical manifestations
1. Digestive system diseases
It includes various diseases of the mouth, esophagus, gastrointestinal tract, liver, gallbladder, pancreas, etc. In addition to the specific manifestations of each disease, there are generally symptoms such as lack of appetite, nausea and vomiting, abdominal distension, abdominal pain, and diarrhea.
2. Endocrine and metabolic diseases
(1) Hyperthyroidism
It may be accompanied by heat intolerance, sweating, irritability, tremor, hyperactivity, palpitations, exophthalmos and thyroid enlargement.
(2) Adrenal insufficiency
It may be accompanied by skin and mucous membrane pigmentation, fatigue, hypotension, anorexia, diarrhea, etc.
(3) Sheen syndrome
It occurs in women of childbearing age, due to ischemic necrosis of the pituitary gland caused by postpartum hemorrhage, leading to hypopituitarism. Symptoms include weight loss, sexual dysfunction, amenorrhea, anorexia, nausea and vomiting, and hair loss.
(4) Diabetes
Accompanied by polyuria, polydipsia, polyphagia and weight loss.
3. Chronic wasting disease
Tuberculosis may be accompanied by low-grade fever, night sweats, fatigue, and hemoptysis. Tumors may present with various tumor-specific symptoms and signs. Chronic infections may present with corresponding symptoms and signs depending on the infection.
4. Neurological diseases
Including bulbar palsy and myasthenia gravis, which can manifest as anorexia, dysphagia, nausea and vomiting.
5. Mental illness
(1) Depression
Patients may suffer from symptoms such as depression, inferiority, lack of self-confidence, slow thinking, sleep disorders, and lack of appetite.
(2) Anorexia nervosa
It is often caused by severe emotional disturbances. Psychological factors are often the basis of the disease. Although the patient is obviously emaciated, sexual characteristics are retained. There is no loss of head, axillary, or pubic hair. Urinary 17-ketosteroid and 17-hydroxycorticosteroid excretion is normal.
① Most patients are female, and the age of onset is earlier than 25 years old.
② Anorexia, and weight loss of more than 25% compared to before the onset of the disease.
③Have stubborn prejudices about eating, nutrition or weight.
④ There is no disease that causes severe weight loss.
⑤ No obvious mental illness.
⑥ At least two of the following symptoms or signs are present: amenorrhea, bradycardia, inability to move in proportion to severe weight loss, paroxysmal anorexia, and self-induced vomiting.
reason
OverviewWasting can be divided into simple wasting (constitutional and exogenous) and secondary wasting. Constitutional wasting is non-progressive, without objective evidence of disease, and is influenced by genetic factors. Exogenous wasting is usually influenced by various factors such as diet, lifestyle, and psychology. Secondary wasting is often caused by systemic diseases.
Cause of symptoms
1. Digestive system diseases
(1) Oral and pharyngeal diseases: Oral ulcers caused by riboflavin, glossitis caused by nicotinamide deficiency, alveolar abscess, toothache, mandibular osteomyelitis, tumors or tuberculosis of the throat and esophagus often cause difficulty in eating or swallowing, resulting in insufficient food intake, negative nitrogen balance and weight loss.
(2) Chronic gastrointestinal diseases: gastric and duodenal ulcers, gastrinoma, gastrointestinal spasm or obstruction, nonspecific ulcerative colitis, regional enteritis, malabsorption syndrome and other gastrointestinal diseases, or severe vomiting and diarrhea caused by other diseases such as pregnancy poisoning and uremia, resulting in insufficient intake of nutrients and inadequate digestion and absorption of food, which may cause weight loss in a short period of time.
(3) Chronic liver disease: In chronic liver diseases such as chronic hepatitis and cirrhosis, due to decreased liver function, the liver’s ability to synthesize and store glycogen is reduced, protein synthesis is also reduced, and the patient’s gastrointestinal congestion also affects appetite, as well as food digestion and absorption, often resulting in weight loss.
(4) Chronic pancreatic disease: Chronic pancreatitis can cause upper abdominal pain, nausea, vomiting and severe pancreatic diarrhea, leading to food digestion and absorption disorders and causing significant weight loss. In severe cases, it can lead to pancreatic cachexia.
2. Endocrine and metabolic diseases
Hyperthyroidism, adrenal insufficiency, diabetes, Sheehan syndrome, etc.
(1) Hyperthyroidism: Hyperthyroidism is one of the most common secretory diseases that cause emaciation. Due to an increased basal metabolic rate and excessive catabolism, although the appetite is increased, the body consumes too much nutrients, resulting in significant weight loss. This disease should be considered in patients with emaciation without obvious clinical reasons. In a few cases, there may be no symptoms such as goiter (or ectopic thyroid) and increased heart rate.
(2) Diabetes: Diabetic patients may gradually lose weight due to excessive consumption of sugar due to the large amount of sugar excreted in the urine and the compensatory increase in fat and protein decomposition.
(3) Chronic adrenocortical insufficiency: emaciation is one of the characteristics of this disease. Chronic dehydration, gastrointestinal dysfunction, loss of appetite, etc. are factors that lead to weight loss. The degree of emaciation is related to the severity of the disease, the duration of the disease, and the original nutritional status. For patients with skin and mucous membrane pigmentation accompanied by emaciation, the possibility of adrenocortical insufficiency should be considered.
3. Chronic wasting disease
(1) Infectious diseases: tuberculosis, chronic suppurative infection, schistosomiasis, parasitic diseases, AIDS, etc.
(2) Malignant tumors: Patients with malignant tumors often have a lack of appetite, especially due to anxiety and treatment reactions. The rapid growth of tumors consumes energy. Malignant tumors may produce a metabolic toxin that reduces the patient’s glucose utilization rate, increases the oxidative metabolism of free fatty acids, increases the gluconeogenesis of amino acids and lactate, and increases the ineffective consumption of ATP. Secondary infection, bleeding, exudation, etc. of tumors make patients with middle and late stage malignant tumors even thinner.
4. Neurological diseases
These include bulbar palsy and myasthenia gravis.
5. Mental and psychological illness
Anorexia nervosa, depression, etc.
6. Others
Taking laxatives or drugs that irritate the gastrointestinal tract such as erythromycin and aspirin for a long time.
Common diseases
Stomatitis, posterior pharyngeal abscess, acute tonsillitis, tongue cancer, esophageal cancer, cardia cancer, esophageal injury, bulbar palsy, myasthenia gravis, anorexia nervosa, depression, reactive psychosis, chronic atrophic gastritis, gastric amyloidosis, pancreatitis, cholecystitis, cirrhosis, diabetes, pulmonary insufficiency, heart failure, chronic renal failure, chronic severe infection, severe gastritis, ulcer, post-gastrectomy, dumping syndrome, gastrinoma, leather stomach, congenital lactase deficiency, sucrase deficiency, short bowel syndrome, severe hepatitis, liver cancer, chronic pancreatitis, pancreatic cancer, biliary dysfunction syndrome, hepatobiliary carcinoma, hyperthyroidism, etc.
Seeking medical treatment
Outpatient indications
1. Accompanied by systemic symptoms such as lack of appetite, fatigue, and anemia;
2. Sharp weight loss in a short period of time;
3. Accompanied by digestive tract symptoms such as dysphagia, indigestion, and abnormal defecation;
4. Children with slow growth, malnutrition, or a history of deworming;
5. Drinking and eating more but losing weight is common in endocrine diseases such as hyperthyroidism and diabetes. Hyperthyroidism patients may also experience symptoms such as excessive sweating, irritability, insomnia, palpitations, and exophthalmos.
6. Accompanied by anxiety, depression, sleep disorders and other mental and psychological abnormalities;
7. Young women who are significantly emaciated, extremely anorexic, frequently vomit, and have a stubborn bias towards eating, nutrition, or weight are often suffering from anorexia nervosa.
8. Other severe, persistent or progressive symptoms and signs occur.
If you are obviously thin or have the above conditions, you should seek medical advice in time.
Treatment department
1. If you suspect that the cause is a digestive system disease, you should consult a gastroenterologist.
2. If you suspect that the condition is caused by endocrine metabolic diseases such as diabetes or hyperthyroidism, you must see an endocrinologist.
3. If the illness is suspected to be caused by infectious diseases such as tuberculosis or parasitic diseases, the patient must seek medical advice from the infectious disease department.
4. If you suspect that the condition is caused by a mental or psychological illness, you must consult a psychiatric department.
Medical preparation
1. You may need to have a blood test. Eat a light diet the day before the appointment, do not eat after 10 pm, and be on an empty stomach the next morning.
2. Make an appointment in advance and bring your ID card, medical insurance card, medical card, etc.
3. If you have had medical treatment recently, please bring relevant medical records, examination reports, laboratory test results, etc.
4. If you have taken some medicine to relieve symptoms recently, you can bring the medicine box with you.
5. Family members can be arranged to accompany the patient to seek medical treatment.
6. Patients can prepare a list of questions they want to ask in advance.
What questions might a doctor ask a patient?
1. When did you start losing weight? How much weight did you lose?
2. Did your weight loss occur gradually or suddenly?
3. In addition to weight loss, do you experience dizziness, anemia, loss of appetite or increased appetite, palpitations, insomnia, etc.?
4. Do any of your relatives have similar situations?
5. Have you ever had any digestive system diseases such as gastrointestinal, liver, or pancreatic diseases?
6. Have you ever had any endocrine or metabolic disease, such as diabetes or hyperthyroidism? What medications are you currently taking?
7. Have you ever been diagnosed with a malignant tumor?
8. Have you been taking laxatives or drugs that irritate your stomach and intestines, such as erythromycin or aspirin, for a long time?
9. What is your occupation? Do you often work in water or come into contact with livestock such as cattle and sheep?
10. What is your usual diet like? Do you have any particular or unusual food preferences? Do you have a habit of eating raw fish, shrimp, crab, vegetables, beef, or mutton?
11. Are you trying to lose weight? Have you been under a lot of work pressure recently? Are you stressed or overly tired?
12. Do you smoke or drink alcohol? Do you have a regular lifestyle? Do you exercise regularly?
13. Have you visited other hospitals? What tests did you undergo? What were the results?
What questions can patients ask their doctor?
1. What is the most likely cause of my weight loss?
2. Are there any other possible reasons?
3. What tests do I need to do?
4. Is my condition serious? Do I need to be hospitalized?
5. What medications can I use? What are the proper dosage and precautions? Are there any side effects?
6. In addition to medication, are there other treatments? Can it be cured?
7. How should I take care of myself in the future? Is there anything I should pay attention to in terms of diet or lifestyle?
8. Do I need follow-up examinations? How often?
examine
Scheduled inspectionPatients routinely need to undergo physical examination, blood routine, urine routine, stool routine and other examinations, and then other laboratory tests and imaging examinations are selectively performed according to the patient’s specific situation.
Physical examination
1. Measure height and weight, calculate standard weight. Weight measurement should be performed regularly and compared with the standard weight to understand whether the weight loss is progressive. Common diseases that cause rapid weight loss include diabetes, hyperthyroidism, malignant tumors, etc.
2. Observe for anemia, edema, superficial lymphadenopathy, etc.
3. Observe certain special signs, such as skin and mucous membrane pigmentation in chronic adrenal insufficiency, tachycardia, goiter, exophthalmos and other signs in hyperthyroidism.
4. Observe whether the patient has hepatosplenomegaly, abdominal mass, ascites, etc.
Laboratory tests
1. Patients should undergo routine blood tests, urine tests (especially urine sugar qualitative analysis), and stool tests (including stool occult blood).
2. For those suspected of having diabetes, blood sugar should be measured and, if necessary, a glucose tolerance test should be performed to assist in diagnosis.
3. Patients suspected of having tuberculosis or other chronic wasting diseases should undergo an erythrocyte sedimentation rate test.
4. Patients suspected of having hepatobiliary diseases may undergo liver function tests, serum glutamyl transpeptidase, serum protein electrophoresis and other tests to assist in diagnosis.
5. For those suspected of hyperthyroidism, thyroid function tests should be performed; for those suspected of chronic adrenal insufficiency, blood cortisol tests should be performed; for those suspected of anterior pituitary hypofunction, anterior pituitary hormone tests should be performed; and related target gland hormone tests, all of which are of great significance for diagnosis.
Imaging examinationsX-ray examination, CT examination, cardiac color ultrasound, abdominal B-ultrasound and other examinations are helpful in clarifying the cause of the patient’s disease.
diagnosis
Diagnostic principles
Based on the patient’s medical history, typical symptoms and relevant examinations, it is usually not difficult to diagnose. During the diagnosis process, doctors often need to check whether the patient has acute tonsillitis, esophageal cancer, cardia cancer, esophageal injury, anorexia nervosa, depression, cirrhosis, severe hepatitis, liver cancer and other diseases.
Diagnostic basis
1. Genetics and family history
People with constitutional emaciation often have a family history but no pathological manifestations. Hyperthyroidism and diabetes often have a family history, and certain tumors also have a family history.
2. Economic status and eating habits
For example, whether the calorie intake is sufficient, whether there is enough protein, whether there is picky eating or unusual eating habits, whether there is a habit of eating raw fish, shrimp, crab, raw vegetables, raw beef and mutton. For example, eating raw water chestnuts, water chestnuts, lotus roots and other aquatic plants can cause ginger fluke disease, which parasitizes the small intestine and causes diarrhea, digestive dysfunction, and malnutrition; eating raw or undercooked fish, shrimp, crabs, etc. can cause infection with clonorchiasis, eating raw stream crabs can cause infection with paragonimiasis, eating raw or undercooked beef and pork can cause tapeworm disease; eating vegetables, fruits and melons with parasite eggs, drinking unclean water, etc. can cause infection with cysticercosis, hydatid disease, ascariasis, etc., all of which can cause weight loss.
3. Place of origin and occupation
There are many paddy fields in southern my country. Farmers or fishermen may be infected with schistosomiasis due to repeated contact with infected water contaminated by schistosome cercariae; in pastoral areas, contact with cattle and sheep sheds may lead to infection with cysticercosis and cysticercosis; hookworm disease is more common in rural areas, and severe infection may cause emaciation and anemia.
4. Other lesions
Ask about sexual contact history, history of male homosexuality, and history of drug or anesthetic use, as using unclean or shared needles can spread HIV.
5. Pay attention to the age of onset of emaciation and ask about accompanying symptoms
(1) If a patient is emaciated and has an increased appetite, one should consider the possibility of hyperthyroidism, diabetes, pheochromocytoma, etc.
(2) If adolescents are emaciated, especially when accompanied by fever, night sweats, swollen lymph nodes, and cough, tuberculosis should be ruled out; if they are accompanied by short stature, enlarged liver plaques, or have been to areas where schistosomiasis is prevalent, schistosomiasis or other parasitic diseases should be ruled out.
(3) Patients with weight loss accompanied by digestive tract symptoms such as loss of appetite, nausea, vomiting, diarrhea or difficulty swallowing should exclude digestive tract diseases.
(4) Women should be asked about their menstrual history, reproductive history, and history of postpartum hemorrhage. If they have emaciation, amenorrhea, or a history of postpartum hemorrhage, Sheehan syndrome should be considered.
(5) Those with weight loss and long-term fever should be considered to have tuberculosis, chronic suppurative infection such as liver abscess, infectious diseases, connective tissue disease, malignant tumors, etc., especially malignant tumors of the liver, lungs, and kidneys, as well as leukemia, lymphoma, and malignant histiocytosis. They may have long-term fever, but the onset of the disease often begins with weight loss, fatigue, and loss of appetite.
Differential diagnosis
1. Simple weight loss
(1) Constitutional wasting: Constitutional wasting is mainly non-progressive and has a certain degree of heredity.
(2) Exogenous emaciation: usually affected by various factors such as diet, lifestyle and psychology. Insufficient food intake, partial eating, anorexia, skipping meals, irregular lifestyle and lack of exercise, high work pressure, mental stress, excessive fatigue and psychological factors are all causes of exogenous emaciation.
2. Secondary emaciation
Secondary wasting is caused by various diseases. Gastrointestinal diseases such as gastritis, gastroptosis, and peptic ulcers; metabolic diseases such as hyperthyroidism and diabetes; and chronic wasting diseases such as tuberculosis and tumors can all cause emaciation. Abdominal surgeries such as cholecystectomy can also lead to emaciation.
treat
Expected treatmentThe treatment of emaciation is mainly targeted at the cause of the disease. The treatment principles for emaciation caused by different diseases are also different, but the key to treatment is to actively control the primary disease, and on the basis of treating the primary disease, try to increase the patient’s food intake and provide corresponding psychological counseling.
Treatment
1. Digestive tract diseases
When treating the primary disease, patients are also required to eat a balanced diet and pay attention to nutritional supplements.
2. Anorexia nervosa
Anorexia nervosa requires psychological treatment in addition to medication.
3. Malignant tumors
In the late stages of malignant tumors, nutrition and symptomatic supportive treatment should be strengthened.
daily
Nursing principles
1. Dietary care
Find out the reasons for insufficient calorie intake, provide reasonable meals and supplement nutrition.
2. Psychological care
Understand the patient’s psychological activities, explain the impact of emaciation on the body’s health, correct the patient’s misunderstanding of emaciation, help patients with anorexia nervosa remove mental and psychological barriers, and establish correct eating behaviors.
3. Medical and nursing cooperation
(1) Primary disease care
For those with symptomatic emaciation, care for the primary disease should be strengthened.
(2) Preventing bedsores
Extremely thin patients should pay attention to skin care to avoid injuries or bedsores on protruding bones.
4. Health education
(1) Explain the causes of weight loss and related knowledge to the patient.
(2) Make patients aware of the impact of weight loss on physical health and the importance of adequate nutrition.
(3) Educate patients to arrange their meals reasonably to increase their weight.