Notes by dr Claudio Italiano
The asthenic patient is that person who tells you not to have strength and valetude, the patient tired, exhausted, without energy and exhausted, with great
need for rest and sleep and, often, who can not rest while wishing it.
This
feeling of asthenia, however, is not the classic lack of strength of the muscles,
although often the asthenia is associated with this eventuality. Asthenia, again,
can have a pathological significance, e.g. in anemia or be a physiological
defense of the body towards an exaggerated stress to which an individual is
subjected, that is, to the pressure of work that must be carried out regardless
of the forces possessed to implement it ("extinguished candle" or "burn out"
syndrome) managers, employees, workers etc.
It may also be a simple
psychological or physiological disorder, or, more simply, the state that results
from an incubation of a viral disease or a viral infection in progress, or an
endocrine pathology (thyroid diabetes misunderstood), cardiovascular disease (
decompensation, angina etc.). Fatigue, unfortunately, is often associated with
tumors.
Asthenia can be associated with hypermetabolic and hypometabolic states
in which nutrients are insufficient to the body's energy needs. We try to read
carefully between these lines to understand what to look for and what lies
behind the low-grade fever (ie in the evening).
It is necessary that the doctor, usually the internist, should visit the person with extreme accuracy and evaluate if the asthenic disorder gets worse with the activity and improves with the rest, possible occurrence in the organic causes; if, on the contrary, it is the opposite, that is, the forces are not lacking in the movement and recreation of the mind, then one can think of a cause of psychiatric and / or psychological pertinence. It is still necessary to investigate possible and previous viral diseases or changes in the lifestyle of the individual, investigate nutritional disorders: bulimia, anorexia, weight loss. Observe the patient if he / she has signs attributable to depressive syndrome; is unkempt, is cured in dressing, has a slumped posture?
This syndrome can be associated with fevery serotin, night sweats, diarrhea, cough, accompanied by chronic intestinal infections and chronic bronchitis.
A mild asthenia appears after exercise and stress, with
weakness and weight loss, with gastrointestinal disorders such as nausea,
vomiting, abdominal pain, chronic diarrhea, skin hyperpigmentation (old
definition of bronzino, or Addison's disease). Addison's disease is a rare
endocrine pathology characterized by a deficiency in the production of
corticosteroids. When the alteration directly affects the adrenal gland the
primitive forms of the disease occur, while the secondary forms are those caused
by an alteration in the production of the hypophyseal hormone adrenocorticotropin (Acth), for a damage to the pituitary or hypothalamus.
The secondary forms are also defined by some "white" Addison's disease, because
there is no variation in the cutaneous color. In primitive forms, however, the
skin is dark, due to the increase in deposition of melanin, especially on the
palms of the hands and in the skin folds (the disease was once called "badly
bronzino").
This disease affects about one in 100,000 individuals, regardless of gender or
age, and has a chronic, slow-onset pattern. The causes are autoimmune diseases
and adrenal tuberculosis (in the primitive form), pituitary surgeries, brain
tumor, skull radiotherapy (in secondary forms). Symptoms are weight loss, muscle
weakness, fatigue, difficulty concentrating, emotional instability.
COPD
It is one of the most frequent causes of asthenia and affects menstruating and postpartum women, or more simply of people suffering from chronic blood loss from the digestive tract, such as people with hemorrhoids
An unexplained absenia, with a lack of appetite that reaches anorexia often
hides a neoplasm. The writer has had the experience of a patient suffering from
a bronchial squamous tumor, which had complete aversion to food, as if it were
eating disgusting foods. In general, simple investigations such as blood count,
stool occult blood, chest x-ray, ultrasound of the upper and lower abdomen,
search for prostatic antigen, Ca 125, CEA, alpha fetus protein, CA 19-9, Ca etc.
to get an idea of the home; visit the patient to rule out the presence of
palpable abdominal masses, consider respiratory and digestive signs. (compare
the oncology part to the gastrohepate index).
The patient with bronchitis has progressive abstinence and
dyspnoea and can lose weight in the most advanced forms, with anorexia. This is
considered a negative prognostic sign quoad vitam et valitudinem. The patient
may have low-grade fever with continuous episodes of exacerbation of the
bronchitis itself, sweating, coughing and poorly expectorant cough and poor
respiratory excursion, barrel thorax in emphysema, poor exercise tolerance.
The cirrhotic patient will have asthenia in the stages of hepatic
failure with ascites and systemic harbor encephalopathy, with cognitive
impairment, when the detoxifying capacity of the liver from toxins and
intestinal gases, jaundice, hepatosplenomegaly, hypotension, intense itching due
to increase in bilirubin.
We refer to the pages of my site. Here we will say that
some cases begin with fever and sweating, fatigue, susceptibility to infections.
In some of my clinical cases, patients came to my attention due to fever and
malaise.
The patient of psychiatric and / or psychological relevance, at
least in the early stages of the disorder, when it is still possible to mend the
"psychological wound" of the mind. He is an anxious, often sleepless, patient
who ruminates on himself and is thought to be the cause of the ills of his
family and of his relatives, even if it is not true, because he is surrounded by
the affection and esteem of his own. Sometimes it has somatic disorders, stypsis
diarrhea and irritable bowel syndrome.
Asthenia is the main symptom of diabetes, a disease that is determined by the altered carbohydrate metabolism, ie the bad use of carbohydrates as the main fuel of our body. Related findings include weight loss, polyphagia, that is excessive hunger, polyuria, that is, the fact that a person continues to urinate often and polydsy, therefore excessive thirst.
Heart Failure, pre tibial edema
This is the pathology that perhaps we should have cited first in this web page,
because when the heart pump is insufficient, the blood supplying nutrients and
oxygen does not circulate as it should in the whole body and as a result the
organism is asthenic , "tired out". Moreover, a decompensated patient, since the
kidney suffers from this pump deficiency, retains liquids that accumulate in the
declivity, a sign of the "fovea" and in the lungs in the pleurae, as a pleural
effusion. Also associated with this syndrome is the engorgement of the small
circle with the signs of stasis auscultus tori, ie the fine bilateral basal
crackles and the starvation of air or anxiety that your patient complains about.
Here too the signs are the asthenia and the loss of the last stages of the
decompensation, when the patient lives in bed, in a seated position (orthopnea),
with his feet dangling out of bed, to hinder in his way the venous return to the
heart. In the right heart failure, however, you will notice the edema of the
neck and the turgor of the jugular that fail to discharge the plethora of blood
that they contain in a heart that, so to speak, "does not aspire".
Another big chapter that refers to the astenie in general. Who among us has not been without forces for a flu syndrome that have reduced him to bed without energy? The picture in these cases is striking, but there are conditions that weaken the patient as chronic infections, with low-grade fever and weight loss and lack of strength. The writer, for example, came across a case of a young patient in the grip of serotine fever with a noticeable drop in weight and lack of strength. After the appropriate investigations of the case (approach to the patient), a remarkable leukocytosis emerged with the finding of a cyst suppurated on the palate where, a few years before, a dentist had done a dental job. Other times a myocardial infection, pericarditis or endocarditis are causes of fever and fatigue, or a urinary infection, especially in women or in a lord with prostatic hypertrophy. Another classic debilitating and chronic infection par excellence is tuberculosis, which we are learning to recognize again in the non-EU and soon also from us, since there are cohabitations between non-EU people and Italians. Infections such as AIDS, such as chronic HCV and HBV related hepatitis follow. Let's also take into account the disease of the kiss by EBV or CMV and chronic tonsillitis.
Compare the page, it is the puncture of the tick to determine, but the thick fever is high and is associated with a rash throughout the body.
Compare the page
Easy fatigue, muscle weakness and worsening of symptoms as the day progresses with intense muscular pain.
Gastroepato