Cachexia

A Cachexia is a pathological weight loss that can occur in the context of serious illnesses. In addition to the fat deposits in the body, this phenomenon also affects the body fat in the organs. One possible treatment measure is artificial nutrition.

What is cachexia?

The causes of cachexia are usually illness or a certain age. Chronic debilitating diseases such as cancer, type 1 diabetes, African sleeping sickness or rheumatoid arthritis are associated with cachexia.
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The concept of Cachexia denotes a weight loss with disease value. In the case of tumor diseases, for example, pronounced weight loss occurs in the form of tumor cachexia. With cachexia, the body mass index falls below a value of 18. The body fat percentage drops by at least five percent within five months. The overall weight loss during this period is more than two percent. Severe cachexia is often interpreted as an announcement of imminent death.

Refractory cachexia is present as soon as the pathological weight loss can no longer be influenced therapeutically, for example in the end-stage of tumor diseases. Life expectancy with refractory cachexia is only a few months. A distinction must be made between cachexia and inanition, which is understood as emaciation.This is the case as long as the body's vital structural fat is not affected by the weight loss. In the case of cachexia, not only the fat deposits of the body are attacked, but also the muscles and organs.

causes

The causes of cachexia are usually illness or a certain age. Chronic debilitating diseases such as cancer, type 1 diabetes, African sleeping sickness or rheumatoid arthritis are associated with cachexia. The same applies to persistent diseases of the gastrointestinal tract, such as enteritis or pancreatitis.

As part of these diseases, the absorption of nutrients in the gastrointestinal tract can no longer take place to the usual extent. Just as often, chronic heart failure, kidney failure or lung diseases trigger cachexia and thus weaken the organism. We are talking about cardiac, renal or pulmonary cachexia. Cachexia can also be caused by malnutrition or even an eating disorder such as bulimia.

Senile cachexia, on the other hand, is a symptom of old age that is often associated with the terminal phase of death. Sometimes cachexia is also associated with intoxication. Alcoholism, drug addictions and chronic mercury poisoning can trigger the symptoms.

Symptoms, ailments & signs

The first signs of cachexia are the appearance of the person affected. The contours of the bones become visible piece by piece. The eyes are deep and the cheeks deform into hollow cheeks. These phenomena are related to the breakdown of the retrobulbar fat deposits and the structurally provided cheek fat. Organic disturbances soon appear.

In the late course, for example, atrophic heart failure often occurs. The bone marrow turns into gelatinous marrow. As part of this, the fat components of the anatomical structure are replaced with a serous fluid and take on a grayish color. The person concerned becomes noticeably weaker. In the late course, the powerlessness turns into lethargy, that is, into sleepiness with an increased stimulus threshold. Since muscles also shrink as part of a cachexia, the heart muscle may eventually be attacked. The damage to organs is irreversible and can result in death.

Diagnosis & course of disease

The diagnosis of cachexia is made by the doctor as part of the visual diagnosis and the BMI measurement. Anamnesis helps to assess the extent of the pathological weight loss. Organs and spinal cord may also be examined for involvement to complete the picture. The course of the disease depends heavily on the underlying cause and the time of diagnosis.

If the cachexia has already attacked the organs when it was diagnosed, then that means a rather poor prognosis. As long as there is no organic damage and the cause of the cachexia can theoretically be eliminated, a full recovery is possible. In this case, the prognosis is favorable. Often the patient's self-will, hunger and cooperation are also rated as favorable prognostic factors.

Complications

Cachexia leads to very severe weight loss in the patient. Being underweight represents a very unhealthy condition for the body that must be avoided or remedied in any case. This can also damage the internal organs, causing irreversible consequential damage to the patient.

The external appearance is also severely restricted by the cachexia, so that most patients do not feel comfortable with their bodies and are ashamed of them. This can lead to inferiority complexes or reduced self-esteem. The muscles also shrink, so that the patient's resilience is reduced. Those affected appear tired and exhausted.

If vital organs are irreversibly damaged, the patient can also die if no treatment is initiated. The heart can also be affected, leading to cardiac death. As a rule, a causal treatment of the cachexia must take place in any case. However, it cannot generally be predicted whether the disease will progress positively. Life expectancy may be reduced.

When should you go to the doctor?

Any unusual weight loss should be investigated by a doctor. People who experience weight loss that may be associated with an eating disorder or other medical condition are best to speak to their doctor. At the latest, when additional warning signs such as increasing weakness and fatigue appear, medical advice is required. The person concerned should also visit a doctor's office if there are psychological complaints or a possible trigger for the complaints.

Should the weight loss cause physical or mental deficiency symptoms, a doctor must be consulted on the same day. In the event of an acute risk of falling or problems with the cardiovascular system, relatives should call the emergency doctor. Cachexia mainly occurs in chronic diseases such as cancer, type one diabetes or rheumatoid arthritis as well. Chronic kidney failure, heart failure, and lung disease are also possible risk factors. Affected patients should consult a doctor immediately. In addition to the family doctor, an internist or a therapist for eating disorders is the right contact. Children should be presented to a pediatrician or a child psychologist.

Therapy & Treatment

When cachexia is present, treatment is usually based on cause. Ultimately, to cure cachexia, the doctor must eliminate the cause. In the case of illnesses, this means curing the causal illness. This goal is approximated via the disease-specific therapy steps. In the case of serious illnesses such as cancer or heart failure, the treatment of cachexia also turns out to be rather difficult.

For cachexia due to malnutrition, treatment includes changing diet and slowly approaching healthy food intake. Self-inflicted cachexia from eating disorders or alcoholism may require treatment from a psychotherapist. If oral food intake is not possible or there is an absorption disorder in the gastrointestinal tract, the doctor, however, initiates parental forms of nutrition.

The patient is given a small molecular infusion of nutrients into the bloodstream. In this way, the gastrointestinal tract can be bypassed and the vital nutrients are available to the organism again. In the case of refractory cachexia or cachexia in the terminal phase of death, the patient's symptoms can no longer be alleviated by measures such as artificial nutrition. In this phase, no meaningful treatment can take place.

Outlook & forecast

Since cachexia are only symptoms of underlying diseases, they have no prognosis per se. However, in some cases they have a significant impact on the prognosis of the diseases that they trigger. So-called tumor cachexia, for example, says a lot about whether a cancer patient's prognosis is good or bad. This type of cachexia often occurs in the course of cancer treatment using chemotherapy and worsens the prognosis, as it robs the affected patient of important energy resources that he needs to better cope with the consequences of his therapy.

Cachexia can also appear quickly in eating disorders, especially in anorexia and bulimia. These diseases are initially not life-threatening, but they can quickly become so if the affected patient has already developed cachexia. If he does not seek professional help now, the internal organs will be damaged. This damage can be permanent or in the worst case fatal.

Most other forms of cachexia are also not positive for a person's health. Age cachexia, for example, is often an indication of dwindling strength in an aging person. Cachexia in third world countries that occur due to famine are also indicative of dangerous health conditions that can quickly lead to life-threatening problems.

prevention

Self-inflicted cachexia in the context of eating disorders or substance abuse can be prevented. On the other hand, cachexia in the context of severe illnesses cannot be directly avoided.

Aftercare

With cachexia, aftercare is primarily about achieving and maintaining a healthy weight. Since the therapy of cachexia also consists in correcting the emaciated nutritional state, the follow-up care should be linked directly to the fact that the body weight remains stable and does not drop again in the meantime.

In follow-up care, it is important to keep eating enough food. High calorie food is best suited here, in some cases high calorie drinking food can be consumed as a supplement or as a substitute. In any case, the optimal nutrient supply and the achievement and maintenance of a normal weight should be aimed for.

Because cachexia often occurs as a result of another underlying disease and rarely occurs in isolation, it is important to diagnose and treat this underlying disease. Therefore, a thorough medical examination for all possible causes is required. Follow-up care should also consist of regular weight checks and blood tests for deficiencies. Since the cachexia also leads to a decrease in muscles, it can be useful to slowly build up muscles again with the help of exercise.

Last but not least, it should also be considered that psychological counseling may be considered, because cachexia patients often suffer psychologically from their external appearance. The emaciated body can be stressful and even lead to depression.

You can do that yourself

The disorder is life-threatening and must be treated by a doctor. Most of the time, the cachexia is due to a serious underlying disease such as cancer, which is in a very advanced stage. In these cases the patient himself can do little to improve his condition. Artificial nutrition is then very often required.

However, there is room for self-help measures where the cachexia is due to malnutrition or malnutrition. People who suffer from anorexia or bulimia are particularly at risk. Since those affected usually have a severely disturbed self-image due to the illness and cannot or do not want to recognize the external signs of cachexia, it is up to the social environment to take the necessary measures to help themselves. People who suffer from an eating disorder often try to hide it. Strong weight loss is then explained by supposedly healthy activities such as a lot of sport or therapeutic fasting. In the event of sustained severe weight loss, the families of those affected should pay attention and sensibly but consistently insist that the affected person seek medical treatment.

There are special counseling centers for parents of anorexic and bulimic children and adolescents who provide family members with information and support them in taking the measures that are indicated if a serious nutritional disorder is suspected.