Anorexia-Cachexia syndrome Flashcards
Stavation
Starvation is characterized as HYPOMETABOLIC state with reduced protein and glucose turnover but INCREASING lipolysis without an underlying pro-inflammatory condition.
Starvation is often seen in patients with bowel obstruction, those undergoing radiotherapy for head and neck cancers, and surgical patients
Primary VS Secondary
Primary ACS represents a metabolic status directly caused by the tumor or the chronic illness, in which complex metabolic and neuroendocrine modifications occur in an ongoing, altered inflammatory state. Catabolism is accelerated despite declining food and energy intake
Secondary ACS refers to cachexia occurring from impaired oral intake, including severe symptoms (e.g., pain, depression), concurrent catabolic states, loss of proteins, or loss of muscle tissue due to reduced physical activity (deconditioning)
Etiology of secondary ACS
- REDUCED oral intake
- IMPAIRED GI FUNCTION OR INTEGRITY
- NORMAL GI: wrong diet, distress, depressed, pain, AMS
- Protein LOSS
- CATABOLIC states: COPD, inflamation, Hyperthyroid
Screening assessment and decision making
PHARMACOLOGICAL INTERVENTION
- Progestins: Megestrol acetate
- Cannabinoid: dronabinol
- Psychotropics: Mirtazapine, Olanzapine
- Corticosteroids
- Immunomodulator: Thalidomide
- Anabolic steroid: Oxandrolone
- Weight loss after extensive surgery, chronic infections, or severe trauma
- Some who fail to gain or maintain normal weight without definite pathophysiological reasons
- Offsetting the protein catabolism associated with prolonged administration of corticosteroids
- Relief of the bone pain frequently accompanying osteoporosis
- Pentoxifylline
- Growth hormone
Response concern/ request for artificial nutrition
-DO NOT shut them down
“There’s no proved benifit.”
“There’s increase risk of aspiration, fluid over load, etc”
-Explore Hope, expectation, EMOTIONS
“What do you hope to achieve with the (intervention)?”
-SET up GOAL
OK for time limited trials
