Rheumatology Book

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FatigueAka: Asthenia

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  1. See Also
    1. Fatigue in Cancer
  2. Definitions
    1. Fatigue
      1. Unable to perform activity repeatedly
    2. Asthenia
      1. Physical exhaustion without weakness
  3. Types
    1. Secondary Fatigue (20% of non-chornic causes)
      1. Fatigue with underlying medical cause
      2. Fatigue lasts between 1 and 6 months
    2. Physiologic Fatigue (80% of non-chronic causes)
      1. Fatigue due to lifestyle causes
    3. Chronic Fatigue
      1. Fatigue that lasts longer than 6 months
  4. Symptoms
    1. Frequent presentations
      1. "I can't get out of bed in the morning"
      2. "I'm feeling 'all in'"
      3. "I'm tired all the time"
    2. Lack of pep or energy
      1. Usually complaint of "always tired"
      2. However on careful questioning, varies throughout day
    3. Low vitality
    4. Persistent Exhaustion or tiredness
    5. Strongly desire rest or sleep
    6. Associated symptoms
      1. Subjectively weak
      2. Headache
      3. Assorted pain
  5. Symptoms: Differentiate from Sleepiness
    1. Fatigue is provoked by activity with delayed recovery
      1. Exercise offers a temporary respite from Sleepiness
    2. Nonrestorative rest and sleep
      1. Sleepiness improves with a nap
    3. Poor muscle endurance and mental exhaustion
  6. Diagnosis: Factors suggestive of psychogenic cause
    1. Fatigue lasting longer than 4 months
      1. No associated signs or symptoms
    2. Fatigue that is worse in morning
      1. Improves with activity
    3. Fluctuating course
    4. Stressful social history
    5. Exhaustive lifestyle
    6. History of psychological condition
  7. Signs: Exclude Organic Fatigue Causes including neoplasm
    1. Lymphadenopathy
    2. Cardiac murmur
    3. Thyroid Goiter
    4. Edema
    5. Decreased muscle tone or other neurologic deficit
    6. Careful Neurologic Exam
  8. Red Flags suggestive of organic or physical cause
    1. Fatigue relieved with rest or sleep
      1. Refreshed in morning
    2. Less than ordinary activity causes fatigue
    3. Ill appearing, tired or worn patient
  9. Labs
    1. See Fatigue Diagnostic Testing
  10. Management
    1. Daily Exercise (30 minutes of Moderate Aerobic Activity)
    2. Stress reduction
    3. Adequate sleep (8 hours per night)
      1. See Sleep Hygiene
    4. Treat underlying causes of fatigue
      1. Anemia
      2. Depression
  11. Course
    1. Fatigue may persist for >1 year in 50% of patients
  12. References
    1. Goroll (2000) Primary Care Medicine, Lippincott, p. 41
    2. Lipken in Dornbrand (1992) Ambulatory Care, p. 5-8
    3. Morrison (2001) Obstet Gynecol Clin North Am 28:225
    4. Rosenthal (2008) Am Fam Physician 78(10):1173
    5. Valdini (1988) J Fam Pract 26:33

Asthenia (C0004093)

Definition (MSH)Clinical sign or symptom manifested as debility, or lack or loss of strength and energy.
Definition (NCI)Weakness; lack of energy and strength.
ConceptsSign or Symptom (T184)
ICD9780.79
MSHD001247
EnglishAsthenia, Asthenias, Debility, Feeling weak, General weakness, Generalized weakness, Lassitude, STRENGTH LOSS OF, Weakness, Weakness - general, WEAKNESS GENERALIZED
Spanishabatimiento, astenia, debilidad, debilidad general, desgano
Parent ConceptsDisorders, General, Functional and NEC (C0549512), Symptoms (C1457887), Signs and Symptoms (C0037088), Fatigue (C0015672), [D]Malaise and fatigue NOS (C0024528), Duplicate concept (C1274013)
SourcesAOD, CST, DXP, LCH, MSH, MTH, MTHICD9, NCI, NDFRT, OMIM, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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