syndrome Pickwick - a pathological condition characterized by progressive respiratory failure, in the absence of primary pulmonary pathology.At the same time, the syndrome of Pickwick observed the development of pulmonary heart conjunction with sleepiness and obesity.Also Pickwick syndrome due to extreme obesity observed, leading to the inability to breathe deeply and quickly enough, resulting in a marked decrease in blood oxygen levels and higher rates of carbon dioxide.This syndrome is considered to be a subtype of obstructive sleep apnea, which occurs most frequently in the male half of humanity in the age range of forty to sixty years.
Pickwick syndrome causes
Presumably development of the Pickwick syndrome is associated with a variety of injuries and diseases of the central nervous system.There is also a possible reason accepted to birth defects, mental illness and psychological trauma.At the same time establish a clear link between development and Pickwick syndr
It was noted that not all people suffering from overweight suffer from this syndrome.From this it can be concluded that the development of this syndrome in overweight people or cause any individual genetic characteristics.Adoption of some doctors that Pickwick syndrome develops only in people with obesity, is erroneous becausethis condition is often diagnosed in people whose weight does not meet the criteria for being overweight.
Pathogenesis Pickwick syndrome is currently studied not enough.It is believed that the leading factor is the violation of the proper functioning of the central nervous system, namely the hypothalamus, which is manifested disorders of sleep, increased appetite, obesity, decline in lung ventilation due to respiratory disorders.Hypoventilation often leads to hypertension, pulmonary circulation (ICC) in violation of the acid-base balance, hypercapnia and development of pulmonary heart.Often seen with hypoxia secondary erythrocytosis.
Pickwick syndrome symptoms
Pickwick syndrome is characterized by three main symptoms: respiratory disorders, sleepiness and obesity (typically abdominal type when there is a significant increase in the abdomen).Overweight leads to increased intra-abdominal pressure, violation of gas exchange processes, easing the movements of the diaphragm.Due to the increased number of red blood becomes thick, due to which the heart is forced to work harder, leading to deterioration thereafter cell viability, especially of the brain.
Big belly in the supine position quite strongly compresses the diaphragm, which draws in the lungs, resulting in breathing stops.Accustomed is in conditions of oxygen starvation of the brain cells give the command to restore breathing only when the incoming oxygen becomes very little.Consequently night's sleep with a man Pickwick syndrome consists of alternating episodes of oxygen deficiency and frequent awakenings nezamechaemyh that subsequently leads to constant sleepiness of the afternoon.
The main symptoms of the Pickwick syndrome following:
- Central acrocyanosis and cyanosis
- Extreme obesity (3-4)
- Prolonged restriction of pulmonary respiration
- Sleep disorders and snoring
- In the daytime drowsiness expressed
- Swelling.Initially appear on the legs and feet, then over time can develop a total swelling of subcutaneous tissue.If there is fluid accumulation in the natural cavities of the body - develops pleural swelling
- Shortness of breath.There is at rest with labored breath and increases with falling asleep and physical activity
- periodic cessation of breathing (apnea) and shortness of breath, especially during sleep, and with a strong syndrome Pickwick's also the day
- Hypoxiaand hypercapnia
- Arterial and pulmonary hypertension
- An abnormal increase in the number of red blood cells (polycythemia)
The examination of the patient with the syndrome of Pickwick observed obesity, with preferential deposition of fat on the chest, face, abdomen (especially large deposits).These people marked cyanosis of skin and mucous membranes, there are noticeable swelling.Cyanosis and dyspnea intensified markedly in the position of the body lying on his back during exercise.Radiologically determined decrease respiratory excursions of the diaphragm and the elevation of the lower boundaries of the lungs.You may experience increased blood pressure.
Pickwick syndrome treatment
Therapy Pickwick syndrome should begin to conduct only in specialized clinics, where available sleep laboratory.Treatment Pickwick syndrome is a fairly complicated procedure, asIt noted the ineffectiveness of standard schemes.It requires an individual approach taking into account the developed heart pathological phenomena and changes in the blood.
leading role in the treatment of this disease takes a symptomatic therapy, primarily aimed at maximum reduction of body weight.To do this, appointed specially designed diet (600 to 800 kcal first seven to ten days, after which 1,200 kcal per day).
patients with hypercapnia shows oxygen inhalation necessarily combined with respiratory analeptics, under the control of the dynamics of the presence of carbon dioxide in the plasma.To stimulate diaphragmatic breathing prescribe physical therapy.When decompensated pulmonary heart disease indicated for use diuretics and cardiac glycosides.In order to improve nighttime sleep at night it is recommended reception kordiamin (inside 1 tsp), and elevation of the trunk.Hypnotics, which suppress the respiratory center contraindicated!
forecast syndrome Pickwick quite poor because of the high mortality due to pathological changes in the lungs and heart, as well as sleep apnea.Without treatment, the mortality rate reaches 70%.