Rheumatology Book

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Fatigue

Aka: Fatigue, Asthenia, Fatigue Red Flags
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  1. See Also
    1. Fatigue in Cancer
    2. Fatigue Causes
    3. Chronic Fatigue Syndrome
    4. Fatigue Diagnostic Testing
    5. Medication Causes of Fatigue
  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
      2. See Chronic Fatigue Syndrome
  4. Causes
    1. Fatigue Causes
    2. See Medication Causes of Fatigue
  5. 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
  6. 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
  7. 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
  8. Symptoms: 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
    4. Weight loss
    5. Dyspnea
  9. Signs: Red Flags (suggesting Organic Fatigue Causes including neoplasm)
    1. Lymphadenopathy
    2. Cardiac murmur
    3. ThyroidGoiter
    4. Edema
    5. Inflammatory arthritis findings
    6. Decreased muscle tone or other focal neurologic deficit
      1. Careful Neurologic Exam is critical
  10. Labs
    1. See Fatigue Diagnostic Testing
  11. 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
  12. Course
    1. Fatigue may persist for >1 year in 50% of patients
  13. 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 28:225-40
    4. Rosenthal (2008) Am Fam Physician 78(10): 1173-9
    5. Valdini (1988) J Fam Pract 26:33-8

Asthenia (C0004093)

Definition (NCI) A sign or symptom of weakness and diminished or absent energy and strength.
Definition (MSH) Clinical sign or symptom manifested as debility, or lack or loss of strength and energy.
Definition (PSY) Physical weakness, lack of strength and vitality, or a lack of concentration.
Definition (NCI) Weakness; lack of energy and strength.
Concepts Sign or Symptom (T184)
MSH D001247
ICD10 R53.1
SnomedCT 274236006, 206768006, 158170006, 274638001, 13791008
English Asthenias, ASTHENIA, Asthenic, Enfeebled, STRENGTH LOSS OF, WEAKNESS GENERALIZED, Weak, Asthenia NOS, [D]Asthenia (context-dependent category), [D]Asthenia NOS (context-dependent category), [D]Asthenia NOS, Generalized weakness, Asthenia [D], asthenia (diagnosis), asthenia, Asthenia [D] (situation), General debility, Strength loss of, STRENGTH DECREASED, STRENGTH LOSS, [D]Asthenia NOS (situation), [D]Asthenia, [D]Asthenia (situation), Asthenia [Disease/Finding], feels weak, of strength loss, weakness, weak feeling, feeling weak, debility, lassitude, weaknesses, feel weak, feeling weakness, loss of strength, loss strength, strength loss, weak, asthenic, general weakness, generalized weakness, Weakness, Lassitude, Debility, General weakness, Feeling weak, Weakness - general, Asthenia (finding), Asthenia, Asthenia [D] (finding)
French ASTHENIE, Débilité générale, Perte de force de, FAIBLESSE GENERALE, PERTE DES FORCES, Asthénie
Portuguese ASTENIA, Debilidade geral, Perda de força, FRAQUEZA GENERALIZADA, PERDA DE FORCAS, Astenia
Spanish ASTENIA, Pérdida de fuerza, Debilidad general, [D]astenia, SAI (categoría dependiente del contexto), [D]astenia (categoría dependiente del contexto), Asthenia [D], Asthenia, DEBILIDAD GENERALIZADA, PERDIDA DE FUERZA, [D]astenia, SAI, [D]astenia, SAI (situación), [D]astenia (situación), [D]astenia, abatimiento, astenia (hallazgo), astenia, debilidad general, debilidad, desgano, Astenia
German ASTHENIE, Kraftverlust, allgemeine Schwaeche, KRAFTLOSIGKEIT, SCHWAECHE ALLGEMEIN, Asthenie, Kraftlosigkeit, Schwäche
Dutch algehele zwakte, krachtsverlies, asthenie, Astenia, Asthenie, Krachteloosheid, Zwakte
Italian Perdita di forza, Debolezza diffusa, Astenia
Japanese 筋力喪失, 全身衰弱, 無力症, ｾﾞﾝｼﾝｽｲｼﾞｬｸ, ｷﾝﾘｮｸｿｳｼﾂ, ﾑﾘｮｸｼｮｳ
Swedish Kraftlöshet
Czech astenie, Ztráta síly, Celková slabost, Astenie
Finnish Astenia
Russian ASTENIIA, АСТЕНИЯ
Polish Niemoc, Bezsilność, Utrata sił i energii, Astenia, Osłabienie
Hungarian Általános debilitas, Asthenia, Erő elvesztése
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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