Chronic Fatigue Syndrome

Criteria and evaluation of asthenic syndrome

The basis for diagnosing chronic fatigue syndrome is the correct evaluation of asthenic syndrome. The physician needs to document the presence of increased weakness that occurs without apparent causes and is not relieved by standard rest.

To objectify the patient's condition, the manifestations of fatigue are necessarily evaluated in relation to a number of provoking and modulating factors:

• Changes depending on the circadian rhythm.
• The impact of psychoemotional stress.
• Reaction to physical exertion (which in this syndrome does not correspond to the degree of exhaustion).
• Association with food intake.

A crucial diagnostic tool is the timing of symptoms. If complaints of weakness persist for more than 1 month, it is referred to as prolonged asthenia. However, if the pathological condition does not resolve for more than 6 months, it is clinically valid to speak of the development of chronic fatigue syndrome.

Chronic fatigue as a marker of liver damage

Chronic fatigue syndrome rarely exists in isolation. Often, it acts as one of the first clinical manifestations of severe systemic diseases, in particular, chronic hepatitis.

A thorough history taking is of critical importance for retrospective diagnosis. In a large percentage of cases, the acute phase of viral hepatitis is completely latent. As a result, the diagnosis of chronic hepatitis is established already at the stage of established pathology. During targeted questioning of the patient, it is often possible to identify blurred symptoms of a previously suffered acute infection, among which the following come to the forefront:

1. Unexplained, incessant fatigue.
2. Periodic nausea.
3. Discomfort in the epigastric region.

Subsequently, asthenic syndrome integrates into the complex picture of liver damage. The combination of fatigue with dyspeptic and pain syndromes, as well as hepatomegaly and cholestasis, is typical for chronic hepatitis with minimal or moderate activity. If pronounced cytolysis and mesenchymal-inflammatory syndrome join the asthenia, it indicates high activity of the pathological process. The appearance of portal hypertension and hepatocellular insufficiency signs against the background of chronic fatigue marks the terminal transition of the disease to the cirrhosis stage.

Principles of pharmacological correction

To treat chronic fatigue syndrome and concomitant asthenic conditions of various etiologies, general tonic medications are widely used in medical practice.

Indications for prescribing this group of drugs cover a wide range of pathological and borderline conditions:

• Neurasthenia itself and chronic fatigue syndrome.
• Asthenic conditions caused by overwork, chronic infections, or occurring during the convalescence period after severe illnesses and surgical interventions.
• Decrease in both physical and mental performance.
• Periods of intense psychoemotional and physical stress (including exams, professional activities, sports competitions).
• The period of adaptation to unfavorable occupational and climatic factors.

In addition to a direct effect on fatigue symptoms, general tonic medications are used as part of complex therapy for arterial hypotension, mild forms of diabetes mellitus (as an auxiliary tool to improve glucose metabolism), and functional impotence. An important area of their application is rehabilitation after chemotherapy and radiation therapy, where these agents help restore immunity and hematopoietic functions.

Class and exam questions

What else to study on this topic

• Pathogenesis of mesenchymal-inflammatory syndrome in hepatitis
• Mechanisms of portal hypertension syndrome development
• Features of using general tonic medications in arterial hypotension
• Effect of general tonic drugs on glucose metabolism in diabetes mellitus
• Clinical picture of hepatocellular insufficiency

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.