Fatigue is to start activities, the difficulty and maintain due to lack of energy, accompanied by a desire for peace. Fatigue is normal after exercise, chronic stress, and sleep deprivation.

Fatigue occurs most often in the context of a symptom complex, but also when it is the sole or main symptom, it is one of the most common symptoms. Fatigue is the difficulty to begin activities and maintain due to lack of energy, accompanied by a desire for Quiet. Fatigue is normal after exercise, chronic stress, and sleep deprivation. but patients may also have certain symptoms other than fatigue; the distinction between these and fatigue is usually – but not always – by detailed questions possible. Weakness (weakness), a symptom of diseases of the nervous system or muscles, is the insufficient strength of the muscle contraction at maximum effort. Diseases such as myasthenia gravis and Eaton-Lambert syndrome may include weakness, causing worsened with activity and feign fatigue. Dyspnea on exertion, an early symptom of heart and lung diseases, can reduce the resilience and pretend to have a Fatigue. Respiratory symptoms can typically occur through careful questioning to light or may develop later. Somnolence, a symptom of disorders that cause sleep deprivation (eg., Allergic rhinitis, reflux, painful musculoskeletal disorders, sleep apnea, severe chronic diseases) is an unusually strong desire to sleep. Yawning and daytime fall asleep are common. Patients can define the difference between sleepiness and fatigue in general. However, the withdrawal of deep non-REM sleep muscle pain and fatigue can cause, and many patients with fatigue have a disturbed sleep, so the distinction between fatigue and sleepiness can be difficult. Fatigue may be in different time categories are classified as follows: Recent Fatigue: <1 month duration Persistent Fatigue: 1 to 6 months Duration Chronic fatigue:> 6 months duration Chronic fatigue syndrome (chronic fatigue syndrome) is a cause of chronic fatigue. Etiology The most serious (and many slight) acute and chronic diseases cause fatigue. But many of them have other, more prominent manifestations (eg. As pain, cough, fever, jaundice) than the current complaints. The discussion focuses on diseases that can manifest as fatigue in the first place. The most common diseases that mainly as a recent fatigue (duration <1 month) manifest are anemia stress and / or depression (1 up to 6 months duration) manifest medication side effects, the most common causes that mainly as persistent fatigue, diabetes hypothyroidism sleep ( z. B. sleep) cancer> 6 months) manifest the common causes that are predominantly (as chronic fatigue duration, are chronic fatigue syndrome Psychological causes (eg., depression) medicines Several factors that often cause or a major complaint with fatigue this help are usually longer lasting or chronic fatigue (see Some factors the Common to A longer persistent or chronic fatigue contributing) , Some factors The Common To A Longer Persistent or Chronic Fatigue Contribute category Examples Chronic diseases Chronic kidney disease, rheumatic diseases (eg. As giant cell arteritis, RA, SLE) drug antidepressants, antihistamines (1st generation), antihypertensives, setting of cocaine (in usually recent fatigue), diuretics, hypokalemia cause muscle relaxants, party drugs, sedatives Endocrine disorders Adrenal insufficiency *, diabetes, hyperthyroidism * (usually apathetic), hypothyroidism, hypopituitarism infection cytomegalovirus infection, endocarditis, fungal pneumonia, hepatitis, HIV / AIDS, mononucleosis, parasitic infections *, TB Psychological disorders anxiety, depression, domestic violence, drug addiction , panic disorder, somatization disorders of unknown cause Chronic fatigue syndrome, fibromyalgia, idiopathic fatigue Other Ursac hen anemia, cancer, deconditioning, pregnancy *, malnutrition, hypercalcemia * Multiple Sclerosis * Causes usually no chronic fatigue rating Fatigue can be very subjective. Patients differ by what they perceive as fatigue and how to describe them. There are also several ways to confirm a fatigue objectively, or to say how difficult this is. History and physical examination will focus on the identification of more subtle manifestations of the underlying disease (especially infections, endocrine and rheumatologic diseases, anemia and depression), which can be used to perform tests. History history of present illness includes open-ended questions about what is “fatigue” and listen to descriptions that might indicate exertional, drowsiness and muscle weakness. The relationship between fatigue, activity, rest and sleep should be filtered out, as is the beginning, time course, and patterns as well as factors that increase or decrease fatigue. DieUntersuchung the body systems should be thoroughly because the potential causes of fatigue are as numerous and varied. Among the important non-specific symptoms include fever, weight loss and night sweats (may indicate cancer, rheumatic disease or infection down). Menstrual history in women of childbearing age, patients should be asked questions of screening questionnaires for psychological disorders (eg., Depression, anxiety, substance abuse, somatoform disorders, domestic violence) unless the cause is obvious. The history should be known diseases refer to the full history of drug use should also prescription, OTC and recreational drugs belong. The social history should descriptions of the diet, drug abuse and the impact of fatigue on quality of life, employment and social and family relationships hervorbringen.Körperliche examination Vital signs are checked for fever, tachycardia, tachypnea, and hypotension. The general examination should be very comprehensive, including the general appearance and examination of heart, lungs, abdomen, head and neck, breast, rectum (including prostate examination and testing for occult blood), reproductive organs, liver, spleen, lymph nodes, joints and Skin. The neurological examination should investigations of intellectual status, cranial nerves, mood, emotion, strength, muscle mass and – include tonus, reflexes and gait. Normally, a focused examination is when the fatigue has recently occurred, reveal the cause. If the fatigue is chronic, the investigation will probably not reveal the cause; but a thorough physical examination is an important way to build rapport with the patient and is sometimes diagnostically hilfreich.Warnhinweise Chronic weight loss Chronic fever or night sweats generalized lymphadenopathy. Muscle weakness or -schmerrzen Heavy non-fatigue-related symptoms (eg. As coughing up blood, vomiting blood, severe respiratory distress, ascites, confusion, suicidal thoughts) involvement of> 1 organ system (eg., Skin rash and arthritis) New or different headaches or vision loss , especially for muscle pain in a older adults older age (eg> 65 years) interpretation of the findings generally be found more likely if the fatigue is one of many symptoms than if the fatigue is the sole symptom of a cause. Fatigue that increases with activity and decreases with rest, suggests a physical disorder. Fatigue that is constantly present and does not decrease at rest, v. a. with occasional bursts of energy that may indicate a psychological disorder. No serious findings before a thorough history, physical examination and routine laboratory tests (plus tests targeted to specific findings that are see Table: Interpretation of selected findings in the study of fatigue) should be sufficient for a first review. If the test results are negative, watchful waiting is usually adequate; when the fatigue worse or develop other symptoms, the patient is re-evaluated. Several causes can for patients with prolonged or chronic fatigue and other special frequent or specific clinical findings (see Table: Interpretation of selected findings in the study of fatigue) are considered. Interpretation of selected findings in the study of fatigue symptoms Possible causes Eligible studies * anorexia, crampy abdominal pain, weight loss or Steatorrhea malnutrition as a result of gastrointestinal disease, cancer, endoscopy, MRI of abdomen, MRCP loss of appetite, abdominal pain, weight loss, orthostatic hypotension, hyperpigmentation skin adrenal insufficiency Blutelektrolyt- and cortisol levels Fever, night sweats, weight loss, infections, rheumatic disease (including vasculitis) blood count, ESR, blood or other cultures, rheumatoid factor and ANA shortness of breath with cough or hemoptysis HIV / AIDS (with Pneumocystis jirovecii pneumonia), fungal pneumonia, TB chest x-ray, breast CT or CT-PET, HIV test, sputum cytology and / or culture, pulmonary function tests, PPD dyspnea, orthopnea and / or edema Chronic kidney disease, heart failure, chest x-ray, renal function tests, echocardiography (if or thopnoe) dyspnea, Roth spots, Janeway lesions, new or changing heart sounds, i.v.Drogenkonsum endocarditis Multiple blood cultures, echocardiography decreased resilience with dyspnea on exertion, pallor anemia blood generalized lymphadenopathy. HIV / AIDS, leukemia, lymphoma, mononucleosis HIV test, blood counts, serologic tests for EBV Combined arthritis, rash, and / or other organ involvement Rheumatic diseases (including vasculitis) blood count, ESR, rheumatoid factor, ANA jaundice, ascites, confusion hepatitis, liver function tests, viral hepatitis serology polydipsia, polyuria, increased appetite, weight gain diabetes fasting blood glucose levels, glucose tolerance tests Cold intolerance, weight gain, constipation, rough skin hypothyroidism, hypopituitarism TSH weight loss or atrial fibrillation in the elderly hyperthyroidism (apathetic) thyroid function tests tiredness that worsens with heat, past neurological symptoms (eg. As deafness, ataxia, weakness), in particular> 1 Episode Multiple Sclerosis MRI of the brain and / or spinal cord with contrast headache, claudication masseterica, temporary sensitivity or thickening of the arteries and / or muscle pain in older adults giant ESR, MRI or CT of the brain , temporal artery biopsy fear, sadness, loss of appetite, unexplained sleep disorders anxiety, depression, domestic violence, somatization disorder Clinical examination Recent Sore throat, lymphadenopathy, splenomegaly. Mononucleosis, chronic fatigue syndrome Serologic tests for EBV; Blood count, ESR, TSH, chemicals (like in suspected chronic fatigue syndrome) lymphadenopathy, splenomegaly CMV infection Serologic tests for EBV, sometimes CMV antibody tests Frequent or opportunistic infections, candidiasis, lymphadenopathy, splenomegaly HIV / AIDS HIV testing Chronic, widespread extra-articular musculoskeletal pain, trigger points, irritable bowel symptoms, migraine, anxiety fibromyalgia erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP), CK, TSH, hepatitis C serology weight loss, steatorrhea, inadequate fluid intake malnutrition plasma albumin, total lymphocyte and CD4 count, serum transferrin constipation, lethargy, bone pain (eg. As at night) hypercalcemia serum analysis, including Ca sore throat, non-restorative sleep, difficulty concentrating or short-term memory, myalgia, arthralgia more, headache, sensitive cervical or axillary lymph nodes. Chronic fatigue syndrome blood count, ESR, TSH, serum electrolytes, glucose, calcium, and kidney and liver function tests * The selection of specific tests will be determined by the causes that are clinically suspected. ANA = anti-nuclear antibody; CMV = cytomegalovirus; EBV = Epstein-Barr virus; MRC = magnetic resonance cholangiopancreatography Testing The investigations aim at the causes that are suspected based on the clinical findings from. If no cause is evident or is on clinical findings, suspected based, it is unlikely that laboratory tests reveal the cause. However, many doctors recommend tests with the following: blood BSG TSH chemistries, including electrolytes, glucose, calcium, and kidney and liver function tests CK is recommended if muscle pain or weakness are present. HIV testing and PPD placement are recommended if the patient has risk factors. Chest X-ray is recommended when coughing or dyspnea are present. Other tests, such as infections or immunological deficiencies are not recommended unless there are suggestive clinical findings. The diagnosis of chronic fatigue syndrome requires both of the following characteristics: Chronic fatigue that affects daily functioning, not improved by rest and is not clinical findings or abnormal findings on the above laboratory tests explains the presence of ? 4 of the following: sore throat , non-restorative sleep, difficulty in concentration or short-term memory, myalgia, arthralgia without joint swelling more, new or different type of headache and sensitive cervical or axillary lymph nodes therapy treatment depends on the particular cause. Patients with chronic fatigue syndrome (chronic fatigue syndrome) and idiopathic chronic fatigue are treated similarly. It should be clearly told that no physical causes are evident. Treatment is often successful if the doctor is patient and non-judgmental and recognizes the real impact of fatigue. To effective treatments physical therapy (eg. As graded exercise therapy) and psychological support include (z. B. cognitive behavioral therapy). Goals are to return to work and maintain normal activity. Geriatric Essentials fatigue is often the first symptom of disease in the elderly. For example, the first symptom of a urinary tract infection in an elderly woman may be more fatigue as urinary symptoms. Elderly patients with pneumonia may suffer from fatigue, before they have a cough or fever. The first symptom of other diseases such as giant cell arteritis, may also be fatigue in an elderly patient. Since elderly patients are a serious illness can become apparent shortly after sudden fatigue, the cause should be established as soon as possible. Fatigue is also caused more by giant cell arteritis or other serious physical illness in the elderly. Important points Fatigue is a common symptom. Fatigue, which is mainly caused by a physical disorder, increases with activity and decreases with rest. Laboratory tests have no clinical findings suggestive of little significance. Successful treatment is more likely if the doctor is patient and understanding.

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