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Pikvik's syndrome


Pikviksky syndrome — the morbid condition which is characterized by the chronic progressing respiratory insufficiency (in the absence of primary pathology in lungs) and gradual development of a pulmonary heart in combination with obesity, drowsiness. The name of a syndrome is connected with the description of its signs at one of characters of the novel Ch. Dickens "The Pickwick Papers".

Symptoms of the Syndrome of Pikvik:

Patients complain of the asthma amplifying at an exercise stress is frequent on a headache in the mornings, a bad dream at night, drowsiness in the afternoon, fatigue, decrease in a libido. Sometimes drowsiness is so expressed that patients fall asleep at once as soon as they appear in a quiet situation. The dream can come during meal, survey of the patient with the doctor. At the same time the respiratory rhythm is, as a rule, broken, is more often as Cheyn's breath — Stokes with the apnoea periods.

    At inspection of the patient obesity with an adiposity preferential on a face, a thorax, but especially on a stomach (it is frequent in the form of an apron), short wind, cyanosis of mucous membranes and skin come to light; at a decompensation of a pulmonary heart hypostases are possible. Short wind and cyanosis amplify at an exercise stress and in position of the patient on spin. And radiological are defined by Perkutorno an elation of the lower bounds of lungs (2 — 3 edges higher than norm), decrease in a respiratory excursion of a diaphragm. At auscultation of lungs bitter rattles, homogeneous on caliber, in a projection of the lower shares are quite often listened; in case of accession of chronic pneumonia or chronic bronchitis the auskultativny picture respectively changes. At a heart decompensation perkutorno and radiological dilatation of its right departments is found; before according to an ECG their hypertrophy is defined. Increase in the ABP is possible.

Внешний вид больных при синдроме Пиквика

Outward of patients at Pikvik's syndrome

Reasons of the Syndrome of Pikvik:

P.'s emergence by the village is presumably connected with diseases and injuries ц.н.с. The mental injury, infectious diseases, pathology of childbirth are the possible reason. However it is not always possible to establish accurate connection between P. by the village and the postponed diseases.

    The pathogeny is studied insufficiently. Assume that disturbance of functions ц.н.с is leading., in particular a hypothalamus which is shown by increase in appetite, obesity, frustration of a dream, and also decrease in sensitivity of a respiratory center to changes of concentration of carbon dioxide in blood. The last is shown by frustration of a respiratory rhythm and decrease in volume of ventilation of the lungs which is aggravated with high standing and restriction of an excursion of a diaphragm because of increase in intra belly pressure in connection with obesity. Respiratory insufficiency develops on restrictive type. Hypoventilation of lungs leads to a hypoxia with a secondary hyperglobulia and to hypertensia of a small circle of blood circulation with development of a pulmonary heart, and also to a hypercapnia with disturbance of acid-base equilibrium.

Treatment of the Syndrome of Pikvik:

It is reasonable to begin sick P.' treatment by the village in a hospital and to continue in out-patient conditions. In case of increase of respiratory insufficiency with a hypercapnia hospitalization is obligatory. Treatment taking into account an estimated etiology is carried out, but the leading place is taken by the symptomatic therapy directed first of all to decrease in body weight. The diet at the rate of 600 — 800 kcal in the first 7 — 10 days, then on 1200 kcal a day is appointed. Oxygen inhalations which at patients with a hypercapnia can oppress breath apply in combination with respiratory analeptics and with obligatory control of dynamics of carbon dioxide in plasma. Appoint LFK for the purpose of stimulation of diaphragmal respiration. At a decompensation of a pulmonary heart appoint cardiac glycosides, diuretics. For improvement of a night dream recommend to the patient sublime position of a trunk in a bed, reception for night of Cordiaminum (1 teaspoon inside). Use of the hypnagogues oppressing a respiratory center, contraindicated.

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