Atony

from Wikipedia, the free encyclopedia

Atony is the medical term for the lack of tone , i.e. of tension, of smooth or striated muscles. In today's medicine the term is used for the lack of tension in smooth muscles , e.g. B. the uterus, intestines, stomach or bladder used. The term paresis (incomplete paralysis) and plegia (complete paralysis) are used for the lack of tension in the striated , voluntary skeletal muscles . Exceptions are atonic epileptic seizures and sleep atonia . The atony of tissues or organs is a historical medical term.

The opposite ( antonym ) of the atoms is the normal state of tension, which as tone is called, or the pathologically increased tension, ie the hypertension ( bracing , myogelosis (muscle strength), muscle stiffness ). The transitions from the atony and the monotony on the hypotension that normotonia that Ortho Tonie and Eutonie to hypertension , for dystonia and catatonia are fluid. There is no such thing as an absolute atony of 0 Pa .

Word origins and derivations

The word atony comes from ancient Greek ἀ- a- , German “un-” , “-los”; τόνος tonos , German 'tension' from; Associated adjectives aton, atonic, atonic, atonic, atonal, atonatory. In Latin , atonia is the lack of tension (of the muscles).

ICD-10

There are five entries in the systematic index of the ICD-10 that contain atony or atonic:

  • G40.3 Generalized idiopathic epilepsy and epileptic syndromes: nonspecific epileptic seizures: atonic
  • K59.8 Other specified functional bowel disorders: colonic atony
  • N31.2 Flaccid neurogenic bladder, not elsewhere classified. Neurogenic urinary bladder : atonic (motor) (sensory)
  • O62.2 Other uterine inertia: uterine under the birth
  • O72.1 Other bleeding immediately postpartum: Postpartum bleeding (atonic) without further information

In the alphabetical index of the ICD-10 there are far more entries on atony or atonic:

You can see that the term atony is widespread, but has been replaced in many cases by other terms in today's clinical medicine.

Note: If there are many digits, e.g. B. G40.3, numerous rare forms of disease are grouped under one ICD category. For others, e.g. For example, N31.2, numerous names are used for the same disease.

Classification

Atonies of the smooth, involuntary muscles

  1. Atonies of the gastrointestinal tract
    a) Esophageal atonia
    b) gastric atony, atonic dyspepsia
    c) atonic ileus , paralytic ileus
    d) atonic constipation, colon atonia
    e) Caecumatonia (not an independent clinical picture)
  2. Urological atonies
    a) Ureteral atonia
    b) bladder atony
    c) Ectasia of the pampiniform plexus , capillary vessel atony (the pampiniform plexus is a capillary plexus that supplies the testes).
  3. Gynecological atonies
    a) Atonic postpartum hemorrhage
    b) Uterine atony before delivery: in parlance usually referred to as weakness in labor .
  4. Psychogenic gastrointestinal atonia
    a) Psychogenic gastric atony
    b) Psychogenic intestinal atony
    c) Psychogenic cecumatonia

Atonies of the striated, voluntary muscles

  1. Muscle disorder
    a) Congenital atonic pseudoparalysis, floppy infant syndrome
  2. Disorders of the motor nerve tracts (other terms are used in clinical parlance today)
    a) complete paralysis: plegia
    b) partial paralysis: paresis
  3. CNS disorders
    a) Forms of epilepsy : atonic absences, atonic epileptic absences, atonic seizure, unspecific atonic epileptic seizure
    b) Atonic-astatic symptom complex: mostly the result of a lack of oxygen during childbirth ( spasticity )
  4. Sleep atony: normally prevents dreamed body movements

Gastric atony

In today's clinic, the term gastroparesis (English gastroparesis) is mostly used. The syndrome is defined as delayed gastric emptying without mechanical obstruction. The result is a feeling of fullness after meals with nausea, vomiting and belching, sometimes associated with upper abdominal pain. A common cause is diabetes mellitus.

Intestinal atony

In the case of an intestinal obstruction (ileus), a distinction is made between two fundamentally different mechanisms. The cause can be a mechanical blockage, for example by a tumor, or the intestinal contents are not transported further because the intestine is flaccid, i.e. atonic. In the first case one speaks of a mechanical ileus, in the second case of a paralytic or atonic ileus. In both cases the stomach is painfully distended. In the X-ray image, the stretched intestinal loops with liquid intestinal contents and gases show characteristic levels. With mechanical closure, the intact intestine tries to overcome the stop with violent contractions. Ringing, loud bowel noises can be heard. In intestinal atony, on the other hand, the intestinal wall has no strength to move the intestinal contents and gases further. Bowel sounds are absent or severely weakened. Intestinal atony can occur after open abdominal surgery. The intestines resent the mechanical irritation involved and respond with slackening. In most cases, the bowel will spontaneously resume its activity after a while. In severe cases, parasympathomimetics (drugs that stimulate the vegetative nervous system of the intestine) must be applied. The situation is more serious when insufficient blood flow is the cause of bowel relaxation. Parts of the intestinal wall can then die off. Only a swift operation can help the patient.

Uterine atony

Uterine atony is an acute, life-threatening complication of the postpartum period . Before delivery, blood flows from numerous vessels in the inner wall of the uterus to supply placenta and unborn babies with oxygen and nutrients. As soon as the placenta has left the uterus in the form of an afterbirth, the uterus contracts and seals off all maternal veins. If this contraction does not occur, blood is emptied in a thick gush from the uterus. Risk factors for atony are incomplete emptying of the afterbirth and overstretching of the uterus, for example due to polyhydramnios or a multiple pregnancy. Treatment is twofold. The doctor has to make the uterus contract, for example by removing the remains of placenta with curettage , manually compressing the uterus and administering medication to contract the uterus, such as ergot alkaloids . At the same time, the mother must be prevented from going into severe shock from the loss of blood . This includes the laying of several venous accesses, the rapid infusion of plasma expanders and the rapid retrieval of blood reserves .

Atonic epilepsy

Atonic epilepsy is a generalized motor epilepsy. There is a sudden loss of muscle tone, i.e. atony. The patient loses control of his or her body and is often injured if he falls. The opposite is a tonic seizure . In pseudo-Lennox syndrome there are atonic nodding attacks and also atonic-astatic seizures. The epilepsy with myoclonic-astatic crisis is also myoclonic-atonic epilepsy or Doose syndrome with the abbreviation EMAS (epilepsy with myoclonic-atonic seizures). This rare disease begins in early childhood. In two thirds of children, the disease heals after 5–6 years.

Atonic-astatic syndrome

The atonia astasia (Greek: ἡ αστασια e astasia = not maintaining a certain position or position; great restlessness of seriously ill people who constantly throw themselves around; Latin astaticus = not standing still, not standing) is a Diplegia atonica congenita (Latin: congenitus = innate). It is also called Foerster syndrome after the first person to describe it, Otfried or Otfrid Foerster . This atonic-astatic Foerster's syndrome is a form of cerebral palsy with hypotonia, i.e. a loss or decrease in tension in the entire skeletal muscles. The head loses its hold and the large joints can overstretch. Ataxia and mental development disorders are also possible . This innate or sometimes called birth trauma acquired form of infantile cerebral palsy is rare.

Sleep atonia

During sleep , muscle atony occurs in the REM (Rapid Eye Movement) phases . This is a temporary paralysis of the skeletal muscles; Movements are blocked, skeletal muscles are inhibited . One also speaks of sleep paralysis , paralysis or paralysis. It is a flaccid paralysis , which is perceived by the waking up as the opposite , as a rigidity of the body or as a feeling of paralysis. This REM atony is the result of a hyperpolarization of the α motor neurons. The physiological significance of sleep atony during REM sleep is to prevent the muscle movements of dreamed actions. Dreamed aggressive or sexual acts should not be implemented in reality. Even dreamed excretions of urine or feces are not actually carried out. Only the eye muscles are not affected by the sleep atonia. The violent eye movements during REM sleep indicate dreamed actions.

The disorder of sleep atonia is called REM sleep behavior disorder (in English RBD. REM sleep behavior disorder). Due to the inadequate sleep atony, violent body movements, thrashing and rolling, sometimes with vocalizations, occur in dream phases. REM sleep behavior disorder has been linked to changes in the brain stem, for example in chronic alcoholism. It can be an early symptom of Parkinson's disease . In manifest Parkinson's disease and other degenerative brainstem diseases such as multiple system atrophy or Lewy body dementia , REM sleep behavior disorder occurs in 25–50% of cases.

Sleep miosis also occurs in deep sleep and in a coma ; This is a constriction of the pupil as a result of a decrease in the tone (atony) of the sympathetic nervous system . Torpor occurs in some animals . This is a state of actual physical rigidity, the opposite of atony. In narcolepsy there is an imperative need to sleep ( sleep attack ), then an affective loss of tone or cataplexy ( laughing ) with hypnagogic hallucinations and then dissociated awakening or sleep paralysis .

Paralysis

The paralysis (paralysis, plegia, paresis) is defined as complete failure of the skeletal muscles . The resting tone of the affected muscles is either reduced (atony) or increased (spasticity, spasticity ). There is no absolute atony. The relative muscle atonia is here as a flaccid paralysis called, as opposed to the spastic paresis . Atonization of the spastic increase in tone can be sought in addition to physiotherapy as part of multimodal therapy with an antispastic drug ( antispastic ). Occasionally (especially in some foreign languages ) a muscle weakness is referred to as debility or subdebility (Latin: debilis = 'awkward', 'weak', 'paralyzed', 'lame', 'weak'; Latin subdebilis = 'slightly paralyzed').

Veterinary medicine

In ruminants , as a result of atony of the abomasum in the sense of a weak muscle wall, a displacement of the abomasum can occur. This applies to dairy cows and beef production as a performance disease . - Atony of the gastrointestinal tract has been described in rabbits after anesthesia .

Historical and Esoteric Concepts of Atony

An organ weakness used to be called atony in ancient Greek ; Today the Latin term insufficiency is used synonymously , i.e. renal insufficiency and heart failure . In old medical dictionaries one looks in vain for the keyword insufficiency; it is regarded as educational language and cannot be proven (in medicine) before 1800. Galenus of Pergamon (128 to 216 AD ) defined the atonia ( Middle Latin ) regardless of the respective etiology as "a relaxation of the stomach, blood vessels , arteries , muscles and the entire physical and mental nature of the organism ". Galen suspected kidney atony as the cause of diabetes mellitus . In 1847, Carl Christian Schmidt named renal atony as the cause of diabetes insipidus and described successful therapy with a diuretic .

According to Ludwig August Kraus (1844) the ancient Greek word tonos (ὁ τονος) and the synonymous Latin word tonus mean not only "the elasticity of the animal parts" ( i.e. "especially the animal fiber "), but also "the sound in music" .

Various relaxation methods are designed to reduce the tone of body, mind and soul. Such atonalizations can have a beneficial effect on excessive tension and excitement in order to increase calmness , mindfulness and wellbeing . However, it remains unclear whether, in addition to the shift from hypertension to eutonia, an additional shift from eutonia to atonia is also sought.

Relaxation procedures serve for atonalization or detonalization in the sense of a tone reduction . The Detonierung or Detonalisierung does not involve the detonation to be confused. The etymology is identical in all three words : to relax. A detonator acts as an atonator .

Non- medical practitioners see a connection between kidney failure and heart failure in cardiac atony ("The heart tone also determines the kidney tone."). Today in conventional medicine one speaks of the cardiorenal syndrome . An anomaly in the heart muscle tone , particularly in "patients with an unstable vegetative nervous system", was called cardiac atony .

See also

Web links

Wiktionary: Atony  - explanations of meanings, word origins, synonyms, translations

Individual evidence

  1. ↑ Dominik Prinz: Atony. DocCheck Flexikon, accessed on August 9, 2019 .
  2. ^ Wilhelm Dultz (Ed.): DBG foreign words dictionary. Ullstein , Frankfurt / Berlin 1965, p. 238.
  3. ↑ Lingen Lexicon in 20 volumes. Volume 1, Lingen Verlag , Cologne 1976/77, p. 245.
  4. ^ Willibald Pschyrembel: Clinical Dictionary , 267th edition, de Gruyter Verlag, Berlin, Boston 2017, ISBN 978-3-11-049497-6 , p. 179.
  5. ^ Maxim Zetkin , Herbert Schaldach: Lexikon der Medizin , 16th edition, Ullstein Medical Verlag, Wiesbaden 1999, ISBN 3-86126-126-X , p. 172.
  6. ^ Markwart Michler , Jost Benedum : Introduction to Medical Language , 2nd Edition, Springer-Verlag, Berlin, Heidelberg, New York 1981, ISBN 3-540-10667-7 , ISBN 0-387-10667-7 , pages 92, 222, 282.
  7. ↑ ICD-10-GM 2019 systematics PDF - reference version. German Institute for Medical Documentation and Information ( DIMDI ), Cologne, September 21, 2018, accessed on August 7, 2019 .
  8. ^ ICD10. Alpha-ID version 2019 EDP version TXT (CSV). German Institute for Medical Documentation and Information (DIMDI), Cologne, October 5, 2018, accessed on August 7, 2019 .
  9. ↑ M. Camilleri, M. Grover, G. Farrugia: What are the important subsets of gastroparesis ?: Subsets of gastroparesis . In: Neurogastroenterology & Motility . tape 24 , no. 7 , 2012, p. 597-603 , doi : 10.1111 / j.1365-2982.2012.01942.x .
  10. ↑ P. Bytzer, NJ Talley, M. Leemon, LJ Young, MP Jones: Prevalence of gastrointestinal symptoms associated with diabetes mellitus: a population-based adults survey of 15,000 . In: Archives of Internal Medicine . tape 161 , no. 16 , September 10, 2001, ISSN  0003-9926 , p. 1989-1996 , PMID 11525701 .
  11. ^ Robert S. Fisher: The New Classification of Seizures by the International League Against Epilepsy 2017 . In: Current Neurology and Neuroscience Reports . tape 17 , no. 6 , 2017, ISSN  1528-4042 , doi : 10.1007 / s11910-017-0758-6 ( springer.com [accessed August 10, 2019]).
  12. ↑ Shan Tang, Deb K. Pal: Dissecting the genetic basis of myoclonic-astatic epilepsy . In: Epilepsia . tape 53 , no. 8 , 2012, ISSN  1528-1167 , p. 1303-1313 , doi : 10.1111 / j.1528-1167.2012.03581.x , PMID 22780699 .
  13. ↑ Ludwig August Kraus: Critical-etymologisches medicinisches Lexikon. 3. Edition. Verlag der Deuerlich- und Dieterichschen Buchhandlung, Göttingen 1844, p. 136.
  14. ^ Lexicon of Medicine. 4th edition. Special edition, Neumann & Göbel Verlagsgesellschaft, Cologne 2005, ISBN 3-625-10768-6 , p. 132.
  15. ^ Georg-Winfried Schmidt : Guide to infant and paediatrics. In: Medicine of Today. Volume 12, 5th edition. Cologne-Mülheim 1981, Se. 451.
  16. ^ Roche Lexicon Medicine. 5th edition. Urban & Fischer, Munich / Jena 2003, ISBN 3-437-15156-8 , p. 632.
  17. ^ Gustav-Adolf von Harnack (Ed.): Pediatrics. 3. Edition. Springer-Verlag, Berlin et al. 1974, ISBN 3-540-06453-2 , p. 412.
  18. ↑ Erika von Mutius , Monika Gappa, Ernst Eber, Urs Frey (eds.): Pediatric Pneumology. 3. Edition. Springer-Verlag, Berlin / Heidelberg 2014, ISBN 978-3-642-34826-6 , p. 56.
  19. ↑ Wolfgang Greulich, Dietmar Schäfer (Ed.): Parkinson: Sleep & Breathing. Blackwell Wissenschafts-Verlag, Berlin / Vienna 2000, ISBN 3-89412-473-3 , p. 64.
  20. ↑ MA Bedard, M. Aghourian, C. Legault-Denis, RB Postuma, JP Soucy, JF Gagnon, A. Pelletier, J. Montplaisir .: Brain cholinergic alterations in idiopathic REM sleep behavior disorder: a PET imaging study with 18F-FEOBV . In: Sleep Medicine . tape 58 , 2019, p. 35–41 , doi : 10.1016 / j.sleep.2018.12.020 , PMID 31078078 (English).
  21. ^ Claudio L. Bassetti, Panagiotis Bargiotas: REM Sleep Behavior Disorder . In: Frontiers of Neurology and Neuroscience . tape 41 , 2018, ISSN  1662-2804 , p. 104-116 , doi : 10.1159 / 000478914 , PMID 29145189 .
  22. ↑ Peter Clarenbach et al. (Ed.): Schering Lexikon Schlafmedizin. MMV Medizin Verlag, Munich 1991, ISBN 3-8208-1148-6 , p. 106 f.
  23. ^ Markus Ebke: Neurological rehabilitation. In: Forum Sanitas. Issue 4/2018, pp. 27-29.
  24. ↑ Peter Reuter: Springer Clinical Dictionary 2007/2008 , 1st edition, Heidelberg 2007, ISBN 978-3-540-34601-2 , p. 159.
  25. ↑ G. Schützenhofer among others: The castration of the male rabbit. In: Veterinary practice small animals . Schattauer Verlag , issue 3/2009, p. 206.
  26. ^ German text archive : First mention ( catechism ) 1657 ( insufficientz ), second mention ( heart valve insufficiency ) 1845.
  27. ↑ Ludwig August Kraus: Critical-etymologisches medicinisches Lexikon. 3. Edition. Verlag der Deuerlich- und Dieterichschen Buchhandlung, Göttingen 1844, p. 143.
  28. ↑ Hans Schadewaldt in: Dietrich von Engelhardt (Ed.): Diabetes in medicine and cultural history. Springer, Berlin / Heidelberg 1989, ISBN 3-662-06579-7 , p. 54.
  29. ^ Carl Christian Schmidt: Yearbooks of the domestic and foreign total medicine. Volume 55, year 1847, number 1, Leipzig 1847, p. 40.
  30. ↑ Ludwig August Kraus: Critical-etymologisches medicinisches Lexikon. 3. Edition. Verlag der Deuerlich- und Dieterichschen Buchhandlung, Göttingen 1844, p. 1053.
  31. ↑ Holistic therapy according to Dr. med. Friedrich Boesser. In: Paracelsus magazine. Paracelsus alternative practitioner schools, edition 6/1997.
  32. ^ W. Arnoldi, K. Kindermann: Experimentally produced symptoms of cardiac cramps and cardiac atony in humans. In: Clinical weekly . Volume 3, number 45, November 4, 1924, pp. 2056–2057.