In this essay we will discuss about the Scurvy:- 1. Meaning of Scurvy 2. Clinical Features of Scurvy 3. Diagnosis 4. Treatment 5. Prevention.
Contents:
- Essay on the Meaning of Scurvy
- Essay on the Clinical Features of Scurvy
- Essay on the Diagnosis of Scurvy
- Essay on the Treatment of Scurvy
- Essay on the Prevention of Scurvy
Essay # 1. Meaning of Scurvy:
Scurvy is a nutritional disease which results from prolonged subsistence on diets practically devoid of fresh fruit and vegetables. Lack of ascorbic acid causes a disturbance in the structure of connective tissue, leading to swollen, bleeding gums, and haemorrhages into the skin and elsewhere.
Essay # 2. Clinical Features of Scurvy:
a. The gums are swollen, particularly in the region of the papillae between the teeth, sometimes producing the appearance of ‘scurvy buds’. These may be so extensive that they project beyond the biting surface of the teeth and almost completely conceal them. The spongy gums are livid in colour and bleed on the slightest touch. There is always some infection.
b. The first sign of cutaneous bleeding is often to be found on the lower thighs, just above the knees. These haemorrhages are perifollicular- tiny points of bleeding around the orifice of a hair follicle. The condition in scurvy can be distinguished by its appearance from the follicular keratosis sometimes associated with Vitamin A deficiency.
In the latter condition there is usually a horny plug of keratin projecting from the orifice of the hair follicle. In scurvy there is a heaping up of keratin-like material on the surface around the mouth of the follicle, through which a deformed ‘cockscrew’ hair characteristically projects.
Perifollicular haemorrhages may appear on the buttocks, abdomen, legs and arms. African patients often present with pain in a leg due to haemorrhage into inter-muscular septa in the thigh or calf.
c. Anaemia is present in most patients. In patients the bone narrow may be normoblastic or megaloblastic and associated deficiency of iron or folate is often responsible, but there may be other unidentified factors. Destruction of erythrocytes in muscle haematomata may lead to bilirubinaemia and mild jaundice.
d. Osteoporosis may occur in scurvy, since ascorbic acid is necessary for the synthesis of collagen in all parts of the body, including the bones.
e. Haemorrhages into any of the internal organs may occur and a patient dies suddenly and without warning, apparently from cardiac failure.
f. There is scurvy in infants. Until the teeth have erupted, scorbutic infants do not develop gingivitis. When this occurs, the gums have the classical appearance of ‘scurvy buds’. The first sign of bleeding is usually a large sub-periosteal haemorrhage immediately overlying one of the long bones-frequently the femur-producing the characteristic ‘frog legs’ position.
This gives rise to intense pain, especially on movement. The infant may cry continuously and agonizingly, and scream even louder when lifted.
Essay # 3. Diagnosis of Scurvy:
a. The inflamed rim of the gums is bright red in colour, in contrast to the cyanotic appearance in scurvy, and there is usually much less swelling. In Vincent’s angina the gums are acutely inflamed, ulcerated and painful, but the bright red appearance of the lesions is distinctive.
Poisoning with heavy metals, particularly lead and mercury, produces a gingivitis in which the gum margin is stained blue; but there is usually little swelling and the appearance is easily distinguished from scurvy. Phenytoin, a drug used in epilepsy, may cause marked swelling of the gums, but they preserve their normal colour and do not bleed.
b. Scurvy in infants and children may sometimes be mistaken for rheumatic fever or osteomyelitis, because of the pain caused by a sub-periosteal haemorrhage. The refusal of the child to use one leg may cause the disease to be mistaken for poliomyelitis.
c. Blood ascorbic acid can easily be determined. If the concentration of ascorbic acid in blood is low, it is a sure case of scurvy.
Essay # 4. Treatment of Scurvy:
a. Adequate amounts of synthetic ascorbic acid should be given at once because of the danger of sudden death. The vitamin is very soluble and quickly absorbed from the digestive tract. It can be given intravenously, but a large part of it is immediately lost in the urine.
It is the aim to saturate the body with ascorbic acid. The fully saturated body contains about 5 grams of the vitamin. Therefore, a dose of 250 mg by mouth four times daily should achieve this within a week, despite some loss in the urine.
b. Scurvy arises among people far removed from supplies of synthetic ascorbic acid (e.g., among prisoners of war) ; in such conditions valuable therapeutic effects are obtained by the use of natural sources of the vitamin, such as fresh fruit and vegetables.
c. In case of anemic patient ferrous sulfate and folate tablets should be given by mouth.
d. With adequate and immediate treatment no patient dies of scurvy, but if it is delayed he may die.
Essay # 5. Prevention of Scurvy:
a. Scurvy generally occurs at the two extremes of age. The prevention of scurvy in infants has been accomplished by the better education of mothers and helped by the distribution of cheap, concentrated orange juice of standard ascorbic acid content.
For old people living alone, the provision of proper meals is the best means of preventing scurvy. This should be the responsibility of their family. If there are no relations, responsibility falls on the social services. In cases where an old person is unwilling to eat foods containing the vitamin, he should be given ascorbic acid tablets.
b. In cases of persons who travel in barren lands or make long sea voyages, they should be given ascorbic acid tablets to carry along with them.
c. In times of drought and famine, when fresh vegetables are not available, ascorbic acid can be obtained by the germination of pulses or cereals. 30 grams of dried pulse on germination yields 9 to 15 mg ascorbic acid which is sufficient to prevent scurvy.