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Wybroczyny i trudności w gojeniu ran objawami szkorbutu

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Szkorbut to choroba wielonarządowa rozwijająca się wskutek niedoboru witaminy C. W jej przebiegu dochodzi m.in. do samoistnych krwawień i patologicznych złamań. Na szkorbut szczególnie narażone są osoby cierpiące na chorobę Leśniowskiego-Crohna i zaburzenia odżywiania.

W epoce wielkich odkryć geograficznych, między XV a XVII w., szkorbut, nazywany gnilcem, był powszechną chorobą wśród marynarzy. Obecnie szkorbut występuje głównie w krajach o niskim poziomie gospodarczym. Można jednak zachorować na niego niezależnie od statusu majątkowego czy miejsca zamieszkania – czynnikami ryzyka są niektóre schorzenia, metody leczenia czy prowadzony styl życia.

Za co odpowiada witamina C?

Witamina C, czyli kwas askorbinowy, jest kluczowa dla wytwarzania kolagenu. Kolagen odpowiada m.in. za elastyczność skóry, nawilżenie i ruchomość stawów, regulację ciśnienia krwi oraz prawidłową budowę naczyń krwionośnych i kości. Odgrywa również ważną rolę w procesie krzepnięcia krwi, gojenia ran czy zrastania kości.

Spowodowane niedoborem witaminy C zaburzenia syntezy kolagenu skutkują osłabieniem ścian naczyń krwionośnych, ścięgien, mięśni i stawów, zwiększoną wrażliwością na urazy i tendencją do występowania samoistnych krwawień oraz złamań patologicznych.

Deficyt witaminy C powoduje także zaburzenia wchłaniania żelaza i prowadzi do osłabienia układu odpornościowego oraz spowolnienia metabolizmu cholesterolu.

Jak rozpoznać objawy szkorbutu?

Objawy ogólne szkorbutu

Początkowe objawy szkorbutu to zmęczenie, osłabienie, problemy ze snem, zmniejszenie masy ciała, apatia i ból kończyn, zwłaszcza nóg. W pierwszym stadium choroby szkorbut bardzo często mylnie diagnozowany jest jako przeziębienie lub przemęczenie.

Zmiany skórne związane ze szkorbutem

Wraz z rozwojem choroby pojawiają się charakterystyczne zmiany skórne. Wokół mieszków włosowych tworzą się fioletowo-czerwone plamy. Włosy stają się łamliwe i skręcone. Na skórze pojawiają się także rozległe wybroczyny będące konsekwencją pękania osłabionych naczyń krwionośnych. Skóra staje się sucha, szorstka i wrażliwa na podrażnienia.

Trudności z gojeniem ran spowodowane szkorbutem

Kolejnym objawem szkorbutu jest wydłużony czas gojenia ran. W związku z obniżoną odpornością u osób chorych na szkorbut często dochodzi do zakażeń i może rozwinąć się sepsa.

Choroby dziąseł spowodowane szkorbutem

Na dziąsłach mogą pojawić się zmiany zapalno-martwicze. Dziąsła stają się obrzęknięte i mogą samoistnie krwawić. Wraz z postępem choroby dochodzi także do wypadania zdrowych zębów.

Objawy ze strony układu mięśniowo-szkieletowego

W przebiegu szkorbutu pojawia się opuchlizna i sztywność stawów, co utrudnia poruszanie się i powoduje ból. Osłabienie kości skutkuje natomiast złamaniami patologicznymi.

Objawy w obrębie oczu wywołane szkorbutem

Chory może uskarżać się na suchość i podrażnienie oczu. Często występują także nadwrażliwość na światło i zaburzenia widzenia. Może dojść również do krwotoków podspojówkowych i śródgałkowych.

Anemia spowodowana szkorbutem

U większości osób cierpiących na szkorbut rozwija się anemia. Niedokrwistość rozwija się na skutek zaburzeń w metabolizmie żelaza i kwasu foliowego oraz krwawień do przewodu pokarmowego. Anemia powoduje trudności w gojeniu ran, bladość, przewlekłe zmęczenie, depresję i zwiększoną podatność na infekcje.

Objawy kardiologiczne i neurologiczne związane ze szkorbutem

Szkorbut powoduje również problemy kardiologiczne, takie jak niskie ciśnienie tętnicze, spłycenie oddechu i ból w klatce piersiowej. Nieleczony szkorbut może doprowadzić do rozwoju neuropatii.

W jaki sposób leczy się szkorbut?

Terapia szkorbutu polega na jak najszybszym uzupełnieniu niedoboru witaminy C. W tym celu urozmaica się dietę o takie produkty jak m.in. owoce cytrusowe, czarna porzeczka, truskawki, dzika róża, pomidory, kiszona kapusta, brukselka, papryka czy jarmuż.

Witaminę C można przyjmować także w postaci suplementu. Wcześniej jednak warto skonsultować się z lekarzem w celu ustalenia odpowiedniej dawki. Nadmiar kwasu askorbinowego powoduje m.in. nudności, wymioty i wysypkę skórną. Optymalna dawka jest uzależniona od wieku, płci i stanu zdrowia. Szacuje się, że dzienne zapotrzebowanie na witaminę C u dorosłego człowieka to 1 mg/kg masy ciała, a u dziecka około 2 mg/kg masy ciała na dobę.

Jeżeli suplementacja witaminy C zostanie rozpoczęta po wystąpieniu pierwszych objawów, leczenie szkorbutu zwykle zajmuje od kilku dni do dwóch tygodni.

W przypadku zaawansowanego szkorbutu konieczne mogą okazać się dożylne wlewy witaminowe. Należy także wdrożyć leczenie objawowe.

Kto jest narażony na szkorbut?

Szkorbut w przeważającej liczbie przypadków jest konsekwencją niedożywienia. Może być ono spowodowane brakiem zbilansowanej diety lub niewłaściwym przygotowywaniem pożywienia (witamina C ulega zniszczeniu pod wpływem zbyt długiego gotowania).

Niedobory witaminowe często są efektem restrykcyjnych diet stosowanych ze względu na alergie pokarmowe lub w celu zmniejszenia masy ciała. Mogą być też wynikiem alkoholizmu, narkomanii czy zaburzeń odżywiania, m.in. bulimii czy anoreksji. Do obniżenia poziomu witaminy C przyczynia się także palenie papierosów.

Na deficyty składników odżywczych narażone są zwłaszcza osoby w podeszłym wieku oraz niemowlęta. Przypadki szkorbutu odnotowuje się wśród dzieci karmionych pasteryzowanym mlekiem butelkowym. Podczas procesu pasteryzacji dochodzi do zniszczenia witaminy C. Chociaż jest dodawana do preparatów mlecznych, pod wpływem obróbki chemicznej może ulec rozkładowi.

Ryzyko wystąpienia szkorbutu jest oprócz tego szczególnie wysokie wśród osób cierpiących na schorzenia zaburzające wchłanianie składników odżywczych. Dotyczy to m.in. choroby Leśniowskiego-Crohna, nieswoistego zapalenia jelit, ostrej dyspepsji, celiakii czy wrodzonych niedoborów enzymów trawiennych. Szkorbut może być też następstwem przewlekłej niestrawności.

Na deficyty witaminowe narażeni są także pacjenci w trakcie chemioterapii i radioterapii oraz osoby dializowane.

Źródło: who.int

 

Przeczytaj także: Badanie: jaka dzienna dawka witaminy C jest potrzebna do prawidłowego formowania blizn?

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