Ramos, Alyssa Rose B.

September 23, 2019

BSMLS 1 – LAB

RICKETS
Definition:

Rickets is a childhood bone disorder where bones soften and become prone to
fractures and deformity. It is rare in industrialized nations, but common in some
developing countries. Rickets occurs relatively commonly in the Middle East, Africa, and
Asia. It is generally uncommon in the United States and Europe, except among
certain minority groups. It begins in childhood, typically between the ages of 3 and 18
months old. Rates of disease are equal in males and females. Cases of what is believed
to have been rickets have been described since the 1st century, and the condition was
widespread in the Roman Empire. The disease was common into the 20th century.

Causes:
The main cause of rickets is a lack of vitamin D. Also, not consuming
enough calcium can cause rickets, as may vomiting and diarrhea. Certain complications
of digestive disorders can also cause rickets. Hypophosphatemic rickets is a rare genetic
fault that prevents the kidneys from processing phosphates properly. Low levels of
phosphate in the blood lead to weak and soft bones. Some kidney, liver, and intestinal
diseases can interfere with the way the body absorbs and metabolizes minerals and
vitamins, resulting in rickets.

Diagnostic Test:
The diagnosis of rickets is achieved through blood tests. These tests measure the
levels of calcium and phosphorus. Levels of alkaline phosphatase may also be high.
Arterial blood gases tests check how acidic the blood is. X-rays may reveal calcium loss
in bones, or alterations in the structure or shape of the bones. Bone biopsy can confirm
rickets but is rarely used. Physical symptoms of rickets, such as bowed legs or a soft
skull, will also be checked. However, these are not reliable enough to use on their own.
A positive indication of rickets from one of the above tests is also required for a rickets
diagnosis.

Signs and Symptoms:

Sign and symptoms include:

• bowed legs
• stunted growth
• bone pain
 • large forehead
• trouble sleeping
• floppiness in the limbs of an infant
• bone pain and bone tenderness
• bones break easily
• costochondral swelling, or prominent knobs on the bone between the ribs
and the breast plate
• Harrison's groove, which is a horizontal line visible on the chest where the
diaphragm attaches to the ribs
• low levels of calcium in the blood
• knock knees in older children
• a soft skull
• short height and low weight
• possible spinal, pelvic, or cranial deformities
• bowed legs in toddlers
• uncontrolled muscle spasms that can affect the entire body
• widening wrists
• complications may include bone fractures, muscle spasms, an abnormally
curved spine, or intellectual disability

Treatment:
The treatment of rickets focuses on increasing the patient's intake of calcium,
phosphates, and vitamin D. This may involve exposure to sunlight, consuming fish oils,
and ergocalciferol or cholecalciferol, which are both forms of Vitamin D. Exposure to UVB
light and consuming calcium and phosphorus is usually enough to reverse or prevent
rickets. If rickets is caused by a poor diet, the patient should be given daily calcium and
vitamin D supplements and an annual vitamin D injection, as well as being encouraged
to eat vitamin-D-rich foods. When treating rickets that has a genetic cause, the patient
will be prescribed phosphorus medications and active vitamin D hormones. If rickets has
an underlying medical cause, such as kidney disease, that disease will need to be treated
and controlled. Early treatments included the use of cod liver oil.

Management:

Ensuring adequate intake, vitamin D is both a nutrient and a hormone. Infants up

to age 12 months require 400 international units (IU) daily of vitamin D; children and
adolescents require 600 IU daily.

In the U.S., many foods are fortified with vitamin D, including milk, orange juice,
cereals and yogurt. One cup of vitamin D fortified milk provides 100-125 IU. Oily fish also
are a good source; 3 ounces of salmon provide 447 IU, according to the National Institutes
of Health, infants who are exclusively breastfed or receive less than 1 liter of formula
daily should be supplemented with 400 IU of vitamin D daily, starting in the first few days
of life and continuing until they are 12 months of age. Older children often are notoriously
unpredictable eaters and may require supplemental vitamin D. Most multivitamins provide
300-600 IU per serving.

Vitamin D also can be synthesized by the skin through ultraviolet (UV) light
exposure. However, multiple factors affect the magnitude of UV rays that reach the skin,
including latitude, time of day, season, cloudiness and air pollution. Due to the
unpredictability of sun exposure, as well as the increased risk of skin cancer with UV
exposure, consumption of vitamin D through diet is the most dependable way to ensure
adequate intake.

Prevention:

Rickets can be prevented by consuming enough vitamin D. Estimating the exact

amount vitamin D needs of each human is difficult because it is hard to measure how
much of the vitamin is synthesized in the skin via sunlight. In countries that are not near
the tropics and sunlight intensity is lower, it is important to provide a supplementary intake
of vitamin D to prevent rickets. This may involve enriching milk, foods for infants, and
some other food products, the administration of a daily vitamin D supplement, massive
doses of vitamin D when it is impossible for socioeconomic reasons to provide a vitamin
supplement. In areas with a lot of sunlight, the best way to prevent rickets is to expose
the child to the sun. While exposure to sunlight is a good source of vitamin D, it is
important not to overdo it - excess sunlight exposure can lead to sunburn and
eventually skin cancer.

MYONECROSIS
Definition:
Gangrene is the death of body tissue. Clostridial myonecrosis, a type of gas
gangrene, is a fast-spreading and potentially life-threatening form of gangrene caused by
a bacterial infection from Clostridium bacteria. The infection causes toxins to form in the
tissues, cells, and blood vessels of the body. These bacteria will release toxins that cause
tissue death and release a gas. It can affect any part of the body but typically starts in the
toes, feet, fingers and hands or the extremities.
Most gangrene infections occur in situations where open wounds from an injury or
surgery are exposed to bacteria. Non-traumatic gas gangrene, a rarer form of gas
gangrene, can develop when blood flow to body tissues is compromised and bacteria
gets inside. There is a greater risk in people who have a peripheral vascular
disease, atherosclerosis, or diabetes mellitus.

Causes:
 Gas gangrene is caused by exotoxin-producing Clostridium species which are
mostly found in soil, and other anaerobes (Bacteroides and anaerobic streptococci). The
exotoxin is commonly found in C. perfringens type A strain and is known as alpha toxin.
This alpha toxin is a lethal toxin and also known as phospholipase C (lecithinase). It
increases vascular permeability and produces necrotizing activity. These environmental
bacteria may enter the muscle through a wound and go on to proliferate in necrotic tissue
and secrete powerful toxins. These toxins destroy nearby tissue, generating gas at the
same time.

In some cases, it may be caused by group A Streptococcus bacteria. The infection

occurs suddenly and spreads quickly. Gas gangrene generally develops at a recent
surgical or injury site. In rare cases, it may happen spontaneously, without an apparent
cause.

Certain injuries have a higher risk of causing gas gangrene, including:

• muscle injuries
• severely damaged tissues
• wounds that are very deep
• wounds that are contaminated with stool or dirt, especially those that might occur
on a farm
You are also at an increased risk for developing this condition if you have:
• diabetes
• arterial disease
• colon cancer
• frostbite
• open fractures
• used a contaminated needle to inject substances into your muscles

Diagnostic Test:
Your doctor can diagnose gas gangrene by performing a physical examination and
ordering various tests. Diagnostic testing may include:

• skin culture to test for the presence of Clostridium perfringens and other bacteria
• blood tests to check for an abnormally high white blood cell count, which can
indicate an infection
• imaging tests, such as a routine X-ray, to visualize tissues and check for the
presence of gas or special studies such as magnetic resonance imaging (MRI) or
arteriogram
• surgery to evaluate the spread of gas gangrene within the body

Signs and Symptoms:

Symptoms of gas gangrene often include:

• fever
• air under the skin
 • pain in the area around a wound
• swelling in the area around a wound
• pale skin that quickly turns gray, dark red, purple, or black
• blisters with foul-smelling discharge
• excessive sweating
• increased heart rate
• vomiting
• yellow skin and eyes (jaundice) is a late sign

Treatment:

Treatment for gas gangrene must begin immediately. Once a diagnosis is made,
high doses of antibiotics will be administered intravenously, or through a vein. For more
serious cases, it may be necessary to begin treatment before diagnostic tests are even
performed. Dead or infected tissue will need to be surgically removed right away. Your
doctor may also try to repair damaged blood vessels to boost blood flow to the affected
area. Damaged tissues can also be treated with a type of reconstructive surgery called a
skin graft. During a skin graft, your doctor will remove healthy skin from an unaffected
part of your body and attach it over the damaged area. This can help restore any skin
damage caused by gas gangrene.

In severe cases of gas gangrene, amputation of a limb may be necessary to

prevent the infection from spreading to the rest of your body. Once your wound has
healed, you may be fitted with a prosthetic limb. This is an artificial limb that may be
attached to the amputation site to replace the missing body part. Some doctors and
hospitals use hyperbaric oxygen therapy to treat gas gangrene. This type of therapy
involves breathing pure oxygen in a pressurized chamber for about 90 minutes. You may
receive two to three treatments per day. Hyperbaric oxygen therapy steadily increases
the amount of oxygen in your blood, helping infected wounds to heal faster.

Management:

Although Gangrene can be managed by its symptomatic treatment, yet it is also

necessary to diagnose and treat the underlying cause. The symptomatic treatment is as
follows:

• Infections are usually treated with antibiotics.

• Debridement is the surgical removal of the dead tissue that results from
gangrene.
• Vascular surgery can be used to restore the blood flow either by Angioplasty or
Bypass surgery.
✓ Angioplasty – Where a tiny balloon is placed into a narrow, or blocked,
artery and is inflated to open up the vessel. A small metal tube, known as a
stent, may also be inserted into the artery to prevent it from getting closed.
 ✓ Bypass surgery – Where the surgeon redirects the flow of blood and
bypasses the blockage by connecting (grafting) one of the veins to a healthy
part of an artery.
• Hyperbaric oxygen therapy is an alternative treatment for some forms of
gangrene is hyperbaric oxygen therapy. As part of the therapy, a specially
designed chamber that also contains a plastic hood filled with pure oxygen, is
filled with pressurized air. The plastic hood is then placed over the damaged body
part.

Prevention:
The best way to prevent gas gangrene is to practice proper hygiene. If you have
an injury, make sure to clean the skin thoroughly and to cover the wound with a bandage.
Contact your doctor at the first signs of infection. Signs of infection include redness,
swelling, pain, and discharge. Your doctor will remove any foreign objects and dead tissue
from the wound. It’s also important to take any prescribed antibiotics according to your
doctor’s instructions. This will help lower your risk of developing an infection.

Making certain lifestyle changes can also help reduce your risk for gas gangrene.
These include:

• avoiding tobacco products

• properly caring for any existing health conditions, such as diabetes or arterial
disease
• maintaining a healthy weight by exercising regularly and eating a healthful diet that
largely consists of lean protein, vegetables, and whole grains
REFERENCES:

James, William D.; Berger, Timothy G.; et al. (2006). Andrews' Diseases of the Skin:
clinical Dermatology. Saunders Elsevier. p. 269.

Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume
Set. St. Louis: Mosby.

Jerrold B. Leikin; Frank P. Paloucek, eds. (2008). "Clostridium perfringens

Poisoning", Poisoning and Toxicology Handbook (4th ed.), Informa, pp. 892–893.

Pailler JL, Labeeu F (1986). "[Gas gangrene: a military disease?]". Acta Chir. Belg. (in
French). 86 (2): 63–71.

Hatheway CL (January 1990). "Toxigenic clostridia" (PDF). Clin. Microbiol. Rev. 3 (1):
66–98.

Healthline (2019). Retrieved from https://www.healthline.com/health/gas-gangrene

Medicine Net (2019). Retrieved from https://emedicine.medscape.com/article/985510-

medication.

AIMU (2019). Retrieved from https://www.aimu.us/2017/08/30/gangrene-symptoms-

causes-diagnosis-and-management/.