GANGRENE AND EMBOLISM

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GANGRENE AND EMBOLISM
HOW TO TEACH

• Dr.S.S. HIREMATH
• PROFESSOR HEAD
• DEPARTMENT OF PATHOLOGY
• J.J.M.MEDICAL COLLEGE,
• DAVANGERE

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GANGRENE

• INTRODUCTION
• DEFINITION
• CLINICAL SIGNS
• CLINICAL TYPES
• AETIOLOGICAL TYPES
• VARIETIES OF GANGRENE

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INTRODUCTION

• Gangrene does not represent a distinctive pattern
  of cell death, - term is still commonly used in
  surgical clinical practice.
• (GRAO TO GNAW)
• Tissues undergo ischemic cell death and
  coagulation necrosis modified by the liquefactive
  action of the bacteria and lecuocytes.

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DEFINITION

• Gangrene is defined as massive necrosis of
  tissue, superadded by putrefaction

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CLINICAL SIGNS

• Loss of temperature
• Loss of pulsation
• Loss of sensation
• Loss of function
• Change of colour pale, bluish, purplish and
  finally black colour.

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CLINICAL TYPES
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AETIOLOGICAL TYPES

• I) Primary
• Gas gangrene
• Meleneys postoperative synergistic gangrene
• Noma
• Fourniers gangrene
• Puerperal gangrene
• Boil, carbuncle

• II) Secondary
• Raynauds disease
• Ergot alkaloids
• Senile
• TAO
• Embolism
• Diabetes mellitus

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GAS GANGRENE

• It is rapidly spreading mosit gangrene,
  characterised by oedematous myonecrosis due to
  pathogenic clostridia Cl.Welchii.
• Incubation period 7 hours to 7 days.
• Clinical Toxemia, Oedema and tenderness.
• Toxins Alpha toxin (Lecithinase C).
• Types
• Subcutaneous type
• Local type
• Group type
• Massive type

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MELENEYS POSTOPERATIVE SYNERGISTIC GANGRENE

• Rare complication after laparotomy for a
  perforated viscus (perforated appendicitis), gall
  bladder operations and after drainage of empyema
  thoracis.
• It is due to synergistic action of
  microaerophilic nonhemolytic streptococci and
  staphylococci.

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NOMA

• Noma is a gangrenous lesion of vulva or mouth
  (cancrum oris) occurring usually in malnourished
  children after an infectious disease such as
  measles.
• It is a slowly but relentlessly spreading
  condition and causes great tissue destruction.

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• Fourniers gangrene is a fulminating lesion of
  scrotum, which is usually completely destroyed,
  so that the testes are left exposed.
• Puerperal gangrene Organisms concerned include
  anaerobic streptococci and bacteroides
  (Fusobacterium fusiforme) often found along with
  Borrelia Vincenti (Fusospirochaetal gangrene).

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• BOIL (Furuncle)
• Infection of a hair follicle or sebaceous gland
  by staphylococcus aureus.
• Extends into subcutaneous tissue infective
  gangrene.
• CARBUNCLE
• More extensive
• Associated with diabetes mellitus
• Common in back, nape of neck and shoulders.
• Purulent discharge through several openings on
  the skin.

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RAYNAUDS DISEASE

• Young women
• Symmetrically affected upper limbs especially
  fingers (thumb escaping).
• Series of attacks
• Local syncope
• Local asphyxia
• Recovery
• Followed by local gangrene
• Pulse remains unaffected
• Troublesome sweating is a common feature.

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ERGOT ALKALOIDS

• Cause vasospasm
• Extremities and sometimes the nose and ears are
  affected.
• Causes
• Eating rye bread infected with claviceps purpurea
• Migraine sufferers
• Postpartum hemorrhage.

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SENILE GANGRENE

• Elderly person above 50 years
• Lower limbs commonly involved
• Gangrene is preceded by intermittent claudication
  and marked coldness of feet.
• Dry gangrene due to arteriosclerosis.

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THROMBO-ANGIITIS OBLITERANS (TAO)

• Men below 40 years
• Occurs in lower limb first on one side and then
  both sides
• Pain on exertion ? intermittent claudication ?
  Rest pain.
• Postural changes affect the colour of limb.
• Recurring superficial phlebitis.
• Pulse becomes feeble and gradually dry gangrene
  supervenes in the foot.

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EMBOLIC GANGRENE

• Onset is sudden with agonising pain radiating
  down the course of the artery.
• Distal to the occlusion, the limb is cold and
  numb. It is either blue or white.
• Superficial veins are empty.

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DIABETIC GANGRENE

• Usually moist gangrene
• Factors
• Arteriosclerosis impairing circulation
• Peripheral neuritis
• Infection.

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OTHERS

• Cardiovascular diseases Syphilis, Cervical rib.
• Nerve diseases
• Traumatic gangrene
• Physical gangrene frost bite, radiation, bed
  sores.
• Misclelaneous Ainhum.

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