Dry gangrene

Examples of dry gangrene :

(I) Senile gangrene of lower limb
1 - predisposing factors : affect old male.
* Atherosclerosis common in old age,predispose to thrombosis.
* Weak heart stasis of blood.
* nutritional disturbances Low body resistance.
2 - Site : Starts in big toe farthest from ! heart
3 - pathogenesis :
@ arterial occlusion occur due to :
Thrombosis in atherosclerotic artery.
Spontaneously by wearing tight shoes .
! toxic products of putrefaction act as an irritant
cause a zone of acute Inflammation in ! near healthy tissue
form line of demarcation (Def : narrow red line ( ) ! healthy &
gangrenous part)


@ line of separation
= granulation tissue appear below ! line of demarcation
produces a groove w` slowly deepens to separate ! gangrenous part
leaving cone shaped stump autoamputation because !
Gangrenous process spreads more in ! skin & subcutaneous tissue
than in muscles & bone.
@ N/E:
* Early : affected part is pale & cold due to
ischemia and sensation is lost.
* Later : ! necrotic area stains red by blood
escaped from ! necrotic vessels.
* Drainage & evaporation of blood & tissue fluids
dryness of ! part becomes shrunken & mummified
* After putrefaction black area e` bad odour.
(II) Diabetic gangrene *
I t is the same as senile type Except :-
1- start at young age because in D.M there is atheroma
Followed by arterial occlusion.
2- the gangrene start dry then become wet gangrene because
hyperglycemia is a good culture medium for saprophytic bacteria.
Moist gangrene = Wet gangrene

Examples of moist gangrene :
(I) Moist gangrene of intestine*
1 - causes :
I - Infarction due to mesenteric arterial or venous occlusion
Ii - strangulation :
- Strangulated hernia
- volvulus
- intussusception.
2 - pathogenesis :
In strangulation, venous obstruction occurs first ! affected loop shows congestion
& edema. appears dark red , thick & swollen
Next arterial occlusion occurs ! loop undergoes necrosis invaded by putrefactive
bacteria from ! intestinal lumen putrefaction occurs rapidly
! loop stains black e` iron sulfide :-
@ Toxemia is severe.
@! patient suffers from acute intestinal obstruction & peritonitis.

(II) Moist gangrene of ! limb*
1 - follow severe crushing injury both artery & vein are occluded by thrombosis & hematoma
2 - occurs in diabetic patients due to high glucose level. Sub types of moist gangrene :
I) - Gas gangrene = War gangrene.
II) - Infective gangrene.
i) - Gas gangrene =War gangrene :-
a ) it is the moist gangrene of muscle occur in deep wounds contaminated
by anerobic spore in the soil.
b ) muscle necrosis occur due to trauma & anerobic pathogenic bacteria
muscle putrefaction occur due to contamination of wound by
anerobic spore anerobic saprophytes.
C ) Saprophytes are 2 type :
(1) Saccharolytic as clostridium Welchii & cl. Septicum
produce enzymes & exotoxins :-
* Lecithinase lyses ! cell membrane.
* Necrotoxin kills ! muscle Cs.
* Hyaluronidase digest ground substance


(2) Proteolytic as cl. Histolyticum
* They liquefy ! dead tissue
(necrotic tissue) producing bad odour.
* muscle become swollen, pink and stained red by
Liberated Hb due to hemolysis of RBCs by toxins
* e` bubbles of CO2 Gas emphysematous
crackling on palpation.
d ) prognosis : highly fatal due to acute hemolysis by lecithinase
severe toxemia.
* Both lead to shock.
I I ) - I nfective gangrene :
- bacteria cause both tissue necrosis & putrefaction.
- Pathogenic bacteria produce toxins tissue necrosis & thrombosis of blood vessels.
- Next saprophytic bacteria act on dead tissue putrefaction
* Examples
a - Cancrum oris : occur in cheeks of debilitated children due to
treponema vincenti
b - Acute gangrenous appendicitis
c - Gangrene of ! lung, vulva or scrotum.


Edema


Nutritional edema
Renal edema
Cardiac edema

Nephrotic Nephritic

* plasma osmotic
pressure due to
hypoproteinemia that
result from :-
a- Inadequate Ptn intake
b- formation of Ptn by
liver.
c- defect in digestion Or
absorption of protein.

* plasma osmotic
pressure due to excess
loss of albumin and
plasma protein in
urine ++
Renin angiotensin -
aldosterone mechanism
increase
reabsorption of Na &
H2o dilution of
Plasma protein.


tissue osmotic
pressure due to
Nacl retension.

* capillary
permeability.
Rt sided heart failure w` causes :
* chronic venous congestion
of kidney decrease GFR
Nacl retension in tissue
decrease tissue
osmotic pressure.
* increase capillary
hydrostatic pressure.
* increase capillary permeability.



Causes






Start in face
,eyelids then
become
Generalized not
Generalized gravational :-
affected by gravity ,it start in the
most deep part then stained
upwards E.g :

Site

Generalized Generalized

gravational. * In ampulant patient:begins
around ankle.
* In recumbent patient : begins in
sacral region.


Same. Transudate ch` by . (return to inflame.)


1 - the edematous part is swollen ,moist ,soft ,pale and heavy.
2 - Cut section drips fluid.
3 - Pitting.


Nature of
the fluid


N/E










Obstructive edema
inflammatory edema

Lymphatic edema Venous edema
1-Filariasis
2- Tumor emboli reaching
lymph vessels & L.Ns.
3- Surgical removal of L.N..

Chronic local venous congestion
:e.g
* tumor.
* Enlarged L.Ns.
*Pregnant uterus.
*Cirhosis.
*Fibrosis.
Occur in case of acute inflammation
&hypersensitivity reactions due to:-
* capillary permeability.
* capillary hydrostatic pressure.
* tissue osmotic pressure due to:
- escape of blood proteins into tissues.
- splitting of large molecules of
Tissue into smaller ones.
*obstruction of lymph drainage by fibrin.



Causes


* Lower limb.
* Scrotum.
* penis.


According to site of congestion
E.g:-
- edema of lower limb
due to pressure
of pregnant uterus.





According to site of inflammation.




Site

- intestinal edema and ascitis in
liver cirrhosis.

Lymph fluid(transudate rich in
protein)

Transudate ch` by.(return to
inflame.)

Exudate ch` by.(return to inflame.)


Nature of
fluid
1- the edematous part is
swollen ,moist ,soft ,pale and
heavy.
2-Cut section drips fluid.
3-non-Pitting.

1- the edematous part is swollen
,moist ,soft ,pale and heavy.
2-Cut section drips fluid.
3-Pitting.

1- the edematous part is swollen ,moist
,soft ,pale and heavy.
2-Cut section drips fluid.
3-non- Pitting.



N/E