NECROSIS - a lifetime necrosis (or death) of cells, organs and tissues under the influence of different pathogenic factors.

Morphogenesis necrosis consists of several stages: 1) paranecrosis dystrophy, with the reversible nature .. 2) necrobiosis, irreversible degenerative changes, characterized by a predominance of catabolic processes in the cell over anabolic. 3) The death of the cell-cell completes its operation, its morphology is preserved. 4) autolysis process of destruction and samoperevarivaniya cells under the action of hydrolytic enzymes or dying cells under the action of proteolytic enzymes, inflammatory infiltrate cells (leukocytes and macrophages). Microscopic signs of necrosis is a change in the nucleus and cytoplasm of cells. Characteristic changes in the nucleus is kariopiknoz, karyorhexis and kariolizis. Kariopiknoz-condensation of chromatin and shrinkage of the nucleus, resulting in hyperchromatic nuclei observed by light microscopy. Karyorhexis-fragmentation or disintegration of the nucleus in clumps Kariolizis-complete dissolution of the nucleus (ie the disappearance of the contours and basophilia of the nucleus).These changes in the nucleus are associated with activation of hydrolases (ribonuclease and deoxyribonucleases). In the cyto plasma occur: Denaturation and coagulation of proteins, Plazmoreksis decay in the cytoplasm clumps Plazmolizis-dissolution of organelles. Depending on the reason that causes necrosis, distinguish five types of necrosis: traumaticoptical, toxic, trofonevrotichesky, allergic and vascular necrosis. Traumatic necrosis is the result of direct action on the fabric of physical factors (such as the effect of low and high temperature, vibration, radiation, electricity) and chemical agents (acids, alkalis). Toxic necrosis develops when exposed to toxins, bacteria and tissue of a different nature. Trofonevrotichesky necrosis due to impaired circulation and innervation of the tissue in diseases of the peripheral and central nervous system (bed sores). Allergic necrosis is the result of immune destruction of tissue in the immediate hypersensitivity reactions and delayed-type (Arthus phenomenon). Vascular necrosis is associated with absolute or relative deficiency of circulation in the arteries, veins and lymph vessels.The most common form of vascular necrosis caused by disturbance of blood flow in arteries thrombosis, embolism, prolonged spasm, as well as funktsionavlnoy overload the body during hypoxia. Vascular necrosis occurs in many diseases (atherosclerosis, hypertension, thromboembolic complications, as in cardiovascular diseases and rheumatic diseases (vasculitis, bacterial endocarditis, rheumatic, etc.) Mechanism of action of the pathogenic factor distinguished: direct and indirect my death. Direct necrosis caused by direct effects on the fabric of the pathogenic factor (traumatic, toxic necrosis) Necrosis caused by indirect effects on the fabric of the pathogenic factor indirectly through blood vessels and nerves (vascular, trofonevrotichesky, allergic necrosis). On clinical and morphological forms of release: 1) coagulation necrosis;

2) kollikvatsionny necrosis; 3) gangrene; 4) sequestration; 5) Institute farkt. Coagulation necrosis develops in the low activity of hydrolytic enzymes with high protein and low levels of fluid in the tissues.Coagulation necrosis at the dead areas of tissue gray-yellow, firm, dry (dry necrosis). Examples of dry necrosis are GUT erysipelatous (cheesy) necrosis in tuberculosis, fibrinoid necrosis in allergic and autoimmune diseases, waxy (Zenker's) necrosis of the muscles in the abdominal and typhus. Kollikvatsionny necrosis develops in the tissues of the rich liquid with a high activity of hydrolytic enzymes. For kollikvatsionnogo necrosis is characterized by a melt tion of dead tissue (wet necrosis). These are the foci of softening and melting races, such as brain or spinal cord. Gangrene, tissue necrosis, which are in contact with the external environment, and it with necrosis becoming gray-brown or black. There are three types of gangrene: dry, wet and bedsore.In dry gangrene mummified tissue. On the border with the intact living tissue is clearly defined zone demarcation of inflammation.Dry gangrene occurs in the extremities. Wet gangrene develops in the tissues under the action of putrefactive bacteria. Tissue swelling, swollen publishes a fetid smell, the zone demarcation of inflammation is not defined. Wet gangrene occurs in the lungs, intestine, uterus, in debilitated children on the skin of cheeks and crotch (noma). Bedsore is trofonevrotichesky necrosis occurs in areas of maximum pressure in debilitated patients suffering from cardiovascular, neurological and oncological diseases. Sequestration site, dead tissue, which is not subject to autolysis, and is not replaced by connective tissue, and is free of living tissues. Sequesters are usually purulent inflammation and may be removed by forming fistulous passages. Sequestration is usually exposed to the bone, but in rare cases may occur in soft tissues. Infarction - a vascular necrosis (ischemic). Causes of heart attack: thrombosis, embolism, prolonged spasm and functional overstrain of the body under conditions of hypoxia. Heart attacks are distinguished by shape and color. The form of a heart attack depends on angioarchitectonics body and can be tapered and irregular. The wedge shape is characteristic of a heart attack with the main type of branching vessels (spleen, kidneys, lungs).Irregular shape of a heart attack occurs in bodies with loose or mixed type of branching vessels (myocardium, brain). By the color of a heart attack may be white (spleen, brain), white with a hemorrhagic rim (heart, kidney) and red (lungs, liver). Hemorrhagic halo formed by the zone demarcation of inflammation. Apoptosis - a natural and genetically zapragrammirovannaya cell death in vivo. Apoptosis occurs in physiological conditions, as a sign of aging and cell death with their elimination and subsequent physiological regeneration. In one situation with a balance of proliferation and apoptosis is provided by a stable state of the body (for example, the body is constantly going on the death of erythrocytes, T and B lymphocytes and their replacement by a new formed elements of blood, and is constantly dying off of the epithelium of the skin, mucous membranes of the epithelium and its regeneriratsiya), in other situations with a predominance of cell proliferation over apoptosis is provided by the growth of the organism (there is a young growing organism), and third situations - with the prevalence of apoptosis over proliferation of developing atrophy of tissues and organs (eg, during embryogenesis, involution occurs by apoptosis and Mller Volfova ducts, interdigital webbing, the formation

of the lumen in the abdominal organs, and aging of the organism in case of cancellation of the endocrine organs are incentives age involution of the thymus, endometrial and prostate gland, mammary gland after cessation of lactation. Differences between apoptosis and necrosis: 1) necrosis may seize territory from the cell to the whole organ, apoptosis only applies to individual cells or groups of them. 2) necrosis condensation of chromatin and then swelling of the cells with subsequent activation of hydrolytic enzymes and destruction of cytoplasmic structures and the nucleus. The nucleus during apoptosis is not lysed as necrosis, is wrinkling cells. In the cytoplasm of cells during apoptosis is not activated by hydrolytic enzymes and all the organelles remain intact for a long time. The cell splits into apoptotic bodies (particles with a core part of the organelles). Apoptotic cells rapidly undergo phagocytosis parenchymal and stromal cells. 3) around the necrotic zone is always a zone of demarcation inflammation, but not apoptotic cells around a zone of demarcation inflammation. Blood disorders - and lymph There are three groups of circulatory disorders: 1) violation of blood circulation organ, tissue, and 2) a violation of the permeability of blood vessels, and 3) violation of state and the flow of blood. Violation of blood flow. Distinguished: 1) plethora (arterial and venous) and 2) anemia. Arterial hyperemia (redness) - this increased blood flow to body tissues due to the increased inflow of arterial blood. May be general and local. Depending on the causative factor are the following types of arterial congestion: 1) angioedema (neyroparaliticheskaya) - occurs when the nervous disorders; 2) collateral, appears in connection with obstruction of blood flow on the main arterial trunks; 3) after ischemia-hyperemia develops in the elimination of factors that compressing an artery (tumor, ligation, liquid, etc.); 4) vakatnaya congestion occurs, due to the decrease in barometric pressure; 5) The inflammatory hyperemia occurs in the area of inflammation due to paretic vasodilatation; 6) congestion on the background of arteriovenous shunt-develops in a vein on admission arterial blood through the shunt into the vein. Venous hyperemia is increased blood supply to an organ or tissue due to obstructed outflow of blood, blood flow is not disrupted. Venous stasis leads to expansion of veins and capillaries, slowing blood flow in them, which leads to the development of hypoxia and increased permeability of the capillary basement membrane. Venous hyperemia may be general and local, acute and chronic. Acute total venous plethora developing acute cardiovascular failure. The causes of acute cardiovascular failure are: macrofocal myocardial infarction, thromboembolism of large pulmonary artery branches, cardiac tamponade, acute diffuse myocarditis. Acute venous stasis morphologically expressed: plazmorragicheskimi edematous, hemorrhagic and necrotic changes in tissues and organs. Chronic venous plethora developing common chronic cardiovascular disease, when taking chronic hypoxia. Causes of chronic cardiovascular disease are many heart disease: defects, coronary artery disease, cardiomyopathy, myocarditis, GB etc. For long-term maintenance of hypoxia in the tissues and organs develop: edema, hemorrhagic, necrotic changes, sclerosis of the stroma and atrophy of the parenchyma organs.

For chronic venous plethora characterized by widespread swelling of subcutaneous tissue, anasarca, and accumulation of fluid in the cavities: in the pleural cavity, hydrothorax, in the pericardial cavity, gidroperikard in the abdomen, ascites. Bodies increase in volume, become cyanotic, and dense. Among the important morphological features of chronic venous plethora distinguished: brown induration of lungs, liver, nutmeg, tsianoticheskuyu induration kidneys and spleen. Brown induration of light-light and compact look Boers. In the morphogenesis of brown induration of the lungs plays a major role marked hypoxia. Due to increasing hypoxia increases vascular permeability, there are multiple diapedetic hemorrhage.As a result, the alveoli, interalveolar septa, bronchi, lymph vessels and nodes accumulates a lot of sideroblasts and siderofagov containing hemosiderin, and as free hemosiderin. Develops diffuse hemosiderosis. Hypoxia also stimulates the activity of fibroblasts that synthesize collagen fibers, thickening of interalveolar septa develops and pulmonary fibrosis (thickening or induration of the lungs). Muscat liver venous stasis was named as reminiscent of nutmeg: A dense, mottled gray on the cut-yellow with dark red Crapo.Microscopic examination shows that the full-fledged central parts of the lobules and in the context they appear dark red, as there are marked hemorrhage, destruction of hepatocytes and multiple sclerosis. At the periphery of the lobules hepatocytes are in a state of fatty degeneration, which explains the gray-yellow liver tissue. Tsianoticheskaya induration kidneys - kidneys become large, dense, and cyanotic. Especially full-blooded veins of the brain substance. In an increasingly hypoxia develops atrophy nefrotsitov, sclerosis of the glomerular capillaries and renal sclerosis of the stroma. Tsianoticheskaya induration of spleen-spleen increased (up to splenomegaly), dense, dark cherry color. Marked atrophy of the follicles and sclerosis of the pulp. Local've noznoe plethora develops when obstruction or compression of the veins, it can occur in a single organ (eg liver), part of the body (finite sion). The changes do not differ from those that occur in the general venous plethora. Anemia (ischemia), this decrease in blood supply to the body, body parts, as a result of insufficient blood flow. It may be acute or chronic. In acute anemia, dystrophic and necrotic changes in tissues and in chronic parenchymal atrophy, sclerosis of the stroma cells and body. Depending on the causes and conditions distinguish the following types of anemia: 1) angiospastic-is due to spasm of the arteries; 2) obstructive, caused by the closure of the arterial lumen thrombus or embolus; 3) compression-compression of the arteries in the tumor, effusion, bundle, the ligature; 4) anemia due to blood redistribution (eg, anemia of the brain by removing fluid from the peritoneal or pleural cavities, which directs most of the blood). Among the violations of the permeability of blood vessels produce bleeding, hemorrhage, plazmorragiyu. Bleeding (hemorrhage) - is the output of blood from the lumen of a blood vessel or heart cavity to the environment (external bleeding) or in the cavity of the body (internal bleeding). Hemorrhage-bleeding type in which blood accumulates in the tissues. Types of bleeding: 1), hematoma accumulation of coagulated blood in the tissues of the violation of its integrity and the formation of the band, 2) hemorrhagic impregnation-hemorrhage while preserving the tissue elements, 3) bruising (ecchymosis) - junction of hemorrhage,

4), small petechiae petechial hemorrhages on the skin and mucous membranes. The causes of bleeding: rupture of the vessel wall, erosion of the vessel wall, increased permeability of vascular wall with the development of diapedesis of red blood cells (hemorrhage occurs dipedeznoe microvascular). Outcomes of hemorrhage: resorption of blood formation rusty cysts (due to hemosiderin), encapsulation, and germination of connective tissue hematoma, infection and suppuration of accession. Plazmorragiya is out of the plasma from the bloodstream, is a manifestation of increased vascular permeability. The consequence is plazmorragii plasmatic impregnation, ie, plasma saturation of the vessel wall and surrounding tissue, resulting in vessel wall becomes thickened, homogeneous, may develop in the outcome of fibrinoid necrosis and hyalinosis of vessels. Among the violations of state and blood flow is isolated: stasis, thrombosis, embolism. Stasis - it stops the blood flow in the vessels of the microvasculature (capillaries, venules). In the occurrence of stasis are important changes in the rheological properties of blood and the development of sludge-phenomenon (the adhesion of erythrocytes, leukocytes and platelets to each other and increase blood viscosity, which leads to disruption of blood flow through the vessels of the microvasculature). Factors contributing to the development of sludge-phenomenon: 1) increase the permeability of the capillaries with the development of plazmorragii 2) violation of the physico-chemical properties of red blood cells, and 3) increase in blood viscosity in the accumulation of protein in her coarse, and 4) failure of blood circulation (venous plethora), and 5) ischaemia. Thrombosis - blood clotting in vivo in the lumen of blood vessels or heart cavities. The resulting roll blood in this case is called Trom bong. Depending on the structure and the appearance of distinguished white, red nye, mixed (composite) and hyaline thrombi. White blood clot - consists mainly of blood cells (platelets), is localized in the arteries and heart cavities, formed slowly with rapid blood flow. Red thrombus, contains a large number of red blood cells, is formed quickly by slow blood flow, is localized in the veins. Mixed thrombus-represented elements of white and red blood clot can develop in the arteries of the heart cavities and veins. In mixed thrombus isolated head, body and tail. The head is represented by white thrombus, is soldered to the vessel wall and blood flow naprvlena always. The body of thrombosis white-red (mixed thrombus), the tail is represented in red thrombus. Hyaline thrombi, usually multiple, localized in the vessels of the microvasculature.