Gangrene
The content of the article:
- Gangrene Causes and Risk Factors
- Forms of the disease
-
Gangrene symptoms
- Dry gangrene
- Wet gangrene
- Gas gangrene
- Gangrene of internal organs
- Diagnostics
- Gangrene treatment
- Possible complications and consequences
- Forecast
- Prevention
Gangrene is a pathological process in which necrosis of parts of the body or organs occurs, a sign of which is a change in the color of necrotic tissues from bluish to dark brown or black. Gangrene can affect any organs and tissues, but most often the pathological process occurs in the distal areas. The discoloration of the affected areas is due to iron sulfide, which is formed due to the destruction of hemoglobin. Gangrene is an extremely serious disease in which there is a high probability of loss of the affected part of the body, and in the case of insufficiently fast and effective treatment and death.
Dying off of tissues with gangrene
Gangrene Causes and Risk Factors
All causes of gangrene can be divided into the following groups:
- physical and chemical factors (bedsores, extensive trauma, exposure to temperatures above 60 ° C or below -15 ° C, electric shock, acid or alkali burn, etc.);
- infectious lesion (infection with Escherichia coli, streptococci, Clostridia, Proteus, etc., which can occur with knife or gunshot wounds, crushing of tissues, as well as with minor injuries against the background of concomitant tissue nutritional deficiency);
- circulatory disorders (with cardiovascular diseases, prolonged spasm or blockage of blood vessels, vascular sclerosis, embolism, obliterating endarteritis of the lower extremities, excessively prolonged application of a tourniquet, ergot poisoning, etc.).
The factors that can affect the rate of development of gangrene and the spread of the pathological process include the anatomical and physiological characteristics of the patient's body, as well as the effect of the environment. At the same time, a more severe and rapid course of the disease is observed with depletion of the body, intoxication, anemia, vitamin deficiency, acute and chronic infectious diseases, hypothermia, metabolic disorders. The development of gangrene is influenced by the condition of the walls of blood vessels (changes that have occurred as a result of endarteritis or sclerosis), anatomical features of the vascular system, the presence or absence of infection in the affected area. The progression of necrosis can be promoted by a low or high ambient temperature.
Gas gangrene develops when infected with bacteria of the genus Clostridia. These microorganisms live in street dust, soil, water, and sewage. The risk of developing gas gangrene increases with infection of wounds that have pockets and areas of necrotic tissue, as well as insufficiently supplied tissue with blood. The endotoxins secreted by clostridia promote faster spread of infection in tissues.
Clostridial bacteria cause gas gangrene
Risk factors for the development of gangrene include: old age, surgery, childbirth, infringement of the hernial sac, allergic processes, smoking, wearing narrow rings and tight shoes (especially against the background of diabetes mellitus), long-term chronic inflammatory processes with impaired tissue trophism.
Forms of the disease
Depending on the consistency of the necrotic areas, gangrene is dry and wet.
By pathogenesis:
- lightning fast;
- hospital;
- gas.
Gas gangrene, in turn, is divided into emphysematous, edematous-toxic and mixed forms.
Depending on the cause, infectious, allergic, toxic, ischemic gangrene are isolated.
Depending on the localization of the pathological process, gangrene can occur:
- lower extremities (nail, toe, foot, leg);
- upper limbs (nail, finger, hand, arm);
- internal organs (lung, intestines, gallbladder, appendix, etc.);
- genitals (perineum, scrotum, penis, labia);
- areas of the face (noma);
- skin (bedsores);
- fetus.
Gangrene symptoms
The manifestation of certain signs of gangrene depends on the form of the disease.
Dry gangrene
Dry gangrene usually occurs in dehydrated patients as well as malnourished patients. It develops slowly, sometimes for several years. First of all, distal areas (fingers or toes, feet) are affected.
The first sign of developing gangrene is pain. At the initial stages, the pain sensations are tolerable, but gradually the intensity of the pain increases, it does not stop with ordinary analgesics. The pain is aggravated at night, while the patient assumes a forced position, in which the intensity of pain is somewhat less. Usually this is an elevated or, conversely, a lowered position of the affected limb. With the development of the pathological process due to loss of sensitivity in the area of necrosis, pain disappears, but some patients may experience phantom pain. The skin in the affected area turns pale, becomes cold to the touch, the affected limb grows numb, the pulse in the peripheral arteries is not detected. The necrotic area decreases in volume and darkens, acquiring a mummified appearance. Healthy tissues have a clear border with necrotic ones (demarcation shaft). An unpleasant smell is not characteristic of this type of disease. Dry gangrene is limited and does not extend to healthy areas with normal circulation. The patient's condition is usually stable, with the exception of cases when gangrene becomes wet.
The first sign of dry gangrene is pain.
Wet gangrene
Wet gangrene develops rapidly, due to abrupt interruption of blood supply in a certain area, often as a result of thrombosis or thromboembolism. Overweight patients are more susceptible to this form of the disease.
At the initial stages, the skin in the affected area turns pale, acquires marbling, a network of blood vessels is clearly expressed on them. The affected area swells, loses sensitivity, the pulse in the peripheral arteries disappears. Subsequently, the affected area acquires a blue-violet or green tint, increases in volume. The appearance of the affected area resembles cadaveric decomposition. Crepitation is possible when pressing on the affected area, due to the accumulation of waste products of putrefactive microorganisms (in particular, hydrogen sulfide). Decomposition products entering the general bloodstream from the affected area cause severe intoxication of the body. The general condition of a patient with wet gangrene is usually moderate to severe. The body temperature rises to febrile values, the patient has a dry mouth,tachycardia, rapid shallow breathing, lethargy, lethargy. Wet gangrene tends to spread to adjacent tissues, the demarcation shaft is not formed.
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Gas gangrene
Gas gangrene is developing rapidly. The wound becomes sharply painful, the skin becomes bluish-gray, the edges of the wound are pale, the bottom is dry. With pressure on the edges of the wound, gas bubbles appear with a characteristic putrid odor. On palpation, crepitus is determined. The general condition suffers significantly, symptoms of intoxication are expressed, and they rapidly increase, up to shock.
There are specific symptoms of gas gangrene:
- a ligature symptom - when a ligature is applied to the affected limb, after 15-20 minutes, the thread begins to cut into the skin due to rapid swelling;
- a symptom of a champagne cork - when a napkin or tampon is removed from the wound course with gas gangrene, a cotton is heard;
- a symptom of a spatula - when tapping with a medical spatula, a characteristic crisp sound appears in the affected area.
Gangrene of internal organs
The clinical picture of gangrene of internal organs depends on the localization of the process.
With gangrene of the abdominal organs, patients develop clinical manifestations of peritonitis. The body temperature rises, there is severe pain in the abdomen, the abdominal muscles become tense, nausea and vomiting appear, which does not bring relief. On palpation of the affected area, a sharp pain occurs.
Gangrene of the lung is manifested by fever, severe weakness, lethargy, increased sweating, rapid heart rate, and decreased blood pressure. Wet rales are heard in the lungs. The general condition of the patient deteriorates sharply, a cough appears with the separation of fetid sputum, which, when left standing, is divided into three parts.
With gangrene of the abdominal organs, the patient has clinical signs of peritonitis
Diagnostics
The diagnosis is usually straightforward because of the characteristic visual signs of the disease. In order to confirm it, the following methods are used:
- general blood test (there is an increase in the number of leukocytes, a decrease in erythrocytes and hemoglobin, the absence of eosinophils);
- blood chemistry;
- microscopic examination of discharge from the wound;
- cultural study of pathological discharge from the affected area;
- ultrasound duplex scanning of blood vessels;
- X-ray examination (in case of gas gangrene, intermuscular accumulations of gas in the picture look like "fir trees", this phenomenon is called Krause's symptom).
Differential diagnosis is carried out with putrid infection and fascial gas-forming phlegmon.
Gangrene treatment
Treatment of gangrene is carried out in a hospital setting and includes both general and local measures. Since gangrene is the death of tissues, the main goal of treatment is to preserve them and prevent further development of necrosis.
Patients with gangrene are shown bed rest. Conservative treatment is aimed at stimulating blood circulation, improving tissue trophism, as well as eliminating symptoms. Due to the severe pain syndrome, the use of analgesic drugs (non-narcotic or narcotic) is indicated for any form of the disease. If thrombosis is diagnosed, thrombolytics are prescribed. It may be necessary to carry out novocaine blockades, which allows to eliminate the spasm of collateral vessels, in some cases, blood transfusion is required. If necessary, bypass and stenting of blocked blood vessels are performed, as well as vascular prosthetics.
Active measures to normalize blood circulation in the affected area make it possible to preserve it with ischemic gangrene.
Novocaine blockade helps to eliminate pain syndrome in gangrene
With dry gangrene, self-amputation of the affected area may occur, in other cases, amputation is performed surgically after the formation of the demarcation shaft. The level of amputation is selected in such a way as to provide optimal conditions for the healing of the stump while preserving the function of the affected limb as much as possible. The wound is healed by primary intention. After the complete formation of the stump, limb prosthetics are possible.
With wet gangrene, excision of necrotic tissue (necrectomy) or amputation of the affected limb is indicated, which are performed on an emergency basis. After cleansing the wound, a stump is formed. The main treatment can be supplemented by a course of antibiotic therapy to eliminate the infectious agent.
Gangrene of internal organs is an indication for emergency surgery with the removal of a necrotic area or organ.
With gas gangrene, the affected limb is placed in a pressure chamber with high oxygen pressure (the method of hyperbaric oxygenation), which has a detrimental effect on anaerobic pathogens.
With gangrene of the lung, antibiotics and antiseptics are usually injected into the bronchi with a bronchoscope. Also used are drugs that expand the bronchi (inhalation or parenteral), immunomodulators, fortifying agents. Resection of a part of the lung or its amputation is indicated if there is no positive effect of drug therapy.
Possible complications and consequences
Gangrene, especially wet and gas, can spread to large areas of the body. The main complication in such cases is the loss of the affected area or organ, with a corresponding loss of function. In addition, gangrene can be complicated by secondary bacterial infection, the development of hemolytic anemia, sepsis, renal failure, intestinal obstruction, peritonitis, and other life-threatening conditions with subsequent death.
Forecast
In the absence of treatment, the prognosis for gangrene is negative.
Timely diagnosis and treatment of ischemic gangrene of the lower extremities in most cases can save the limb.
With adequate treatment of gangrene of the appendix and gallbladder, the prognosis is favorable. With gangrene of the lung, mortality is 25-30%.
The prognosis for dry gangrene is favorable for the patient's life, but unfavorable for the preservation of the affected area. Wet and gas forms of gangrene often have a fulminant course, which requires urgent surgical treatment. The forecast for life depends on how timely it will be implemented.
In patients with diabetes, the prognosis is reduced.
Prevention
Specific prevention of gangrene has not been developed.
Measures for non-specific prevention of gangrene are:
- careful wound care, prevention of wound infection;
- compensation of diabetes mellitus;
- avoidance of dangerous temperature effects;
- timely treatment of diseases of internal organs that can lead to their gangrene;
- strengthening of immunity (rejection of bad habits, balanced nutrition, sufficient physical activity, etc.).
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Anna Aksenova Medical journalist About the author
Education: 2004-2007 "First Kiev Medical College" specialty "Laboratory Diagnostics".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
