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Dr Aisha
Tabassum.
Gangrene
A form of necrosis of tissue with superadded
putrefaction.
Necrotizing inflammation provoked by virulent
bacteria
Dry gangrene
Wet gangrene
Gas gangrene
Dry gangrene
Begins in distal part of limb due to ischemia
Eg:dry gangrene of toe and foot in elderly people
due to atherosclerosis
Others;TAO,Raynauds disease,trauma,ergot
poisoning.
Starts in the toe farthest from blood supply
Spreads upwards untill the point of adequate
blood supply
Line of seperation is present
Dry gangrene
Wet gangrene
Occurs in naturally moist tissue;bowel,mouth
cervix,vulva,lung
Others : diabetic foot,bed sores in bed ridden
patient
Develops rapidly due to venous obstruction,less
commonly arterial
Effected part stuffed with blood,favours rapid
growth of putrifying bacteria
Lacks clear cut line of demarcation
Wet gangrene
S.NO
FEATURE
SITE
COMMONLY
LIMBS
MORE COMMON
IN BOWEL
2.
MECHANISMS
ARTERIAL
OCCLUSION
VENOUS OBSTR.
MORE COMMON
3.
MACROSCOPY
ORGAN,DRY,
SHRUNKEN,
BLACK
MOIST,SOFT,
SWOLLEN
4.
PUTREFACTION
LITTLE
MARKED
5.
LINE OF
DEMARCATION
PRESENT
NO CLEAR LINE
6.
BACTERIA
FAIL TO SURVIVE
NUMEROUS
7.
PROGNOSIS
BETTER
POOR
Gas gangrene
A form of wet gangrene
Caused by gas forming clostridia
Gain entry into the tissue through open wounds ;
muscles,colonic surgery
Toxins produce necrosis and edema
Morphology
Cell shrinkage
Chromatin condensation
Formation of cytoplasmic blebs and apoptotic
bodies
Phagocytosis of apoptotic cells or cell
bodies,usually by macrophages
Ultrastructural features :
some nuclear fragments with peripheral crescents
of compacted chromatin and others are uniformly
dense
Mechanisms of apoptosis
INITIATION PHASE
The extrinsic ( death-receptor-initiated) pathway
The intrinsic (mitochondrial) pathway
EXECUTION PHASE
REMOVAL OF DEAD CELLS
Extrinsic pathway
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