Gangrene is a term that refers to the death of body tissue due to diminishment or loss of blood supply, leading to nutrient and oxygen deprivation. There are three major types of gangrene: moist, dry, and gas gangrene. Although gangrene usually affects extremities, it can sometimes affect the internal organs.
Moist gangrene is generally caused by a sudden stoppage of blood floe to a body site, usually resulting from burning by heat or by acid, from severe freezing, from a physical accident that destroys the tissues, from keeping a tourniquet in place too long, or from a blood clot or other blockage. The tissue death that results form loss of blood supply is accompanied by decomposition due to bacterial action. The gangrenous rapidly as toxins (poisons) are formed in the affected tissues and absorbed.
Dry gangrene usually occurs gradually and results from a slow, progressive reduction of blood flow in the arteries. There is generally no bacterial decomposition; the tissues simply become dry and shriveled. This type of gangrene occurs only in the extremities. It may occur as a secondary effect of arteriosclerosis in the elderly, of advanced stages of diabetes, or of Buerger’s disease (an inflammatory condition tha affects the blood vessels of the limbs, primarily the legs).
Gas gangrene is often caused by infection of a wound by anaerobic (able to live without air) bacteria, which are commonly found in soil. It can follow rapidly after contamination of deep wounds. The bacteria break down tissues, giving off gas and toxic by-products.
Gangrene in an internal organ can be caused by any condition that cut off blood supply to an area. For example, if a loop of intestine is caught in an opening in the abdominal wall, the blood supply to that part of the intestine may be cut off (causing what is called a strangulated hernia), and gangrene may the occur in that section of the tissue. In acute appendicitis, areas of gangrene may occur in the walls of the appendix, with rupture of the appendix through the gangrenous area. In severe cholecystitis (inflammation of the gallbladder, usually associated with gallstones), gangrene can develop in areas where the stones compress the mucous membrane, cutting off the blood supply.
Moist gangrene is characterized by a purplish-red, bruised appearance; by swelling; and, often, by blisters.
Dry gangrene is marked by gradual shrinking of the tissues, which first grow cold and lack a pulse, then turn brown, then black. Usually there is a sharp line of demarcation where the gangrene stops because the unaffected tissue nearby is continuing to receive blood. This type of gangrene is sometimes called mummification of tissue because of the dry, shriveled, and dark appearance.
The initial symptoms of gas gangrene are swelling, paleness of skin, and thin, bloody (but not foul) discharge. The characteristic foul smell comes later in progression of this form of the disorder. It is an acute, painful condition in which the muscles and tissues under the skin become filled with gas and a thin, brownish-black fluid.
Symptoms of gangrene in an internal organ may include pain, tenderness over the organ, and fever.
The appearance of the affected area usually suggests the diagnosis to the physician. Laboratory analysis of a tissue specimen will allow the identification of the ineffective microorganism, which is necessary for selection of an appropriate antibiotic. Areas of gas gangrene may be seen on X-ray.
Treatment of gangrene generally involves cleaning of the area and administration of antibiotics. The effectiveness of antibiotic therapy seems to depend on the time elapsed between injury or infection and the beginning of treatment.
In the case of gangrene caused by deterioration in the blood supply of the elderly or gangrene associated with appendicitis, hernia, diabetes, or Buerger’s disease, the treatment begins with the diagnosis and treatment of the underlying condition.
Preventing gangrene in an open wound begins with cleanliness. All dirt and particles in an open wound should be removed as soon as possible, and the wound should be cleansed with a soap solution and water. Burned skin requires careful, antiseptic handling to avoid infection. Frostbite also is dangerous because freezing impairs the circulation of the skin, making it tender and easily damaged. Frostbitten skin, especially on the fingers, toes, and earlobes, must be handled with great care.
(Chasnoff, Ira J, Jeffrey W. Ellis, Zachary S. Fainman. Family Medical & Health Guide .Publications International, LTD (1991) : 179-181.
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