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Necrosis (from the Greek νεκρός «dead."), Or necrosis - a pathological process, expressed in local death of tissue in vivo as a result of any of exogenous or endogenous her injuries. Necrosis appears in the swelling, denaturation and coagulation of cytoplasmic proteins, destruction of cellular organelles and finally, the entire cell. The most frequent causes of necrotic tissue damage are: loss of blood supply (which may lead to infarction, gangrene) and impact pathogenic bacteria or virus products (toxins, proteins that cause a hypersensitivity reaction, et al.).
- Direct (toxic, traumatic)
- Indirect (allergic, ischemic, trofonevrotichesky)
Cause tissue death can be immediate destruction of any agent (physical or chemical), as well as consequential changes: allergic reactions, nervous disorders and blood circulation.
The effect on tissue temperature above 60 ° or below -15 ° leads to their rapid destruction, necrosis (burns, frostbite). Strong acids, coagulating proteins the cells to cause coagulation necrosis of dry; strong alkalis, dissolving the proteins and fats are saponified, lead to the development liquefactive necrosis tissues (chemical burns). Microbial toxins also can lead to necrosis of cells, tissues, e.g., (gas gangrene of extremities, gangrenous appendicitis et al.).
Zenker (waxy) necrosis - dry necrosis of muscle, wherein the pockets have a gray-yellow color with greasy luster (similarity with wax). Observed in typhoid, typhus, trauma, convulsive states.
Disseminated necrosis Girgolava - initial phase gangrene in severe frostbite; characterized by a separate, yet not fused together necrosis sites scattered (disseminated) in tissues.
Marantichesky necrosis - develops from a long compression compression of the tissue. Especially pronounced in malnourished patients, in which he goes to bed sores.
Gummatozny necrosis - occurs as a result of syphilis. Gunma - granulemnoe education, often on the face, caused by tissue reaction to the spirochete. Necrotic center surrounded by so-called demarcation inflammation in the heart gummas - shapeless mass of tissue melts.
Organization - the replacement of connective tissue necrosis.
Petrification - substitution necrosis calcium salts.
Ossification - the replacement of necrotic bone.
Autoamputation (amputation Spontaneous) - rejection of tissue.
Necrosis - WHAT IT IS, AND TYPES OF STAGE DRUG ...
The causes of tissue necrosis
Before treating dangerous disease, it is important to know what factors it is provoked. Mostly death of tissue begins due to circulatory disorders. In some cases, necrosis develops due to diabetes mellitus, major damage nerves, spinal cord injuries. The following are other possible causes tissue disintegration:
- Physical necroses developed under the influence on the organism low or high temperature, radiation, electric current, multiple trauma, gunshot wounds and the like.
- Biological tissue necrosis appear under the influence of bacteria and viruses.
- Allergic necrosis occurs due to infectious diseases, provoked by certain stimuli, causing fibrinoid tissue damage.
- Toxic necrosis appear under the influence of toxic agents on the patient's body.
- Vascular necrosis (infarction) occurs when blood circulation in the tissues and internal organs.
- Trophic dying provoke sores and open wounds. Developing a state after blood microcirculation disorders or process innervation (organs due to central nervous system).
Types of tissue necrosis
To evaluate the nature of the pathology and prescribe the right treatment, you need to determine the type of necrotic damage. Illness are classified according to clinical, etiological and morphological characteristics. Belonging to a group depends on the conditions of disease development, the characteristics of the affected tissue. The following types of necrosis:
- Dry (coagulation) affects structures rich protein (spleen, kidney, liver). It is characterized by dehydration seal. This type includes cheesy (tvorogoobraznye), Zenker (waxy), fibrinoid lesions, necrosis of adipose tissue.
- Wet (kollikvatsionny) affects the structure of rich moisture (spinal or brain). The illness develops due to autolytic disintegration provoking thinning.
- Myocardial develops because of a sudden complete or partial circulatory disorders bodies process.
- Bedsores are local lesions due to circulatory disorders caused by the constant compression.
- Gangrene develops when tissue contact with the external environment. At the place of localization is subdivided into a gas, dry and wet. It is characterized by swelling, crepitus, depending on the specific type.
- Sequestration - necrotic portion structure (mostly bone), which is not subjected to autolysis (self-dissolution).
The origin of the pathological condition is also important. On this parameter dying tissue is divided into the following types:
- Traumatic (primary or secondary) - developed under the influence of the pathogenic agent enters the number of direct necrosis.
- Ischemic occur due to problems with the peripheral circulation, thrombosis, low oxygen content in the blood vessel occlusion.
- Allergic belong to the group of indirect necrotic lesions. There is this type of disease because of the individual reactions to stimuli.
- Toxigenic developed under the influence of toxic substances of various kinds.
- Trofonevroticheskie lesions appear due to malfunction of the central or peripheral nervous system, provoke nervous disorders of the skin or internal organs.
Start irreversible dying structures of the body is characterized by tingling, numbness in the legs or arms, loss of sensation in the affected area. In addition, the skin of the patient becomes pale, brilliant. Over time, due to the cessation of circulation it becomes cyanotic first, later dark green and even black. If necrotic lesions caused by poisoning, the general health of the patient may deteriorate, the nervous system is exhausted. In addition, the patient has fatigue.
In time to take action, you need to pay attention to the first signs of the disease. The main symptoms of skin withering away, bones or internal organs are as follows:
- loss of sensation;
- flushing of the skin;
- cold in the extremities;
- a change of respiratory rhythm;
- general weakness;
- permanent increase in body temperature;
- loss of appetite;
- trophic ulcers;
- increase in heart rate.
By their nature, necrotic lesions are terrible disease. The disease has several stages, each of which has its own characteristic features. Below are the stage of development of the pathological condition:
- Paranecrosis (or agony cells). At this stage the dying process is reversible, subject to a proper treatment. Timely medical care can prevent complications.
- Necrobiosis. In this step, the process of destruction has become irreversible. When necrobiosis tissue metabolism is disrupted, the new healthy cells are not formed.
- Extinction. If apoptosis is a natural, genetically caused the death, the death of the cell, in this case takes place under the influence of pathogenic factors and has negative consequences for the organism.
- Autolysis. At this stage, there is a complete decomposition of the dead body structures. The process starts at the expense of enzymes secreted by dead cells.
To provide expert assistance to the patient and the time to begin treatment, it is important to determine where the necrotic tissue and what is the scale of the problem. For these purposes, the following methods are used in medical diagnostics:
- CT scan;
- Magnetic resonance imaging;
- radioisotope scanning.
Presented kinds of research can help determine the exact localization of the lesion, its size, characteristics. Due to detect characteristic changes, and forms the disease stage, an accurate diagnosis can physicians prescribe the effective treatment of the patient. Superficial necrotic lesions do not present difficulties for diagnosis. These include gangrene of the limbs and so on. Development of the disease is determined by the complaints of the patient, presence of bluish or green color on the affected area.
tissue necrosis Treatment
Timely diagnosis and identification of the causes of necrosis are important components of a successful therapy. This disease requires immediate patient rooms in the hospital. Drug-induced tissue necrosis therapy is usually aimed at the restoration of blood flow . If necessary, detoxification therapy can be carried out, administered antibiotics. In severe cases, the patient is sent to the operation.
skin necrosis in the early stages can be treated at home. To this end, the following efficacy of traditional medicine:
- trays of fruit chestnut;
- ash oak;
- ointment with lard
- slaked lime.
dry necrosis Therapy
Depending on the type of disease therapy may vary. Dry necrosis treated in two stages. Drying the first conductive tissues, the restoration of blood circulation and preventing the further spread of the disease. The area around the affected area is treated with antiseptic necrosis. After decontamination portion it bandage soaked in Boric acid, ethyl alcohol or chlorhexidine. During the first stage of treatment the diseased tissue necrosis dried. To do this, they are treated with a solution of potassium permanganate or green paint.
The second step is performed excision of nonviable tissue. Depending on the extent of the necrotic lesion patient can cut the foot or make a resection of the phalanx. All actions must be aimed at the restoration of blood circulation in the affected organs. In addition, it is important to eliminate the cause, to provoke disorder. To avoid bacterial contamination of necrotic tissue patient is prescribed antibiotics. Otherwise, the potential for serious complications, including death.
wet necrosis therapy
In the cases of wet type necrotic lesions treatment is given to the extent of organ damage. This type of pathological condition is more dangerous to humans. Physicians initially try to translate wet necrosis discharge dried. The early stages of the disease make it possible to do this. If you change the necrosis discharge does not succeed, then the patient is sent to the operation.
Local treatment with a pathological condition is based on washing the wounds with a solution of hydrogen peroxide (3%). Necessarily performed an autopsy pockets and streaks, drainage applied in different ways. It is important to constantly make a bandage on the affected area with antiseptic. For this purpose, suitable boric acid Furatsilinom, Chlorhexidine. Another measure is the local treatment of immobilization (superimposition of plaster Longuet).
In wet necrosis patients additionally assigned common treatment. It includes several different methods:
- Antibiotic therapy. In this case, the patient receives intravenous antibiotics.
- Vascular therapy. A measure aimed at restoring blood flow process in the affected areas of necrosis.
- Detoxification therapy. During treatment, it is important to prevent infection and necrosis of living healthy cells, and what the measure is.
Some types of the disease can not be cured by conventional means (wet necrosis of the soft tissue, etc.). In order to save the patient's life, in this case the operation is prescribed. Surgery involves several steps:
- Preoperative preparation. This step includes infusion therapy, antibiotics and topical decontamination of tissue.
- Operation. Step procedure involves removal of necrosis in the area of viable tissue. Doctors, aware of the possibility of the spread of pathogenic agents, prefer to "high" amputation, in which excised the affected areas together with a part of healthy structures.
- The postoperative period. If necrosis ended operation, the patient should be referred for rehabilitation. Support in this case requires not only physical but also psychological.