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Gangrene

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Submitted By dragonintl
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Gangrene is a term that is used to identify when a large amount of tissue undergoes cell death (necrosis). Gangrene essentially means death of tissues due to lack of blood supply and invasion of deeper tissues with infection (Porth & Gaspard, 2015). There are two main classifications of gangrene, dry type and wet or moist type (Porth & Gaspard, 2015). There are several other types of gangrene that are rarer, however, all types of gangrene manifest either as dry or wet form (Porth & Gaspard, 2015).
Dry gangrene, the part becomes dry and shrinks, the skin wrinkles, and its color changes to dark brown or black (Porth & Gaspard, 2015). Dry gangrene is usually characterized by cold, painless and dry and shriveled up affected part. There is surrounding healthy skin. The area affected is said to appear mummified. The spread of dry gangrene is slow. The irritation caused by the dead tissue produces a line of inflammatory reaction line of separation between the dead tissue of the gangrenous area and the healthy tissue (Porth & Gaspard, 2015). Dry gangrene usually results from interference with arterial blood supply to a part without interference with venous return and is a form of coagulation necrosis (Porth & Gaspard, 2015).
In dry gangrene there is obstruction or slowing of blood flow into the organ or part of the body that is affected. Peripheral parts like toes, fingers, tip of the nose, earlobes etc. are commonly involved. Dry gangrene is usually seen in patients of type 1 and type 2 diabetes. In both types of diabetes long term high blood sugar damages the small arteries and blood vessels that supply the end parts of the body like fingers and toes. This leads to obstruction and slowing of blood flow and ultimately gangrene (Porth & Gaspard, 2015).
Wet gangrene, is discoloured or black usually with acute and excruciating pain the area is cold, swollen, and pulseless (Porth & Gaspard, 2015). As infection is associated with release of discharge and pus, it is known as “wet”. Blebs form on the surface, liquefaction occurs, and a foul odor is caused by bacterial infection (Porth & Gaspard, 2015). There are black blisters and foul-smelling pus beneath the thinned skin at the area. There is no line of separation between the normal and unhealthy tissues, and the spread of tissue damage is fast. Systemic symptoms are usually severe, and death may occur unless the condition can be arrested (Porth & Gaspard, 2015).
Wet gangrene occurs when infection and bacteria invade deeper tissues after injuries, frost bites, foot ulcers or burns. There is excessive swelling of the affected part due to release of the toxins from the invading bacteria (Porth & Gaspard, 2015). This leads to blockage of the blood supply and worsening of the infection as the fighter cells of the body (white blood cells) cannot reach the area affected via blood vessels.
Dry gangrene is confined almost exclusively to the extremities, but moist gangrene may affect the internal organs or the extremities. If bacteria invade the necrotic tissue, dry gangrene may be converted to wet gangrene. Wet gangrene can spread much quicker than dry gangrene and may lead to life-threatening complications like septic shock if not treated immediately.
The last type of gangrene is gas gangrene it is a special type of gangrene that results from infection of devitalized tissues by one of several Clostridium bacteria, most commonly Clostridium perfringens (Porth & Gaspard, 2015). These anaerobic and spore-forming organisms are widespread in nature, particularly in soil; gas gangrene is prone to occur in trauma and compound fractures in which dirt and debris are embedded. Some species have been isolated in the stomach, gallbladder, intestine, vagina, and skin of healthy persons. The bacteria produce toxins that dissolve cell membranes, causing death of muscle cells, massive spreading edema, hemolysis of red blood cells, hemolytic anemia, hemoglobinuria, and renal failure. Characteristic of this disorder are the bubbles of hydrogen sulfide gas that form in the muscle. Gas gangrene is a serious and potentially fatal disease. Antibiotics are used to treat the infection and surgical methods are used to remove the infected tissue. Amputation may be required to prevent spreading (Porth & Gaspard, 2015).

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