Gangrene.pptx

Gangrene

1. Gangrene SYED MASOOD

2. Gangrene: It is a form of necrosis with superadded putrification (infection of dead tissue). there are 2 main types: dry gangrene wet gangrene there is a variant form of wet gangrene , called as gas gangrene .

3. Dry gangrene: It initiates from distal parts. Dry gangrene is mainly due to arterial occlusion. limited putrefaction and bacteria fail to survive. spreads slowly until it reaches the point where the blood supply is adequate . Clinical features : The affected part is dry, cold, shrunken and dark reddish black resembling  mummified  flesh. eventual falling off of the gangrenous tissue if it is not removed surgically, also called  autoamputation

4. Wet gangrene: Wet gangrene occurs in naturally moist tissue and organs such as the mouth, bowel, lungs, cervix, and vulva. It is characterized by numerous bacteria and has a poor prognosis (compared to dry gangrene) due to septicaemia . develops rapidly and is due to blockage of venous (mainly) and/or arterial blood flow. The affected part is saturated with stagnant blood, which promotes the rapid growth of bacteria. The toxic products formed by bacteria are absorbed, causing systemic manifestation of  septicaemia  and finally death. Clinical features : The affected part is oedematous , soft, putrid , rotten and dark . In wet gangrene, tissue swell and emit a fetid smell and pain is there.

5. Gas gangrene: Also called myonecrosis (destruction or death of muscle tissue) is a type of wet gangrene, which is mostly caused by bacterial infections. These bacteria are anaerobic and they produce many gasses and poisonous toxins. They inhibit the gastrointestinal, respiratory and female genital tracts, and attack a recent surgical wound. It is caused by deep wound and crushing injuries and can also be caused by frostbite, diabetes mellitus and cancer. Clinical feature : pus is brown, gas bubbles under the skin (crepitations) , skin colour -red initially ,then turns brown and black, foul odour ,high grade fever.

6. Causes Gangrene happens when a body part loses its blood supply. This may happen from injury, burn, an infection or other causes. higher risk for gangrene if : A serious injury Blood vessel disease (such as arteriosclerosis, also called hardening of the arteries, in arms or legs) Burger’s disease (thromboangitis obliterans) , Raynaud’s disease . Diabetes Suppressed immune system (for example, from HIV or chemotherapy) Surgery Severe frostbite

7. Examination: Blood test results show an increase in the number of white blood cells in persons with wet gangrene. A sample of pus is examined to identify the bacteria causing the infection. An x-ray  film may be performed to examine the affected tissue for the presence of gas bubbles. Imaging studies, including a  CT scan  and/or MRI , can help determine the extent of damage to the tissues and the amount of gas present. In people with dry gangrene, an  arteriogram may be performed to visualize any obstruction in the artery which supplies blood to the affected part.

8. Treatment: medical consists of drugs to improve circulation or surgery to bypass blocked arteries(dry gangrene) but if tissue is already dead, affected area will be removed surgically (debridement), if underlying muscle and bone are also dead, amputation will be necessary any remaining bacteria are also destroyed by antibiotics(penicillin), antiserum or hyperbaric oxygen treatment. Pain relievers , Anticoagulants (heparin) are also given .

9. Physiotherapy : Those who do undergo excision of the gangrene may require  physical  and  occupational therapy prior to discharge from the hospital in order to increase endurance. Physical therapy typically includes learning to care for the residual limb performing stretches weight-bearing exercises to increase mobility.

10. Physiotherapy: toes amputed relearn the mechanics of walking as a result of decreased stability. Individuals learn to walk with a cane or may require a prosthesis that fits over the foot to increase stability .

11. In foot or lower limb amputation: Individuals begin walking in a set of parallel bars and then advance to skills such as walking and negotiating stairs. Some individuals may require a cane or crutches to increase stability, even with the prosthetic limb. Others, such as individuals in poor overall health or those who have had an above-knee amputation, may require a wheelchair for mobility. 

12. One or more fingers amputed:  may require occupational therapy to relearn tasks such as writing, grasping objects, and dressing . Those who lose part of an arm: learn to bear weight through the residual limb using exercises such as wall push-ups that allow more functional return to the residual limb. Individuals use the grasping mechanisms of a prosthetic arm to perform activities such as dressing and driving .

13. Above elbow amputation : In this case, an individual attends occupational therapy to learn how to compensate for the amputated limb by relearning to perform daily tasks with one hand. Individuals with an amputation of the dominant hand relearn handwriting tasks with the nondominant hand.

14. Complications of gangrene: Blood poisoning. Shock. DIC (disseminated intravascular coagulation), a blood-clotting disorder. Limb amputation to prevent death.

15. Prevention: Gangrene may be prevented if it is treated before the tissue damage is irreversible. Wounds should be treated properly and watched carefully for signs of infection (such as spreading redness, swelling, or drainage) or failure to heal. People with diabetes or blood vessel disease should routinely examine their feet for any signs of injury, infection, or change in skin colour and seek care as needed .

16. Prognosis: Usually curable in the early stages with antibiotic treatment and surgery to remove dead tissue. Without treatment, gangrene may lead to fatal infection