Gangrene pathophysiology: Difference between revisions
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{{CMG}}{{AE}} [[User:Edzelco|Edzel Lorraine Co, D.M.D., M.D.]] | {{CMG}}{{AE}} [[User:Edzelco|Edzel Lorraine Co, D.M.D., M.D.]] | ||
==Overview== | ==Overview== | ||
There are three types of [[gangrene]] and they have different pathophysiology. | |||
A reduced [[arterial]] [[perfusion]] is observed in [[dry gangrene]] which results in the compensatory [[arteriolar dilation]] , which eventually results in [[distal]] [[edema]], and damage of the [[endothelial tissue]]. <ref name="pmid32809387">{{cite journal| author=| title=StatPearls | journal= | year= 2022 | volume= | issue= | pages= | pmid=32809387 | doi= | pmc= | url= }} </ref> [[Saprogenic]] [[microorganisms]] such as ''[[Clostridium perfringens]]'' and ''[[Bacillus fusiformis]]'' are the most common organisms observed in [[wet gangrene]] which are responsible for infecting the [[tissues]], thereby producing a putrid smell and [[edema]]. <ref name="pmid29910628">{{cite journal| author=Al Wahbi A| title=Autoamputation of diabetic toe with dry gangrene: a myth or a fact? | journal=Diabetes Metab Syndr Obes | year= 2018 | volume= 11 | issue= | pages= 255-264 | pmid=29910628 | doi=10.2147/DMSO.S164199 | pmc=5987754 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29910628 }} </ref> ''[[Group A Steptococcus]]'' and [[exotoxins]] from ''[[Clostridium perfringens]]'' are responsible for the local and [[systemic infection]] found in [[gas gangrene]].<ref name="pmid1884064">{{cite journal| author=Lehner PJ, Powell H| title=Gas gangrene. | journal=BMJ | year= 1991 | volume= 303 | issue= 6796 | pages= 240-2 | pmid=1884064 | doi=10.1136/bmj.303.6796.240 | pmc=1670510 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1884064 }} </ref> | |||
==Pathophysiology== | ==Pathophysiology== | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Edzel Lorraine Co, D.M.D., M.D.
Overview
There are three types of gangrene and they have different pathophysiology. A reduced arterial perfusion is observed in dry gangrene which results in the compensatory arteriolar dilation , which eventually results in distal edema, and damage of the endothelial tissue. [1] Saprogenic microorganisms such as Clostridium perfringens and Bacillus fusiformis are the most common organisms observed in wet gangrene which are responsible for infecting the tissues, thereby producing a putrid smell and edema. [2] Group A Steptococcus and exotoxins from Clostridium perfringens are responsible for the local and systemic infection found in gas gangrene.[3]
Pathophysiology
The three main types of gangrene occur in different mechanisms.
Dry Gangrene
- Dry gangrene involves a reduction in the perfusion of the arteries results in the compensatory dilation of the arterioles, which eventually results in distal edema, and damage of the endothelial tissue.[1]
- It is an example of coagulative necrosis occurring in an ischemic tissue. Closing
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Wet Gangrene
- In wet gangrene, saprogenic microorganisms (Bacillus fusiformis, or Clostridium perfringens) infect the tissues, thereby causing an emission of a foul odor and edema. [2]
- The accumulation and pooling of blood in the affected part promotes proliferation of bacteria.
- An edematous, putrid, soft and dark tissue is observed.[2]
Gas Gangrene
- Multiplication of exotoxins from Clostridium perfringens and group A steptococcus is responsible for the local tissue destruction and systemic infection in gas gangrene.[3]
- Alpha-toxin is a Clostridium- lecithinase produced by Clostridium perfringens that contributes to tissue necrosis and systemic hemolysis.[4][5]
- Progression of this condition to shock is very rapid.
References
- ↑ 1.0 1.1 "StatPearls". 2022. PMID 32809387 Check
|pmid=value (help). - ↑ 2.0 2.1 2.2 Al Wahbi A (2018). "Autoamputation of diabetic toe with dry gangrene: a myth or a fact?". Diabetes Metab Syndr Obes. 11: 255–264. doi:10.2147/DMSO.S164199. PMC 5987754. PMID 29910628.
- ↑ 3.0 3.1 Lehner PJ, Powell H (1991). "Gas gangrene". BMJ. 303 (6796): 240–2. doi:10.1136/bmj.303.6796.240. PMC 1670510. PMID 1884064.
- ↑ Yang Z, Hu J, Qu Y, Sun F, Leng X, Li H; et al. (2015). "Interventions for treating gas gangrene". Cochrane Database Syst Rev (12): CD010577. doi:10.1002/14651858.CD010577.pub2. PMC 8652263 Check
|pmc=value (help). PMID 26631369. - ↑ Sakurai J, Nagahama M, Oda M (2004). "Clostridium perfringens alpha-toxin: characterization and mode of action". J Biochem. 136 (5): 569–74. doi:10.1093/jb/mvh161. PMID 15632295.