Cell Injury- Gangrene

Dr. Meena Patil

 Cellular adaptations
 Etiology of cell injury
 Mechanisms of cell injury
 Cell Injury- Reversible
 - Irreversible
 Reversible injury-Definition
 - Mechanism
 - Types
 Irreversible injury- Necrosis- Definition
 -Mechanism
 - Types
 -Fate
 Apoptosis -
 Gangrene

 - Definition
 - Etiology
 -Types- 1. Dry gangrene
 2. Wet gangrene
 3. Gas gangrene
 Diff. between dry & wet gangrene
 INTRODUCTION

 Gangrene is a form of necrosis of

tissue ( i.e., cell death) with superadded
putrefaction characterized by the
decay of body tissues, which become
black and malodorous.
 The type of necrosis is usually
coagulative due to ischaemia.

 Gangrene most commonly affects the

extremities, including toes, fingers and
limbs, but can also occur in muscles
and internal organs.
 Types of gangrene

 DRY GANGRENE

 WET GANGRENE

 GAS GANGRENE
 DRY GANGRENE
 Dry gangrene is characterized by dry &
shriveled skin ranging in colour from
brown to purplish-blue to black.
SITES:
 Dry gangrene begins at the distal part
of the limb.

 Often occurs in the toes & feet of

elderly patients due to arteriosclerosis.
 ETIOLOGY

 Arterioscelrosis
 Thromboangitis obliterans
(Burger’s disease)
 Raynold’s disease
 Trauma
 Ergot poisoning.
 GROSS APPEARANCE
 The affected part is dry, shrunken and
dark black, resembling the foot of a
mummy.
 The dark colour is due to liberation of
haemoglobin from haemolysed red blood
cells which is acted upon by hydrogen
disulphide (H2s) produced by the bacteria,
resulting in formation of black iron
sulphide that remains in the tissues.
 The gangrene spreads upwards slowly
until it reaches a point where the blood
supply is adequate to keep tissue
viable.

 A line of seperation is formed at this

point.

 The line of separation usually brings

about complete separation with eventual
falling off of the gangrenous tissue if it
is not removed surgically.
Dry gangrene
“DRY” GANGRENE
 MICROSCOPIC APPEARANCE

 Necrosis with smudging of tissues.

 Line of separation consists of

inflammatory granulation tissues.
 WET GANGRENE
 Wet gangrene develops rapidly due to
blockage of venous & less commonly
arterial blood flow from thrombosis or
embolism.

 The affected part is stuffed with blood

which favours the rapid growth of
putrefactive bacteria.
 The toxic products formed by bacteria
are absorbed causing systemic
manifestations of septicaemia & finally
death.

 The spreading wet gangrene lacks clear-

cut line of demarcation & may spread to
peritoneal cavity causing peritonitis.
 SITES
 Occurs mostly in naturally moist
tissues such as Mouth, Bowel, lung,
Cervix, Vulva.

 Diabetic foot (high sugar in necrosed

tissue favours growth of bacteria.)

 Other sites - sacrum, buttocks and

heels ( in bedsores ).
 GROSS APPEARANCE

 The affected part is soft, swollen,

putrid, rotten & dark.

 The classic example is gangrene of

bowel due to strangulated hernia,
volvulus or intussusception.
 MICROSCOPIC APPEARANCE
 There is Coagulative necrosis.

 Ulceration of the mucosa, intense

inflammatory infilteration.

 Lumen contains mucus and blood.

 No line of demarcation.
 DIFFERENCES BETWEEN DRY & WET
GANGRENE

 DRY GANGRENE  WET GANGRENE

SITE - LIMBS -BOWEL
CAUSE - ARTERIAL -VENOUS
OCCLUSION OBSTRUCTION
ARTERIAL OCCLUSION
(LESS OFTEN)
GROSS - ORGAN DRY, - PART MOIST, SOFT,
SHRUNKEN, BLACK SWOLLEN, ROTTEN &
DARK.
4) PUTREFACTION-
LIMITED DUE TO - MARKED DUE TO
LESS BLOOD SUPPLY STUFFING OF ORGAN
WITH BLOOD
5) LINE OF
DEMARCATION - -ABSENT.
PRESENT.

6) BACTERIA - ABSENT. PRESENT.

7) PROGNOSIS- -POOR.
BETTER
 GAS GANGRENE

 Gas gangrene is a special form of wet

gangrene caused by gas forming Clostridia
( Gram +ve anaerobic bacteria).

 Sites - 1) open contaminated wounds,

especially in muscles.
2) As a complication of operation on
colon.
 PATHOPHYSIOLOGY

 Gas gangrene is caused by Clostridial

species (most often Clostridium
perfringens), which is mostly found in
soil but also found as normal gut
flora, and other anaerobes .
(e.g. Bacteroides and anaerobic
Streptococci).
These environmental bacteria may enter
the muscle through a wound and multiply
in necrotic tissue and secrete powerful
toxins which destroy nearby tissue,
generating gas at the same time.

 Clos. Perfringens produces exotoxin known

as alpha toxin, which is phospholecithinase.
 FEATURES

 Gas gangrene can cause

1. Myonecrosis
2. Gas Production
3. Sepis
4. Progression to toxemia and shock is
often very rapid.
 GROSS APPEARANCE

 The affected area is swollen, oedematous,

painful & crepitant due to accumulation of
gas bubbles within tissues.

 Subsequently, the affected area becomes

dark black & foul smelling.
 MICROSCOPIC APPEARANCE
 The muscle fibres undergo Coagulative
necrosis with liquefaction.

 Large no. of gram +ve bacilli present.

 A zone of leucocytic infiltration, oedema

and congestion at the periphery.
Tissue Damage Caused by Microbial Enzymes of
Clostridium perfringens
 Complications

 Disabilities from amputation or removal of

dead tissue

 Prolonged wound healing or the need for

reconstructive surgery, such as skin grafting
 TREATEMENT

 DEBRIDEMENT
 HYPERBARIC OXYGEN
 AMPUTATION of an arm or leg.
 Antibiotics, preferably penicillin-type.
 IMMUNOTHERAPY- AGS
(PASSIVE IMMUNISATION).
 Summary

 Gangrene- Definition
 - Etiology
 -Types- 1. Dry gangrene
 2. Wet gangrene
 3. Gas gangrene
 Diff. between dry & wet gangrene