Gangrene refers to the death of the tissue in any particular area of the body caused by the loss of blood supply. Though gangrene can occur in any part of the body, it normally affects toes, fingers, feet and hands. Infections, vascular disease, diabetes, injury and weakened immunity are some of the causes of gangrene.
Types of gangrene
Dry gangrene: Dry gangrene involves lack of blood supply due to cell death and necrosis. This condition is not associated with infection and develops gradually over a period of time. Patients with diabetes, atherosclerosis and other blood vessel diseases are most likely to develop dry gangrene. Those suffering from injuries, burns, frostbite and any other arterial trauma are also prone to dry gangrene.
Symptoms of dry gangrene
Wet gangrene: Bacterial infection, loss of blood supply due to swollen tissues and gas production are some of the causes of wet gangrene. Wet gangrene spreads very quickly and in no time turns into sepsis. It restricts the white blood cells from reaching affected area, allowing the bacteria to feed on the surrounding muscles. Hence wet gangrene is a medical emergency and requires immediate treatment.
There are few variations to wet gangrene and one of them is gas gangrene. The bacterial organism called Clostridium perfringens causes gas gangrene. The bacteria present in the site releases toxins and produces gas bubbles in the dead tissues affecting not only the local site, but adjoining tissues and muscles. Though gangrene normally occurs on external parts of the body like hands, toes and legs, it can also attack internal organs like gallbladder, intestines and appendix. This condition is called internal gangrene. Internal organs may develop hernia, get strangulated and as a result do not receive sufficient blood supply causing gangrene.
Fournier gangrene is the gangrene that occurs in the male genital area due to an infection or urinary tract infection. Red skin, swelling, tenderness associated with pain are some of the symptoms of Fournier gangrene.
Necrotizing fasciitis is a type of wet gangrene that is caused by bacterial infection, affecting the deep layers of skin. It progresses rapidly and starts eating up the flesh in the body.
Symptoms of wet gangrene
Causes of gangrene
The first and the primary cause of gangrene is complete loss or insufficient supply of blood to the tissue. When there is no blood supply, the required oxygen does not reach the cells allowing them to decay and die. Bacterial infections, trauma, damaged blood vessels, and blood vessel disease like atherosclerosis are some of the causes that restrict the blood supply leading to gangrene. Surgery wounds, frost bites, severe burns are typical breeding sites for bacteria causing infection and gangrene.
Doctor will conduct a thorough physical examination and look for the symptoms like discoloration, pus, shrinking of skin, odor to determine the type of gangrene. If it is a wet gangrene, further tests like blood test, blood culture and tissue cultures are carried on to find out about the white blood cell count and the kind of bacteria causing the issue. This helps the doctors to decide on the right course of antibiotics. Imaging studies like X-ray, MRI and CT scan are done to determine the spread of gangrene.
Treatment approach varies depending upon the type of gangrene. However, whatever be the type of gangrene; it should be brought to the notice of the medical practitioner at the earliest to prevent it from spreading. In case of dry gangrene, firstly, doctor will remove the dead tissues from the affected area surgically. Next, he will try to correct the destroyed blood vessels to smoothen the blood flow. Patient will be administered antibiotics to curtail the spread and will also be given some anti blood clotting drugs.
Wet gangrene is a medical emergency and once diagnosed, treatment should start as quickly as possible. Debridement procedure is normally adopted to treat wet gangrene. Debridement refers to the removal of dead and decaying tissues from the affected site. Antibiotics are administered to control the infection and pain killers are given to relieve the patient from pain. In worst cases surgeon may have to amputate, where the affected limb will be separated from the body to prevent further deterioration. Gas gangrene is a deadly disease. Though it is treated in the same way as mentioned above, it necessitates swift action when compared to all other gangrenes. The infection can spread and enter the blood stream very quickly causing organ failures.
There is also an alternate therapy called hyperbaric oxygen therapy that is gaining momentum to treat gas gangrene. This process involves exposing the patient to 100% oxygen at inflated pressure for 90 to 120 minutes, three times a day for 2 days. Then the frequency will be brought down as per the patient's requirements. This therapy stimulates the cell growth, enhances the white blood cell count thereby regulating the infection and increasing the blood flow to areas affected by the arterial blocks.
Dry gangrene is easily treatable provided there is no infection associated with it. Chances of recurrence are higher in diabetes patients. The outlook for wet gangrene is poor and patients with severe infection and sepsis may also lose their life, if treatment is not initiated in time. It requires an aggressive treatment and patients with wet gangrene may end up with amputation.
Flatulence is caused by substances that are indigestible. Antiflatulent agents ensure that small gas bubbles merge into larger bubbles and ease out of the gastrointestinal tract. Antiflatulents alleviate intestinal gas. They are usually enzyme-based and break down the indigestible elements and expel them by burping or flatulence.
Spontaneous pneumothorax is a condition where the lung collapses due to accumulation of air or gas in the chest. The lung caves in due to inability to fill up with air during inhalation. This can happen to thin tall men without any prior symptoms. Spontaneous pneumothorax is more pronounced among men, especially smokers. Primary spontaneous pneumothorax occurs without any history of lung disease. It is usually attributed to the rupture of a air-filled sac within the lung. Secondary spontaneous pneumothorax is noticed among persons who are suffering from chronic obstructive pulmonary disease, tuberculosis, pneumonia, asthma, cystic fibrosis or lung cancer.
Primary spontaneous pneumothorax usually occurs in persons less than 40 years. On the other hand, secondary spontaneous pneumothorax is noticed among older patients. Sudden shock or low blood pressure or distended neck veins can bring on a condition of tension pneumothorax. This type of pneumothorax can also result from a serious accident or violent crime.
Breathlessness is the most prominent symptom of pneumothorax. There is dull or stabbing pain in the chest that is accentuated by coughing. A patient suffering from spontaneous pneumothorax experiences shortness of breath and abnormal breathing patter. The patient feels agitated and enlarged neck veins will be observed. A physician will conduct a thorough physical examination and listen to your heart and breath sounds if he suspects a spontaneous pneumothorax condition. A chest x ray can confirm the collapse of the lung. The level of oxygen in the blood is measured with a pulse oximeter or an arterial blood gas analysis.
Treatment for spontaneous pneumothorax involves removal of air from the pleural space so as to allow the lungs to expand again. It may take several days for the lungs to re expand. A Catheter is used for aspiration of air from the pleural cavity. A chest tube is placed between the ribs to allow the air to be evacuated from that space. Doxycyline may be passed through the chest tube to seal the space.
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Bibliography / Reference
Collection of Pages - Last revised Date: January 22, 2020