Grow, necrosis,
gangrene, ulcer, fistulas
Shydlovscky A.V.
NECROSIS –
are local death
Necrosis is grow of tissues, or all
organ of living organism.
Reasons of necrosis are:
Exogenous:
Action of extreme temperatures.
A contact is with chemical matters.
Defeat an electric current and penetrable radiation.
Festering-septic infection
Endogenous:
Disorders of blood circulation and lymphokinesis
(spasms of blood vessels, thromboses, embolisms,
obliteration of vessels, lymphostasis).
Damage of nerves and diseases which result in
violation of trophic innervations (siringomielia,
leprosy).
Allergic and metabolic disorders
Blood diseases
Distinguish :
1) coagulative or dry necrosis;
2) kolliquative or moist necrosis.
gangrene
infarction
3) Direct
4) Indirect
Basic variants of blood circulation
insufficiency.
І Arterial insufficiency:
1. Acute ischemic syndrome (acute arterial
insufficiency AAI).
2. Chronic ischemic syndrome (chronic arterial
insufficiency, ChAI).
ІІ Venous insufficiency :
1. Acute .
2. Chronic .
Acute arterial insufficiency is
more frequent all conditioned
embolism or thrombosis of
arteries.
Embolism of artery
Reasons
А. Left half of heart.
1. A sub wall blood clot is as a result of arrhythmia, heart attack of
myocardium, mitral stenosis, endocarditis.
2. The vegetation on valves.
3. Foreign bodies.
4. Tumors.
B. Aorta.
1. Atherosclerotic plates.
2. A trauma with a next thrombosis.
3. Aneurysm.
4. Foreign bodies.
C. Pulmonary veins.
1. Thrombosis.
2. A trauma with a next thrombosis.
3. Tumors.
Г. Right half of heart.
Д. Veins of large circulation of blood.
Thrombosis of artery
Virchov’s triade.
А. Damage of vascular wall.
1. Obliterance atherosclerosis.
2. Arteriitis.
3. Trauma.
4. Paratherapeutic damages of vessels.
5. Frost-bitten, action of electric current.
B. Change of blood composition.
1. Diseases of blood
Veritable polycytemia.
Leycosis.
2. Disease of internal organs (atherosclerosis, tumors).
3. Influence of medicinal preparations.
C. Violation of blood stream.
1. Extravazal compression.
2. Aneurysm.
3. Spasm.
4. Acute blood circulation insufficiency.
5. Operations are on arteries.
Chronic arterial insufficiency is
caused by gradual stenosis and
occlusion of arteries.
Reason of acute violation of
venous blood stream is a
thrombosis or thrombophlebitis
of main veins of extremities, to
chronic venous insufficiency the
carried thrombophlebitis of
deep veins, varicose disease,
lead before.
Special methods of research:
1.Oscillography.
2. Reovazografiya.
3. Ultrasonic floumetriya.
4. Pin thermography.
5. Radioisotope diagnostics.
7. Contact coloured thermography of kholesteric
liquid crystals.
8. Polyarografia.
9. X-Ray contrast methods : arterio-, flebo- and
lymphography.
10. Capillary scopia.
11. Functionally dynamic flebomanometria, at which
measuring of venous pressure is conducted with
different dynamic tests - test of Val'sal'va and
muscular loading (10-12 squat). It is possible to
define communicating of deep veins.
12. Laboratory researches (general analysis of
blood, general analysis of urine, biochemical
blood test, tromboelastografy, electrocardiogram)
allow mediated to confirm the diagnosis of
disease, and also control efficiency of the
appointed treatment.
A necretomy is executed
such methods :
mechanical (by scissors, scalpel);
chemical (proteolitic enzymes);
physical (ultrasound, laser therapy);
TROPHIC ULCERS.
Trophic ulcers are the defect of
skin or mucus, which develops as
a result of tearing away of necrotic
tissue.
Classification :
І. Ulcers which arise up under the action of external
influences :
1. thermal burns;
2. chemical burns;
3. radial burns;
4. electro-burns;
5. getting frost-bitten.
ІІ. Ulcers which developed as a result of different diseases;
1. vasotrophic (chronic venous and chronic arterial
insufficiency);
2. neurotrophic (damage of cns and peripheral nerves);
3. ulcers which arise up at metabolic diseases and system
diseases (collagenosess, saccharine diabetes, illnesses of
blood and bloodprodusing organs);
4. ulcers which arise up as a result of the protracted chronic
intoxication a) professional intoxications (arsenic, lead,
chrome); b) medicinal preparations (bromide, foxglove,
corticosteroids);
5. ulcers which arose up as a result of widespread necrosises
and phlegmons (epifascial gangrene, necrotizing and
phlegmonous forms of erysipelas);
6. specific ulcers (microbial: tuberculosis, syphilis, leprosy,
mycotic, parasitogenic, tumour);
7. Osteomielitic ulcer.
TREATMENT.
1. Local: use of proteolitic enzymes, vacuum therapy,
antiseptics, physiotherapy, laser, preparations which
improve reparative processes.
2. Surgical treatment: saphaenaectomy, proceeding in
communicating of arterial barrel, autodermoplastic,
the plastic arts by a Philatov shred.
3. General strengthening valuable feed, vitamin therapy,
strengthening of anabolic processes.
4. Treatments of diseases, which resulted in formation of
ulcer ( syphilis, tuberculosis, disease of blood).
FISTULAS
Fistulas is name pathological motions,
covered granulation tissues or
epithelium, that connect a pathological
hearth in soft tissues , bones, hollow
organs with an environment or between
itself.
Classification
І. Innate fistulas (defects of development) is a complete or partial
nonclosure of embryo channels and cracks. Examples: middle
fistula of neck (anomaly of development of thyroid gland),
lateral cysts of neck.
ІІ. Purchased fistulas - caused a pathological process (ulcer,
stone of gallbladder, osteomielitis, tuberculosis of bones and
joints, suppuration of ligatures);
- at destruction of malignant tumor tissue (urine bladderfallopian, gallbladder, and other.);
- traumatic damages (intestinal, bronchial fistulas);
- artificial, that executed with a medical purpose an operative
way:
- “stoma” is artificial fistula of hollow organ (intestinal, stomach,
gallbladder);
- “anastomosis” - internal interorgan fistula is artificially
created, and operation - stomya.
Depending on indication impose temporal and permanent fistulas.
ІІІ. In relation to an external environment:
External fistulas of soft tissues
External fistulas of hollow organs
Internal fistulas
ІV By a structure: granulating, epitelising, lipform (the epithelium of hollow organ goes
out on a skin).
V After character of excretions: mucous,
festerings, salivary, with the profluvium of
cerebral liquid, milk, bile, excrement, urine,
mixed (festering-milk and other.).
Factors which result in
formation of fistulas:
Permanent selection on fistula canal of
pus, mucus, intestinal content, and
others like that.
A destroying action is on granulation by
chemically active secrets (gastric,
pancreatic, duodenal content)
Destruction of fistula canal granulations
by toxins and virulent microbes.
BEDSORES
It is a ulcer-necrotic process, which
develops for hyposthenic patients in those
areas of body, which are added
permanent pressure.
Distinguish endogenous and exogenous
bedsores.
Treatment of bedsores
Necrectomy (mechanical, physical
and chemical) and local therapy,
directed on the improvement of
reparative processes, and also
treatment of reasons of basic disease
(treatment of sepsis, proceeding in
innervations, treatment of exhausting
diseases).