NECROSIS, GANGRENE. I. practical training 2 rd year Dentistry

Transcription

1 NECROSIS, GANGRENE. I. practical training 2 rd year Dentistry

2 Signs of death Cardiac arrest (no pulse) Pallor mortis, paleness which happens in the minutes after death Livor mortis, a settling of the blood in the lower (dependent) portion of the body Algor mortis, the reduction in body temperature following death. This is generally a steady decline until matching ambient temperature Rigor mortis, the limbs of the corpse become stiff (Latin rigor) and difficult to move or manipulate Decomposition, the reduction into simpler forms of matter, accompanied by a strong, unpleasant odor. Diffusion of the liquid and gasses from the intestine pseudomelanosis, verdohemoglobin Cell Autolysis destruction of lysosomes

3 Vital reaction Inflamation (redness, white blood cells - polymorfonuclears, lymfocytes, plazmocytes, macrofages) Demarcation Reparation

4 Regresive changes Deth, necrosis, apopthosis, dystrophy Apoptosis is the process of programmed cell death that may occure in multicellular organism and leads to characteristic cell changes and death of the cell - the programmed destruction of cells during embryogenesis - cell death injury DNA demage, drug injury (cytostatics), cell death in tumours Morfology cell shrinkage, chromatin condensation, formation of the cytoplasmatic blebs and apoptotic bodies

5 Regresive changes Necrosis cell death in living tissue, results form the progressive degenerative reaction of enzymes on the lethaly injured cell Morfology increased eozinophilia, nuclear changes (karyolysis, pyknosis (nuclear shrinkage and increased basophilia) Ethiology microorganisms, chemicals, physical factors,

6 Necrosis Coagulative - is a type of accidental cell death typically caused by ischemia or infarction. Injury denatures structural proteins as well as lysosomal enzymes thus blocking the proteolysis of the damaged cells. (In tissues rich for proteins typicaly infarction of myocardium) Liquefactive - In liquefactive necrosis, the affected cell is completely digested by hydrolytic enzymes, resulting in a soft, circumscribed lesion consisting of pus and the fluid remains of necrotic tissue. Sometimes it is associated with focal bacterial or fungal infections. Typical for tissues poor for proteins ischemic brain nekrosis Gangrenous - this term is used in clinical surgical practice. Usually aplied for limbs, mumiffication (dry gangrene), modiffication by microorganisms (wet gangrene)

7 Necrosis Caseous in foci of tuberculous infection, name form white gross appearance of the area of necrosis. Microscopicly acellular pink areas of necrosis surrounded by a granulomatous inflammatory process. In necrosis amorphous granular debris composed of fragmented coagulated cells Zenker s necrosis muscles, influensa infection Fat necrosis (Balzer s) in which the neutral fats in adipose tissue are split into fatty acids and glycerol, usually affecting the pancreas and peripancreatic fat in acute hemorrhagic pancreatitis. Fibrinoid - accumulation of amorphous, basic, proteinaceous material in the tissue matrix with a staining pattern reminiscent of fibrin. (vasculitis, gastric ulcer)

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9 Recent myocardial infarction

10 Recent myocardial infarction

11 Coagulative necrosis myocardial infarcrion

12 Older myocardial infarction

13 Older myocardial infarction

14 Postinfarction scar of the myocard

15 Postinfarction scar of the myocard

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17 Renal infarct

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20 Caseous tbc lymphadenitis

21 Cerebral infarct (encephalomalacia)

22 Cerebral infarct (encephalomalacia)

23 Lung tromboembolism and haemorrhagic infarct

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25 gastric ulcer Fibrinoid necrosis revmatoid artritis

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27 Liquefactive necrosis brain

28 Gangrena Secondary modified necrosis Dry (mumification) drying up of necrotic parts diabetes patient s legs (hematin), fetus papyraceus Wet (sfaceus, humida) modified by bacterias Emphysematous (emfyzematóza) anearobic bacterias Clostridia, toxins

29 Gangrene of foot

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