Gangrene Flashcards

1
Q

Define gangrene

A

Death of tissue from poor vascular supply (sign of critical ischaemia)

Complication of necrosis characterised by decay of body tissues

2 main categories: ischaemic (dry) and infectious gangrene (wet)

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2
Q

Aetiology of gangrene

A

Ischaemic: Atherosclerosis | diabetes-associated microangiopathy | thrombosis | IVDU | vasculitis | malignancy | antiphospholipid syndrome

Infectious: group A beta-haemolytic strep species | staph | non-group A strep | enterobacteriaceae

Gas: spore-forming gram +ve anaerobic clostridial species - C. perfringens

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3
Q

Risk factors for gangrene

A
Diabetes mellitus 
Trauma 
Malignancy 
Atherosclerosis 
Smoking 
Renal disease
Drug and alcohol abuse
Contaminate wounds
Immunosuppression 
Malnutrition
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4
Q

Symptoms of gangrene

A

Rapid onset severe pain + muscle swelling/oedema + gas production + skin discolouration

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5
Q

Signs of gangrene

A
Crepitus (gas)
Sepsis 
Myonecrosis
Diminished pedal pulses and ABI (ischaemic)
Low grade fever + chills (infectious)
Cold extremities
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6
Q

Investigations for gangrene

A

Rapid progression, spread or clinical deterioration -> surgical exploration / biopsy to identify if the fascia is involved (necrotising fasciitis)

Bloods:
FBC (leucocytosis, haemochromatosis, anaemia)
CRP+ESR (elevated)
LDH (elevated in haemolytic anaemia)
Metabolic panel (metabolic acidosis , liver or renal derangement)
Blood cultures (infectious)

Plain X-rays (gas in soft tissues or osteomyelitis)

CT/MRI (abscess formation or evidence of enhancement, oedema or fascia involvement)

Doppler (indicate presence + severity of arterial or venous obstruction

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