Grow, necrosis, gangrene, ulcer, fistulas

1. Grow, necrosis, gangrene, ulcer, fistulas m.d. Shydlovscky A.V.

2. NECROSIS – are local death Necrosis is grow of tissues, or all organ of living organism.

3. 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

4. Distinguish : 1) coagulative or dry necrosis; 2) kolliquative or moist necrosis. gangrene infarction 3) Direct 4) Indirect

8. Basic variants of blood circulation insufficiency. І Arterial insufficiency: • Acute ischemic syndrome (acute arterial insufficiency AAI). • Chronic ischemic syndrome (chronic arterial insufficiency, ChAI). ІІ Venous insufficiency : 1. Acute . 2. Chronic .

9. Acute arterial insufficiency is more frequent all conditioned embolism or thrombosis of arteries.

10. 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.

12. 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.

14. Chronic arterial insufficiency is caused by gradual stenosis and occlusion of arteries.

19. 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.

20. 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.

21. 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.

29. A necretomy is executed such methods : • mechanical (by scissors, scalpel); • chemical (proteolitic enzymes); • physical (ultrasound, laser therapy);

30. TROPHIC ULCERS. Trophic ulcers are the defect of skin or mucus, which develops as a result of tearing away of necrotic tissue.

32. 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.

33. 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.

34. 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).

35. 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.

36. 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 bladder-fallopian, 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.

37. ІІІ. In relation to an external environment: • External fistulas of soft tissues • External fistulas of hollow organs • Internal fistulas ІVBy a structure: granulating, epitelising, lip-form (the epithelium of hollow organ goes out on a skin). VAfter character of excretions: mucous, festerings, salivary, with the profluvium of cerebral liquid, milk, bile, excrement, urine, mixed (festering-milk and other.).

38. 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.

39. 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.

41. 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).