Grow, necrosis, Grow, necrosis, gangrene, ulcer, fistulasgangrene, ulcer, fistulas

Shydlovscky A.V.Shydlovscky A.V.

NECROSIS – NECROSIS – are local deathare local death

Necrosis is grow of tissues, or all Necrosis is grow of tissues, or all organ of living organism.organ of living organism.

Reasons of necrosis are: Reasons of necrosis are: Exogenous:Exogenous:

Action of extreme temperatures. Action of extreme temperatures. A contact is with chemical matters. A contact is with chemical matters. Defeat an electric current and penetrable radiation. Defeat an electric current and penetrable radiation. Festering-septic infectionFestering-septic infection

Endogenous:Endogenous:Disorders of blood circulation and lymphokinesis Disorders of blood circulation and lymphokinesis (spasms of blood vessels, thromboses, embolisms, (spasms of blood vessels, thromboses, embolisms, obliteration of vessels, lymphostasis).obliteration of vessels, lymphostasis).Damage of nerves and diseases which result in Damage of nerves and diseases which result in violation of trophic innervations (siringomielia, violation of trophic innervations (siringomielia, leprosy).leprosy).Allergic and metabolic disordersAllergic and metabolic disordersBlood diseasesBlood diseases

Distinguish Distinguish ::

1) 1) coagulative or dry necrosiscoagulative or dry necrosis;;2) 2) kolliquative or moist necrosiskolliquative or moist necrosis..

gangrenegangrene infarctioninfarction

3) 3) DirectDirect4) 4) IndirectIndirect

Basic variants of blood circulation Basic variants of blood circulation insufficiencyinsufficiency..

І І Arterial insufficiency: Arterial insufficiency:

1.1. Acute ischemic syndrome (acute arterial Acute ischemic syndrome (acute arterial insufficiency AAI). insufficiency AAI).

2.2. Chronic ischemic syndrome (chronic arterial Chronic ischemic syndrome (chronic arterial insufficiency, ChAI).insufficiency, ChAI).

ІІ ІІ Venous insufficiency Venous insufficiency ::

1. 1. Acute Acute ..

2. 2. Chronic Chronic ..

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

Embolism of arteryEmbolism of arteryReasonsReasonsА. А. Left half of heartLeft half of heart..1. 1. A sub wall blood clot is as a result of arrhythmia, heart attack of A sub wall blood clot is as a result of arrhythmia, heart attack of

myocardium, mitral stenosis, endocarditismyocardium, mitral stenosis, endocarditis..2. 2. The vegetation on valvesThe vegetation on valves..3. 3. Foreign bodiesForeign bodies..4. 4. TumorsTumors..BB. . AortaAorta..1. 1. Atherosclerotic platesAtherosclerotic plates..2. 2. A trauma with a next thrombosisA trauma with a next thrombosis..3. 3. AneurysmAneurysm..4. 4. Foreign bodiesForeign bodies..CC. . Pulmonary veinsPulmonary veins..1. 1. ThrombosisThrombosis..2. 2. A trauma with a next thrombosisA trauma with a next thrombosis..3. 3. TumorsTumors..Г. Г. Right half of heart.Right half of heart.Д. Д. Veins of large circulation of bloodVeins of large circulation of blood..

Thrombosis of artery Thrombosis of artery Virchov’s triadeVirchov’s triade..А. А. Damage of vascular wallDamage of vascular wall..1. 1. Obliterance atherosclerosisObliterance atherosclerosis..2. 2. ArteriitisArteriitis..3. 3. TraumaTrauma..4. 4. Paratherapeutic damages of vesselsParatherapeutic damages of vessels..5. 5. Frost-bitten, action of electric currentFrost-bitten, action of electric current..BB. . Change of blood compositionChange of blood composition..1. 1. Diseases of bloodDiseases of blood Veritable polycytemiaVeritable polycytemia..LeycosisLeycosis..2. 2. Disease of internal organs (atherosclerosis, tumors)Disease of internal organs (atherosclerosis, tumors)..3. 3. Influence of medicinal preparationsInfluence of medicinal preparations..CC. . Violation of blood streamViolation of blood stream..1. 1. Extravazal compressionExtravazal compression..2. 2. AneurysmAneurysm..3. 3. SpasmSpasm..4. 4. Acute blood circulation insufficiencyAcute blood circulation insufficiency..5. 5. Operations are on arteriesOperations are on arteries..

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

Reason of acute violation of Reason of acute violation of venous blood stream is a venous blood stream is a thrombosis or thrombophlebitis thrombosis or thrombophlebitis of main veins of extremities, to of main veins of extremities, to chronic venous insufficiency the chronic venous insufficiency the carried thrombophlebitis of carried thrombophlebitis of deep veins, varicose disease, deep veins, varicose disease, lead beforelead before..

Special methods of researchSpecial methods of research::1.Oscillography. 1.Oscillography. 2. Reovazografiya. 2. Reovazografiya. 3. Ultrasonic floumetriya. 3. Ultrasonic floumetriya. 4. Pin thermography. 4. Pin thermography. 5. Radioisotope diagnostics.5. Radioisotope diagnostics.7. 7. Contact coloured thermography of kholesteric Contact coloured thermography of kholesteric

liquid crystals. liquid crystals. 8. Polyarografia. 8. Polyarografia. 9. X-Ray contrast methods : arterio-, flebo- and 9. X-Ray contrast methods : arterio-, flebo- and

lymphographylymphography..

10. 10. Capillary scopiaCapillary scopia..

11. Functionally dynamic flebomanometria, at which 11. Functionally dynamic flebomanometria, at which measuring of venous pressure is conducted with measuring of venous pressure is conducted with different dynamic tests - test of Val'sal'va and different dynamic tests - test of Val'sal'va and muscular loading (10-12 squat). It is possible to muscular loading (10-12 squat). It is possible to define communicating of deep veinsdefine communicating of deep veins..

12. 12. Laboratory researches (general analysis of Laboratory researches (general analysis of blood, general analysis of urine, biochemical blood, general analysis of urine, biochemical blood test, tromboelastografy, electrocardiogram) blood test, tromboelastografy, electrocardiogram) allow mediated to confirm the diagnosis of allow mediated to confirm the diagnosis of disease, and also control efficiency of the disease, and also control efficiency of the appointed treatmentappointed treatment..

A necretomy is executed A necretomy is executed such methods such methods ::

mechanical (by scissors, scalpelmechanical (by scissors, scalpel););

chemical (proteolitic enzymeschemical (proteolitic enzymes););

physical (ultrasound, laser therapyphysical (ultrasound, laser therapy););

TROPHIC ULCERSTROPHIC ULCERS..Trophic ulcers are the defect of Trophic ulcers are the defect of

skin or mucus, which develops as skin or mucus, which develops as a result of tearing away of necrotic a result of tearing away of necrotic tissuetissue..

Classification Classification ::ІІ. Ulcers which arise up under the action of external . Ulcers which arise up under the action of external

influences influences ::1. 1. thermal burnsthermal burns;;2. 2. chemical burnschemical burns;;3. 3. radial burnsradial burns;;4. 4. electro-burnselectro-burns;;5. 5. getting frost-bittengetting frost-bitten..

ІІ. ІІ. Ulcers which developed as a result of different diseasesUlcers which developed as a result of different diseases;;1. 1. vasotrophic (chronic venous and chronic arterial vasotrophic (chronic venous and chronic arterial

insufficiencyinsufficiency););2. 2. neurotrophic (damage of cns and peripheral nervesneurotrophic (damage of cns and peripheral nerves););3. 3. ulcers which arise up at metabolic diseases and system ulcers which arise up at metabolic diseases and system

diseases (collagenosess, saccharine diabetes, illnesses of diseases (collagenosess, saccharine diabetes, illnesses of blood and bloodprodusing organsblood and bloodprodusing organs););

4. 4. ulcers which arise up as a result of the protracted chronic ulcers which arise up as a result of the protracted chronic intoxication a) professional intoxications (arsenic, lead, intoxication a) professional intoxications (arsenic, lead, chrome); b) medicinal preparations (bromide, foxglove, chrome); b) medicinal preparations (bromide, foxglove, corticosteroidscorticosteroids););

5. 5. ulcers which arose up as a result of widespread necrosises ulcers which arose up as a result of widespread necrosises and phlegmons (epifascial gangrene, necrotizing and and phlegmons (epifascial gangrene, necrotizing and phlegmonous forms of erysipelasphlegmonous forms of erysipelas););

6. 6. specific ulcers (microbial: tuberculosis, syphilis, leprosy, specific ulcers (microbial: tuberculosis, syphilis, leprosy, mycotic, parasitogenic, tumourmycotic, parasitogenic, tumour););

7. 7. Osteomielitic ulcerOsteomielitic ulcer..

TREATMENTTREATMENT..1. 1. Local: use of proteolitic enzymes, vacuum therapy, Local: use of proteolitic enzymes, vacuum therapy,

antiseptics, physiotherapy, laser, preparations which antiseptics, physiotherapy, laser, preparations which improve reparative processesimprove reparative processes..

2. 2. Surgical treatment: saphaenaectomy, proceeding in Surgical treatment: saphaenaectomy, proceeding in communicating of arterial barrel, autodermoplastic, communicating of arterial barrel, autodermoplastic, the plastic arts by a Philatov shredthe plastic arts by a Philatov shred..

3.3. General strengthening valuable feed, vitamin therapy, General strengthening valuable feed, vitamin therapy, strengthening of anabolic processesstrengthening of anabolic processes..

4.4. Treatments of diseases, which resulted in formation of Treatments of diseases, which resulted in formation of ulcer ( syphilis, tuberculosis, disease of bloodulcer ( syphilis, tuberculosis, disease of blood).).

FISTULASFISTULASFistulas is name pathological motions, Fistulas is name pathological motions,

covered granulation tissues or covered granulation tissues or epithelium, that connect a pathological epithelium, that connect a pathological hearth in soft tissues , bones, hollow hearth in soft tissues , bones, hollow organs with an environment or between organs with an environment or between itselfitself..

ClassificationClassification І. І. Innate fistulas (defects of development) is a complete or partial Innate fistulas (defects of development) is a complete or partial

nonclosure of embryo channels and cracks. Examples: middle nonclosure of embryo channels and cracks. Examples: middle fistula of neck (anomaly of development of thyroid gland), fistula of neck (anomaly of development of thyroid gland), lateral cysts of necklateral cysts of neck..

ІІ. ІІ. Purchased fistulas - caused a pathological process (ulcer, Purchased fistulas - caused a pathological process (ulcer, stone of gallbladder, osteomielitis, tuberculosis of bones and stone of gallbladder, osteomielitis, tuberculosis of bones and joints, suppuration of ligaturesjoints, suppuration of ligatures););

- at destruction of malignant tumor tissue (urine bladder-- at destruction of malignant tumor tissue (urine bladder-fallopian, gallbladder, and otherfallopian, gallbladder, and other.);.);

- traumatic damages (intestinal, bronchial fistulas); - traumatic damages (intestinal, bronchial fistulas); - artificial, that executed with a medical purpose an operative - artificial, that executed with a medical purpose an operative

wayway: : - “stoma” is artificial fistula of hollow organ (intestinal, stomach, - “stoma” is artificial fistula of hollow organ (intestinal, stomach,

gallbladdergallbladder);); - “anastomosis” - internal interorgan fistula is artificially - “anastomosis” - internal interorgan fistula is artificially

created, and operation - stomyacreated, and operation - stomya..Depending on indication impose temporal and permanent fistulasDepending on indication impose temporal and permanent fistulas..

ІІІ. ІІІ. In relation to an external environmentIn relation to an external environment::External fistulas of soft tissuesExternal fistulas of soft tissuesExternal fistulas of hollow organsExternal fistulas of hollow organsInternal fistulasInternal fistulas

ІІVV By a structure: granulating, epitelising, lip-By a structure: granulating, epitelising, lip-form (the epithelium of hollow organ goes form (the epithelium of hollow organ goes out on a skinout on a skin).).

VV After character of excretions: mucous, After character of excretions: mucous, festerings, salivary, with the profluvium of festerings, salivary, with the profluvium of cerebral liquid, milk, bile, excrement, urine, cerebral liquid, milk, bile, excrement, urine, mixed (festering-milk and othermixed (festering-milk and other.)..).

Factors which result in Factors which result in formation of fistulasformation of fistulas::

Permanent selection on fistula canal of Permanent selection on fistula canal of pus, mucus, intestinal content, and pus, mucus, intestinal content, and others like thatothers like that..

A destroying action is on granulation by A destroying action is on granulation by chemically active secrets (gastric, chemically active secrets (gastric, pancreatic, duodenal contentpancreatic, duodenal content))

Destruction of fistula canal granulations Destruction of fistula canal granulations by toxins and virulent microbesby toxins and virulent microbes..

BEDSORESBEDSORES

It is a ulcer-necrotic process, which It is a ulcer-necrotic process, which develops for hyposthenic patients in those develops for hyposthenic patients in those areas of body, which are added areas of body, which are added permanent pressure. permanent pressure.

Distinguish endogenous and exogenous Distinguish endogenous and exogenous bedsoresbedsores..

Treatment of bedsoresTreatment of bedsores Necrectomy (mechanical, physical Necrectomy (mechanical, physical

and chemical) and local therapy, and chemical) and local therapy, directed on the improvement of directed on the improvement of reparative processes, and also reparative processes, and also treatment of reasons of basic disease treatment of reasons of basic disease (treatment of sepsis, proceeding in (treatment of sepsis, proceeding in innervations, treatment of exhausting innervations, treatment of exhausting diseasesdiseases).).