Backup

now browsing by category

We provide education data for MBBS students to help in their academics. Find different aspects of MBBS education and easily get to desired topics. Pathology, eye, ent, community medicine, anatomy, physiology, biochemistry, medicine, surgery and clinical data and other heath topics, find medical tips you need know.

 

Gangrene & It’s Various Presentations

Gangrene & It's Various Presentations
  • Gangrene refers to death of macroscopic portion of tissue which turns black because of breakdown of hemoglobin and formation of iron sulphide.
  • Usually affects distal parts of limb.
  • Dry Gangrene: Tissues are desiccated by gradual slowing of blood flow as result of atheromatous occlusion.
  • Wet Gangrene:It occurs when superadded infection and putrefaction occurs. Crepitus is present as result of infection by gas-forming organisms.
Wet Diabetic Gangrene
Scenario A 52 year-old male with long history of type 2 diabetes, who was presented in ER with ulcerations on Right foot. Until his admission to the Jinnah Hospital ER, he has suffered repeated hospital admissions, repeatedly proposing ray amputation, which the patient refused. On examination, there were necrotic patches over the dorsum of right foot & lateral aspect of right leg with pus discharge and there were ulcers over planter surface of right foot with foul smelling pus discharge. He is known smoker, hypertensive and case of chronic kidney disease. His HbA1c is 9.3 %. Q No. 1,  What is the most probable diagnosis?
  • Diabetic Wet Gangrene
  • Gangrene refers to death of macroscopic portion of tissue which turns black because of breakdown of hemoglobin and formation of iron sulphide.
  • Usually affects distal parts of limb.
  • Dry Gangrene: Tissues are desiccated by gradual slowing of blood flow as result of atheromatous occlusion.
  • Wet Gangrene:It occurs when superadded infection and putrefaction occurs. Crepitus is present as result of infection by gas-forming organisms.
Wet Diabetic Gangrene
Separation of Gangrene
  • A zone of demarcation develops between truly viable and dead or dying tissues.
  • Achieved by formation granulation tissue that is formed between dead and viable tissues.
  • Line of demarcation appears in matters of days if blood supply of the proximal part is adequate and there is minimum infection
  • If blood supply is poor to proximal part then line of demarcation is slow to form or does not develop at all.
  • Unless the arterial supply can be improved, the gangrene will spread to adjacent areas as “skip lesions”
  • To attempt local amputation in presence of poor circulation results in failure and gangrene will reappear in wound or skin edges.
Treatment of Gangrene
  • How much the limb can be salvaged depends upon the blood supply proximal to gangrene.
  • Poor circulation can be improved by surgical intervention and this may allow more conservative debridement or distal amputation.
  • Major amputations may be required in cases of life-threatening sepsis.
Diabetic Gangrene
  • Caused by combination of THREE factors
  • 1)Ischemia secondary to macrovascular disease 2)Peripheral sensorimotor neuropathy (PSN) 3)Immunosuppression
  • Macrovascular disease is atherosclerotic and typically affects crural vessels with relative sparing of pedal vessels
  • PSN usually sensory in early phase, classically is stocking distribution. Then it extends to joints of foot and ankle, resulting loss of nociceptive and proprioceptive reflexes
  • Ischemia and PSN acts synergistically to increase risk of diabetic foot ulceration
Management of Diabetic Gangrene
  • Treatment depends upon degree of arterial involvement.
  • Degree of arterial involvement is assessed and treated by angioplasty or surgery.
  • The gangrene is treated by 1.Drainage of pus 2.Liberal debridement of dead tissue 3.Antibiotics.
  • Primary amputation in case of sepsis
Bedsores/Decubitus Ulcers Bedsores are caused by local pressure. Predisposed by FIVE factors
  1. Pressure
  2. Injury
  3. Anemia
  4. Malnutrition
  5. Moisture
Pressure sores frequently occurs;
  1. Ischium
  2. 2.Greater trochanter
  3. Sacrum
  4. Heel
  5. Malleolus
  6. Occiput
Bed Sore/Pressure ulcer
Management of Bedsores
  • Appear and extend rapidly in immobile patients.
  • A bedsore can be expected if erythema appears that does not change color on pressure.
  • Once bedsores develop, they are difficult to heal.
  • Bedsores should be kept clean.
  • Skilled nursing care and specially designed bed reduces pressure to the skin.
  • Debridement if needed
  • VAC (Vacuum assisted closure) dressing
  • Opinion from plastic surgeon
Frostbite
  • Caused by exposure to cold.
  • Seen both in climbers at high altitudes and in elderly or the vagrant during cold weather.
  • Cold injury damages the wall of blood vessels that results in swelling and leakage of fluid together with severe pain
  • When the pain settles, there is waxy appearance, blistering and then gangrene follows
  • Treatment: 1. Gradual rewarming 2. Analgesics 3. Delayed conservative amputation
Frost Bite
Raynaud’s Disease
  • Idiopathic condition usually occurs in young women.
  • Affects the hands more then feet.
  • An abnormal sensitivity of arteries to cold.
  • Vessels constrict and the digits turn white and become incapable of fine movements.
  • Capillaries then dilate with slowly flowing deoxygenated blood, resulting in digits becoming dusky & swollen.
  • As the attack passes, arterioles relax and oxygenated blood returns into dilated capillaries & digits become red.
  • Characteristic sequence of blanching, dusky cyanosis and red engorgement, often accompanied by pain.
  • Superficial necrosis is very uncommon.
Treatment of Raynaud’s Disease
  • Protection from cold.
  • Avoidance of pulp and nail bed infection.
  • Calcium channel blockers, such as nifedipine.
  • Electrically heated gloves.
  • Sympathectomy
Raynaud’s Syndrome
  • Peripheral arterial manifestation of a collagen disease, such as SLE, Rheumatoid arthritis, etc.
  • Clinical features are as for Raynaud’s disease but is much more aggressive.
  • Recognized as industrial disease and is known as “Vibration white finger”
Treatment of Raynaud’s Syndrome
  • Conservative measures.
  • Calcium channel blockers such as nifedipine.
  • Steroids.
  • Vasospastic antagonists

Cognitive Behavior Therapy (CBT)

Cognitive Behaviour Therapy (CBT)

Cognitive Behavior Therapy (CBT)
Be a Warrior Instead of a Survivor

Author: Dr. Hira Idrees (DPT BZU)

Cognitive behavior therapy is a short term, goal oriented psychotherapy treatment that takes a hands-on practical approach to problem-solving. Its goals is to change the pattern of thinking or behavior that are behind people’s difficulties and so on to change the way they feel. Read More…

Yellow Teeth Are No More Secret Revealed

Yellow Teeth Are No More Secret Revealed

Yellow Teeth Are No More Secret Revealed

Natural color of teeth vary from person to person but it is not pale yellow. Various foods stain teeth directly and sometimes it is just the thin enamel that show teeth as yellow. Dentin, a pale brown substance, Read More…

Top Home Remedies For Constipation

Top Home Remedies For Constipation

Top Home Remedies For Constipation

More often you get constipated and are reluctant to consult about it but it’s not very difficult to kick it out. Some homemade remedies don’t let it difficult to get relieved. Read More…

Migraine – A Mystery of Headache

Migraine - A Mystery of Headache

Migraine – A Mystery of Headache

The migraine is a chronic neurological disease that is characterized by moderate to severe episodes of headache that is mostly associated with other central nervous system (CNS) symptoms. Read More…

How to Take Care of Your Face Skin?

How to Take Care of Your Face Skin?

How to Take Care of Your Face Skin?

Face is the window to emotions especially when you want to get attracted or you are trying to look great in interviews and in public. Certain habits must have to be adopted to have a radiant complexion all long the years. Read More…

ENT Sorted out Send Ups SEQs

ENT Sorted out Send Ups SEQs

ENT Sorted out Send Ups SEQs

Here are some helpful Questions of ENT Send Ups from different Medical Colleges. We aim to provide valuable study stuff and resources. Feel free to contact us with any queries. Read More…

Obesity

Obesity

Obesity

Obesity may be defined as an abnormal growth of adipose tissue due to an enlargement of fat cells or an increase in the fat cell number or a combination of both. Read More…

Diabetes mellitus

Diabetes mellitus

Diabetes mellitus

Diabetes is a heterogenous group of diseases characterized by a state of chronic hyperglycemia, resulting from diversity of etiologies. The underlying cause is the defective production or action of insulin, a hormone that controls glucose, fat and amino acid metabolism. It is a long term disease with variable clinical manifestations.

Read More…

UHS Paper of Pharmacology for M.B.B.S 2nd Professional 2011 (Questions)

Our Proud Authors

UHS Paper of Pharmacology for M.B.B.S 2nd Professional 2011 (Questions)

Q.1

a)      What is receptor? Explain briefly the concept of Spare Receptors with examples. Read More…

Maternal & Child Health (MCH)

Maternal & Child Health (MCH)

Maternal & Child Health (MCH)

Pakistan is one of the countries with a high maternal and infant mortality rates. Women, especially pregnant women suffer even at primary care level due to a lack of properly trained and skill health care worker in the community.To overcome this issue the Mother & Child Health Care Centre, training Institute has been established. Read More…

All About Noise (Basic Facts You Need Know)

All About Noise (Basic Facts You Need Know)

All About Noise (Basic Facts You Need Know)

Noise is defined as wrong sound in wrong place and at wrong times. Noise is created when an object vibrates. Read More…

Housing & It’s Basic Requirements

Housing & It's Basic Requirement

Housing

“Housing” in the modern concept includes not only the “physical structure” for providing protection and shelter but also includes the immediate surrounding and related community services and facilities. Read More…

What Is Best For Your Heart? (Best Foods for Healthy Heart)

What is best for healthy heart?

What Is Best For Your Heart? (Best Foods for Healthy Heart)

From dawn to dusk, each of you’re eating from breakfast to dinner can be heart healthy. Just set up your kitchen into a hub Read More…