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NECROSIS, GANGRENE. I. practical training 2rd year Dentistry Signs of death • Cardiac arrest (no pulse) • Pallor mortis, paleness which happens in the 15–120 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 Vital reaction • Inflamation – (redness, white blood cells - polymorfonuclears, lymfocytes, plazmocytes, macrofages) • Demarcation • Reparation 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 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, 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) 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) Recent myocardial infarction Recent myocardial infarction Coagulative necrosis– myocardial infarcrion Older myocardial infarction Older myocardial infarction Postinfarction scar of the myocard Postinfarction scar of the myocard Renal infarct Caseous tbc lymphadenitis Cerebral infarct (encephalomalacia) Cerebral infarct (encephalomalacia) Lung tromboembolism and haemorrhagic infarct Fibrinoid necrosis gastric ulcer revmatoid artritis Liquefactive necrosis – brain 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 Gangrene of foot