Necrosis occurs when tissue dies and can’t be revived. It often results from a lack of oxygen, but certain bacteria can also cause necrosis by producing toxins.
X-rays and computed tomography (CT) scans can help diagnose necrosis by detecting changes in bones and tissues. A skin biopsy may be used to confirm the diagnosis and determine the type of necrosis.
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Pain is the most common symptom of avascular necrosis. It is deep and unrelenting, and it comes from the bones starving for blood. Think about how hungry you would be if you couldn’t eat for a long time. That’s how painful avascular necrosis is, and you can’t get it off with over-the-counter medications.
The pain may be caused by an infection or a lack of oxygen, which is called hypoxia. Certain bacteria, such as Clostridium perfringens, can cause necrosis by producing toxins that cause gas gangrene. Physical trauma and exposure to extreme temperatures can also lead to necrosis.
There are several types of necrosis: Coagulative, in which dead cells become firm and opaque; Liquefactive, in which dying cells break down into a liquid mass that appears creamy yellow or white (pus); and Caseous, which occurs when the fat cells die and turn chalky and soft. Caseous necrosis is commonly associated with tuberculosis. Fat necrosis can also occur with pancreatitis and breast tissue. The type of necrosis can often be determined by examining the bone changes on a plain X-ray or an MRI scan, but by the time those changes are visible, there is already significant damage.
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In necrosis, damaged cells release enzymes that break down their own structures and turn them into liquid. This process also disrupts the cellular membrane and changes intracellular pH, causing acidosis. This causes the cytoplasm to swell and form densities, with condensation of genetic material. The lysosomes, which house hydrolytic enzymes, dissolve. The dead cell contents become a viscous mass of liquefied cells and other debris, called pus. This type of necrosis is seen in bacterial infections and tuberculosis. It’s also known as caseous necrosis because it has a white and soft appearance, like cheese.
The swelling that comes with Necrosis may be accompanied by a fever, rapid heart rate, and mental deterioration from confusion to unconsciousness (septic shock). Infection can cause your blood pressure to fall as bacteria secrete toxins into your body.
Treatment of a necrotic area starts with restoring the blood flow to it, if possible. Then doctors can remove the dead tissue. They may give you antibiotics to fight the infection and a tetanus shot to prevent further infections. They may also put you in a pressurized room to boost the blood flow and healing.
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The bacteria that cause necrotizing soft tissue infections can spread through any small cut or scrape. Anyone can get these infections, but the risk increases if you have a compromised immune system due to other diseases or lifestyle choices like heavy alcohol use or injection drug use. These infections also happen more often in people who have peripheral artery disease, diabetes, obesity and certain medical conditions like sickle cell anemia or Gaucher’s disease.
Avascular necrosis (also called osteonecrosis, aseptic bone necrosis or ischemic bone necrosis) happens when the blood supply to your bones is cut off. It most commonly affects the ends of long bones, such as in your hip or knees. It can lead to bone damage and collapse, or it may cause the entire bone to die.
X-rays and a computed tomography scan (also known as a CT or CAT scan) can show changes in your tissues and bones if you have necrosis. These tests might be followed by a biopsy to test for certain types of infections or cancers. You might also need a tetanus shot or other immunizations to protect you from further infection.
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Foul odor is one of the earliest symptoms of necrosis. This odor comes from the breakdown of dead tissue, and is usually accompanied by other symptoms and a fever. The odor is caused by hydrogen sulfide produced by bacteria in the affected area. The odor can also be caused by sweat, a lack of saliva, certain medical conditions, dietary choices and certain medications.
A foul odor can also indicate that an infection is serious and needs to be treated right away. Necrotising fasciitis, which is a life-threatening infection, is often accompanied by a foul odor and requires immediate medical attention.
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Although medical science is not able to reverse necrosis, there are some treatments that can slow down or prevent the spread of the condition. For example, antibiotics can treat the infection and help restore healthy tissue.
Infections, toxins, diseases and injuries can trigger necrosis. For example, a blood clot can block the flow of oxygen to an area, resulting in necrosis. If the bacteria Clostridium perfringens enters a cut or wound, it can cause gas gangrene, a severe form of necrosis.
Some patients at risk of developing necrosis include those with diabetes, high blood pressure and peripheral artery disease. People who smoke or use injectable drugs are also at higher risk of the condition.
The first step in treating Necrosis is restoring blood flow to the affected area. This may require surgery. In addition, doctors may treat the area with special medicines or hyperbaric oxygen therapy to speed up healing.