GANGRENE
GANGRENE: Excerpt from Differential Diagnosis in Primary Care
The mneumonic VINDICATE will help formulate a useful list of
possible causes of gangrene.
V—Vascular. Gangrene is seen in peripheral arteriosclerosis, Buerger
disease, thrombosis of the large arteries such as the femoral artery,
thrombosis of the terminal aorta, and arterial embolism.
I—Infection. Gas gangrene is typically produced by Clostridium perfringens and other
clostridia. Streptococci, peptostreptococci, and staphylococci can produce
progressive bacteria-synergistic gangrene.
N—Neoplasm and neurological. Cryoglobulinemia and multiple myeloma are associated with the Raynaud
phenomenon producing gangrene in the fingers. Peripheral neuropathy,
syringomyelia, transverse myelitis, and tabes dorsalis may be associated
with gangrene.
D—Degenerative diseases are not generally associated with gangrene.
I—Intoxication should bring to mind the gangrene associated with the
use of ergot alkaloids.
C—Congenital disorders are not usually associated with gangrene.
A—Autoimmune disease. Lupus erythematosus, sclerederma,
periarteritis nodosa, and RA may be associated with the Raynaud phenomenon
and gangrene.
T—Trauma. Laceration of a major artery to an extremity or pressure
from splints may cause gangrene. Extreme cold will produce gangrene from
frostbite.
E—Endocrinedisorders bring to
mind the well-known diabetic gangrene.
Approach to the Diagnosis
All patients should have a CBC, sedimentation rate, venereal disease
research laboratory (VDRL) test, chemistry panel, and serum protein
electrophorosis. In cases of the Raynaud phenomenon, an ANA and RA
titer should also be done. Aerobic and anaerobic cultures of exudates
from the wound should also be taken. Plain x-rays of the area involved are
recommended. If an embolism or obstruction of the large arteries is
suspected, contrast angiography needs to be done. An ice water test, Sia
water test, and serum immunoelectrophoresis will be useful in cases of the
Raynaud phenomenon. A rheumatology consult is wise.
Book Source Details
- Book Title: Differential Diagnosis in Primary Care
- Author(s): R. Douglas Collins MD, FACP
- Year of Publication: 2007
- Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.
More About Buerger's disease
More Medical Textbooks Online about Buerger's disease
Review other book chapters online related to Buerger's disease:
Medical Books Excerpts
- GANGRENE
- "Algorithmic Diagnosis of Symptoms and Signs" (2003)
- [ read ]
- GANGRENE
- "Differential Diagnosis in Primary Care" (2007)
- [ read ]
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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