GANGRENE
GANGRENE: Excerpt from Algorithmic Diagnosis of Symptoms and Signs
Ask the Following Questions:
- Does it involve the upper or lower extremity? Involvement of the upper extremities should suggest Raynaud's disease, scleroderma, and other collagen diseases.
- Are there good peripheral pulses? The complete absence of a peripheral pulse, particularly if it is sudden onset, should suggest an arterial embolism. If it is gradual onset, suspect arteriosclerosis or diabetic ulcer.
- Are there signs of systemic disease? If there are other signs of systemic disease, collagen disease, macroglobulinemia, and cryoglobulinemia should be suspected.
- Is the gangrene sudden in onset? A sudden onset of the gangrene should make one suspect clostridia infections or arterial embolism.
- Is there a positive culture? The culture will be positive in clostridia infections, anthrax, and cancrum oris.
DIAGNOSTIC WORKUP
Routine orders include a CBC, sedimentation rate, chemistry panel, VDRL test, serum protein electrophoresis, ANA titer, and glucose tolerance test. The gangrenous area should be cultured. Plain x-rays of the area sometimes are helpful. If there are diminished pulses, especially if the onset is acute, angiography will be useful. A muscle biopsy or skin biopsy will be useful in diagnosing collagen diseases. The Sia water test and serum immunoelectrophoresis will be useful in diagnosing macroglobulinemia and cryoglobulinemia.
Book Source Details
- Book Title: Algorithmic Diagnosis of Symptoms and Signs
- Author(s): R. Douglas Collins
- Year of Publication: 2003
- Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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