Compare and contrast gas gangrene and wet gangrene.

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Week 6 Disseminated Intravascular Coagulation Case Study
Case Study: A 60-year-old Type I diabetic presents with discoloration of his right leg. The pathogen is clostridium perfringens.
Compare and contrast gas gangrene and wet gangrene.
Compare and contrast apoptosis and necrosis.
Identify the mechanism of cellular injury.
How did diabetes contribute to this condition?
1.) Gangrene is a type of tissue necrosis generally caused by infection, ischemia, or both (Buttolph & Sapra, 2021). Wet gangrene is the result of liquefaction necrosis, which occurs when caustic enzymes dissolve necrotic cells (Dlugash & Story, 2021). It can also be accompanied by infection. In this scenario, the byproduct of necrosis mixes with white blood cells and produces a liquid wound. Gas gangrene, on the other hand, is caused by bacteria that release toxins that destroy surrounding cells. It is characterized by the gas, a byproduct of the tissue lysis, that is trapped under the skin. This type of gangrene is caused by the clostridium pathogen and is the most damaging, spreads rapidly, and has the potential to be life-threatening (Dlugash & Story, 2021).
2.) Apoptosis is programmed cellular death (Dlugash & Story, 2021). It is not a pathological process. It is quite the opposite, in fact. It is a physiological process to rid the body of cells that are damaged in some way. The different apoptosis pathways can be triggered by things such as DNA damage, nutrient deprivation, hypoxia, etc. (Chen et al., 2018). In contrast, necrosis is generally considered to be a pathological process. This is unscheduled or accidental cell death in response to unintentional injuries or stressors. Necrosis is usually the result of hypoxia or bacterial invasion (2021).
3.) Clostridium perfringens is an anaerobic bacteria that spreads quickly, by the process of fermentation, in an oxygen-poor environment. Its virulence depends on the cytotoxins it produces, such as alpha and theta toxins (Buboltz & Murphy-Lavoie, 2021). Alpha toxin is a phospholipase (lecithinase) that breaks down cell membranes triggering platelet aggregation, thrombosis, and histamine release Theta toxins cause direct vascular injury and breakdown of leukocytes causing blunted host inflammatory response to the infection (2021). These processes cause widespread cellular destruction and waste gases to be released in the tissues.
4.) Gangrene is a condition that develops from impaired blow flow and infection. Diabetes is a condition that, over time, causes changes atherosclerotic-like changes in the vasculature that lead to diminished flow to the tissues, resulting in diffuse ischemia and necrosis (Dlugash & Story, 2021). Also, ischemia of the nerves causes diminished sensation, pre-disposing people to injuries that go undetected and untreated. When anaerobic bacteria, such as clostridium perfringens are introduced to tissues that are ischemic and have high glucose levels for them to feed on, they proliferate. Because diabetes further diminishes the immune response, the infection spreads unchecked.
Buboltz, J.B. & Murphy-Lavoie, H.M. (2021, January 11) Gas Gangrene. StatPearls
Buttolph, A., & Sapra, A. (2021, February 23). Gangrene. StatPearls
Chen, Q., Kang, J., & Fu, C. (2018). The independence of and associations among apoptosis, autophagy, and necrosis. Signal transduction and targeted therapy, 3(1), 1-11.
Dlugasch, L. & Story, L. (2021). Applied pathophysiology for the advanced practice nurse. Jones & Bartlet Learning.