Necrosis: Symptoms, Types, Risk factors & Treatment

 

Necrosis is a medical term for the death of body tissue. When cells in your tissues die, they can harm various parts of your body, including your bones, skin, and organs. Necrosis can result from illness, infection, injury, disease, or a lack of blood flow to your tissues.

Necrosis (from Ancient Greek vέκρωσις (nékrōsis) 'death') is a type of cell damage that causes the premature death of cells in live tissue by autolysis. The term "necrosis" first appeared in the mid-nineteenth century and is often attributed to German pathologist Rudolf Virchow, who is widely recognized as one of the pioneers of contemporary pathology.

 Necrosis is induced by stimuli outside the cell or tissue, such as infection or trauma, which promote unregulated digestion of cell components. In contrast, apoptosis is a natural, intentional, and targeted cause of cellular death. While apoptosis is usually beneficial to the organism, necrosis is virtually always harmful and can be fatal.

Also Read: Tetanus: Symptoms, Causes, Treatment & Prevention

What is necrosis?

Necrosis is the death of cells within your body's tissues. Necrosis can result from accidents, infections, or diseases. Necrosis can be caused by a lack of blood supply to your tissues, as well as extreme environmental conditions. Dead body tissue can be removed, but it cannot be brought back to health.

What are the different patterns of necrosis?

When your body's cells die from necrosis, they form various patterns and looks. The dead cells can occur in one of six ways. These patterns include the following:


Coagulative necrosis.
In coagulative necrosis, dead cells remain hard and appear normal for several days after death. Coagulation necrosis can occur when there is a lack of blood flow or oxygen to any part of your body other than the brain.

Liquefactive necrosis.
Liquid necrosis causes dead cells to partially or totally disintegrate within hours of death. Then they turn into a thick, sticky liquid. Pus is developing in the cells, which seem creamy yellow. Infections and a shortage of oxygen in the brain can both cause liquefactive necrosis.

Fat necrosis
Fat necrosis occurs when injured cells release enzymes, causing them to become liquid. The liquid cells interact with calcium to form chalky, white deposits on the cells. Acute pancreatitis is the leading cause of fat necrosis. It can also appear in breast tissue.

Caseous necrosis.
In caseous necrosis, the dead cells appear white and soft. They've been described as resembling cheese; the term caseous means "cheese-like." Tuberculosis is an infectious lung disease that is characterized by caseous necrosis.

Fibroid necrosis
In fibrinoid necrosis, the dead cells are pink and lack structure. This is because plasma proteins (fibrins) are leaking through your blood vessel walls. Fibrinoid necrosis develops when an autoimmune disease or an infection damages your blood vessels.

Gangrenous necrosis.
With gangrenous necrosis, your skin turns black and begins to rot. Gangrenous necrosis can occur when your legs do not receive enough blood supply. It can also affect your arms and fingers.

What are the different types of necrosis?

Necrosis can affect various parts of your body, including your bones, skin, and organs. There are several types of necrosis, including:


Avascular necrosis (osteonecrosis).

Avascular necrosis has numerous names. Avascular necrosis is also known as osteonecrosis, aseptic necrosis, or bone necrosis. Avascular necrosis develops when blood flow to bone tissue is blocked. A lack of blood flow to your bones leads them to break down and eventually die. Hip necrosis is the most common type of avascular necrosis.

Osteonecrosis of the Jaw

ONJ is a type of avascular necrosis. ONJ is a mouth (oral) disorder that develops when cells in your jawbone die. Osteonecrosis of the jaw can result in significant mouth and jaw pain. Additionally, pus may seep from your mouth and jaw.


Pancreatic necrosis.

Pancreatic necrosis is a serious complication of acute pancreatitis. When the blood supply to your pancreas is cut off, your pancreatic tissue may die. When this occurs, your pancreas may get infected. The infection can spread to your bloodstream (sepsis), causing organ failure.

Fat necrosis of the breast

Fat necrosis of the breast is a noncancerous (benign) disorder that can develop when fatty breast tissue becomes injured. Your body generally restores injured breast tissue with scar tissue. In fat necrosis, certain fat cells die rather than produce scar tissue. This creates a pocket of greasy fluid known as an oil cyst.
 

Acute tubular necrosis.

ATN, also known as tubular necrosis, is a kidney disorder.   A kidney disorder can result from damage to your kidney's tubule cells. The tubules are microscopic channels in your kidneys that filter your blood as it travels through them.

Radiation necrosis.

Radiation necrosis is an uncommon adverse effect of receiving high-dose radiation to the brain, head, or neck. It can lead to the permanent death of brain tissue.


Renal papillary necrosis.

Renal papillary necrosis is a kidney condition in which the renal papillae of the kidneys die. The renal papillae are the apertures of the tubes (ducts) that enter your kidneys and drain urine into your bladder.


Skin necrosis, or gangrene

Skin necrosis (gangrene) happens when blood flow to your body's tissues or internal organs is disrupted. It can also result from a bacterial infection. It most usually affects your fingers, toes, hands, and feet, although it can occur anywhere on your body.

Spider bite necrosis

A recluse spider bite can cause necrosis. A recluse spider's venom can produce a skin-decaying wound. However, necrosis from a spider bite is uncommon.


Pulp necrosis

Pulp necrosis occurs when the soft tissue (pulp) within your tooth dies. Each of your teeth contains a chamber that stores little fragments of flesh. Each chamber contains blood vessels and nerves. If a tooth is injured or decayed, the flesh may become infected and die.

Risk Factors:

Age makes you more vulnerable to conditions that can cause necrosis, such as trauma and vascular disease. This makes age one of the most significant risk factors for necrosis.

Abusing alcohol also increases your risk of getting necrotic tissue. Alcohol is cytotoxic, which means it is toxic to your cells. Long-term alcohol abuse can destroy liver cells and cause necrosis in the liver.

An open wound, such as an abscess or surgical incision, increases the chance of infection and thus necrosis. Traumatic traumas and insect bites are other risk factors for necrosis.

Long-term corticosteroid use, such as prednisolone, is connected with an increased risk of necrosis. Necrosis is a typical side effect of the autoimmune disease lupus. People who use corticosteroids to manage lupus symptoms are at an increased risk.

Other factors that raise the risk of necrosis include:

• Diabetes mellitus

• Vascular disease

• Chronic renal (kidney) failure

• HIV

Symptoms:

The symptoms of necrosis differ depending on where the necrotic tissue has formed in your body. For example, indications of necrosis in your kidneys include:

• Back or flank pain

• Bloody, cloudy, or black urine

• Painful or frequent urination

• Urinating in huge quantities or often at night

When necrosis results from a wound, symptoms may include:

• Johns Hopkins Medicine. Infection of soft tissues that causes necrosis.

• Symptoms may include severe pain, high fever (over 100.4 degrees), or chills.

• Rapid heartbeat (over 100 beats per minute)

• Numbness or discomfort extending beyond the wound

• Rapid spread of redness from the wound.

• Pain and warmth around the wound

• Skin Blisters

• A crackling feeling beneath the skin (crepitus).

• Grayish, odorous liquid pouring from the incision.

• Symptoms may include difficulty thinking properly and excessive sweating.

Treatment:

A full blockage of blood flow is frequently painful, and it should prompt someone to seek medical attention right away.

Surgery to restore blood flow or remove injured tissues, antibiotics to prevent or treat infection, and treatment for the burn or other conditions that caused the initial injury are all possible options.

In many cases, necrosis treatment begins with determining and addressing the source of cell death. The most critical objective is to restore blood flow to the damaged areas in order to prevent additional harm.

After the blood flow is restored, which may necessitate surgery, any dead tissue can be removed.

Removal of Tissue

The removal of necrotic tissue, also known as surgical debridement, prevents infection from spreading. Amputation of a limb is also an option for treatment.


Medication

Antibiotics and antifungal medications are recommended to treat the infection.

Hyperbaric Oxygen Therapy

Hyperbaric oxygen therapy utilizes a pressurized oxygen chamber to increase the amount of oxygen available to your red blood cells. This may aid in wound healing, although the evidence is equivocal.

Tetanus immunization

Your healthcare professional may recommend a tetanus injection to protect you against additional infections.

References

• U.S. National Library of Medicine. Osteonecrosis (https://medlineplus.gov/osteonecrosis.html). Accessed 8/9/2022.

• Adigun R, Basit H, Murray J. Cell Liquefactive Necrosis (https://www.ncbi.nlm.nih.gov/books/NBK430935/). [Updated 2021 Aug 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan. Accessed 8/9/2022.

• U.S. National Library of Medicine. Acute tubular necrosis (https://medlineplus.gov/ency/article/000512.htm). Accessed 8/9/2022.

• Khalid N, Azimpouran M. Necrosis (https://www.ncbi.nlm.nih.gov/books/NBK557627/). [Updated 2022 Mar 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan. Accessed 8/9/2022.