Necrosis
Necrosis is the process of tissue damage that occurs as a result of cell death, often affecting localized areas of the body. This degeneration typically arises from causes such as ischemia (reduced blood flow), traumatic injury, bacterial infections, or exposure to toxins, including excessive alcohol. Initially, necrosis may present no symptoms, but as it progresses, individuals may experience pain, reduced range of motion, and the formation of gangrenous tissue. The damage inflicted by necrosis is permanent and irreversible, making treatment focused on minimizing further tissue injury rather than restoring the affected area. Common treatments include pain relievers, antibiotics for infections, and surgical interventions, especially in cases of avascular necrosis, where blood supply to bone tissue is compromised. Historically, the understanding of necrosis has evolved from ancient observations to modern interpretations using advanced microscopy. The term itself has been linked to discussions on tissue breakdown dating back nearly two millennia. Awareness of necrosis is crucial for timely intervention, which can help prevent further complications.
Necrosis
ALSO KNOWN AS: Gangrene, mortification
ANATOMY OR SYSTEM AFFECTED: Bones, cells
DEFINITION: Tissue damage occurring as a result of cell death.
CAUSES: Cell death leading to degeneration of tissue over time
SYMPTOMS: Pain, tissue decay
DURATION: Permanent, irreversible
TREATMENTS: Pain relievers (NSAIDs), surgery
Causes and Symptoms
“Necrosis” refers to the degeneration of cells or tissues after cell death occurs for any reason, generally in localized regions of the body. Thus, necrosis is tissue degeneration, which occurs secondary to cell death from any cause. Necrosis is most commonly the result of ischemia, traumatic injury, bacterial infection, or toxins (including excessive or alcohol).
In its earliest stage, there are often no symptoms of necrosis. Tissue damage begins to occur within twelve hours of cell death. When symptoms do begin to occur, they range from to decreased range of motion and pain to the development of gangrenous tissue.
Treatment and Therapy
The damage done to the tissue resulting from cell death is permanent. Any treatment of necrosis is aimed at minimizing further cell death and tissue injury. In the case of heart disease, treatment of the underlying condition to alleviate prevents further cell death from ischemia. In the case of bacterial infection, antibiotics are used to treat the infection and prevent cell death and tissue damage. In the case of necrosis of bone tissue from decreased blood supply, the aim of treatment is to minimize further bone loss. This type of necrosis, known as “avascular necrosis” or “osteonecrosis,” is treated with nonsteroidal (NSAIDs) to relieve pain, exercise to improve range of motion, electrical treatment to stimulate bone growth, or surgery to reshape or graft bone or to replace joints.
Perspective and Prospects
The term “necrosis” was used nearly two thousand years ago in ancient Greek textbooks to refer to changes within tissue, long after cell death had occurred, that were visible to the naked eye. With the advent of light microscopy, the tissue damage following cell death became visible within twelve to twenty-four hours.
In 1859, Rudolf Virchow, in his renowned text Cellular Pathology as Based upon Physiological and Pathological Histology, discussed degeneration, necrosis, mortification, and gangrene, using these terms more or less synonymously. It should be noted that he used the term “necrosis” to refer to an advanced stage of tissue breakdown. At this point, the breakdown had to be visible to the naked eye, since light had not yet been developed. Today, using the microscope, tissue damage resulting from cell death is obvious and often identical whether caused by ischemia, traumatic injury, bacteria, or toxins.
Bibliography
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Slouma, Maroua. "Effect of Tumor Necrosis Factor Inhibitors on Hip Involvement in Ankylosing Spondylitis: Is Structural Repair Possible?" The Journal of Rheumatology, vol. 51, no. 1, Jan. 2024, doi.org/10.3899/jrheum.2023-0446. Accessed 3 Apr. 2024.
Zhang, Guangzhi. "Regulated Necrosis, a Proinflammatory Cell Death, Potentially Counteracts Pathogenic Infections." Cell Death & Disease, vol. 13, no. 637, 22 July 2022, doi.org/10.1038/s41419-022-05066-3. Accessed 3 Apr. 2024.