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Old 10-31-2010
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Heart question - types of necrosis

INPATIENT/ ER/ CLINIC/ OTHER ER
PATIENT PROFILE - 49 yo male with chest pain, diaphoresis, and light headedness, sx started 2 hours ago, ekg shows ST elevation in II,III and aVF
QUESTION if not treated aggressively, what type of cell injury this patient will most likely result in?
A Coagulative necrosis
B Liquefactive necrosis
C Caseous necrosis
D Enzymatic fat
E Fibrinoid
F Gummatous
G Gangrenous dry

please explain all types of necrosis and pathogenesis if possible
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Old 10-31-2010
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C- coagulative necrosis, which is the type that occurs in myocardial infarct. I remember this because when I think coagulation I think bloody. This can also happen in liver or kidney, i.e. very vascular organs.
Liquifactive is when the tissue is liquified or mushy, and usually occurs in brain.
Caseous means "cheeselike", and you can usually see this in lungs infected with TB.
Enzymatic fat is when the damage to the pancreas cause it to leak lipases, so the pancreas digests itself and nearby tissues, such as intestines.
Gangrenous usually occurs in the setting of a would infection and affects limbs (think diabetic foot) or GI.
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Absolutely - Coagulative necrosis
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A Coagulative necrosis heart, liver, kidney
B Liquefactive necrosis brain
C Caseous necrosis tuberculosis, fungi
D Enzymatic fat pancreas
E Fibrinoid immunologic injuries, small blood vessel vasculitis, vegetations in rheumatic heart dis and libman-sacks
F Gummatous tertiary syphilis
G Gangrenous dry ischemic coagulative

This is transmural ischemia of inferior wall
Persistence of ischemic cardiac pain or complete cardiac muscle ischemia for longer than 30minutes is associated with progressive myocyte death in affected vascular territory
Within the infarcted myocytes, macromolecules first denature (rather than undergoing immediate enzymatic degradation), leading to coagulative necrosis
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A Coagulative necrosis
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