Transcript Presentation

Fever syndrome and
skin ranges at surgical
infections
Department of surgical diseases of TMA for
general practitioners
Lecturer
Fever at surgical
infections
Surgical department
Fever
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increasing of a body temperature as a
result of nonspecific protective-adaptive
organism reaction , described by reorganization
of processes heat regulation and arising in reply
to influence of pathogenic irritants.
Fever distinguished by nature to infectiousinflammatory (viruses, bacterium, parasites) and
noninfectious genesis (autoimmune processes,
allergic diseases, tumours, methabolic syndrome,
application of some medications.
Fever is
Fever
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Fever is a symptom of many diseases, is especial
often it is observed at infections. Increasing of
temperature of a body activates exchange
processes, nervous functions, endocrine,
immune system (increases of development
antibodies, interferon, increases chemotaxis,
phagocytal activity of WBC), the function of a
liver raises , renal circulation is increased . Also
in serum of blood the level of iron, zinc and
copper are decreased, growth and duplication of
microorganisms are broken.
Endogenous pyrogens
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Nowadays it is known 11 cytockins, having
pyrogenous activity, most important of which
are:
IL - 1, IL - 6
Tumour necrose factor-a
Interferons - alpha, beta and gamma
Under action the action of endogenous
pyrogens protein synthesis is stimulated « at an
acute phase », which playing the important role
in specific and nonspecific health protection.
Temperature measuring:
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In rectum or by special catheter for pulmonary
arteries;
In mouth cavity, but low reliable indicator
At armpit, noninformative.
Normal temperature is not more than 37,00С
(98,60F). Fever 37,20С (990 F) is clinically
significant and has to involve physicians
attention.
Changes occurring in organism at
a fever
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Fever accompanies:
Tachycardia. At increasing of body temperature to 10 points
occurs by increasing HR to 10-15 strokes per minute.
Development extrasystoly. Is caused by action of
viruses,bacteria and under activation sympathoadrenal system by
cytockins.
In a phase of rise of temperature increases BP, and in a phase of
decreasing falling down to collaptous condition is also possible.
At achievement of maximal temperature perspiration
considerably grows, that can promote decreasing of CBV and
results in deterioration of a condition of the patients with a
cardiac pathology. Liquid losing also amplifies by increasing of
breath frequency.
Changes occurring in organism at
a fever (continuation)
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Protein occurrence in urine, cylinders and increased
level of creatinine even after normalization of
temperature because of damaging action of a fever.
GI disfunctionsТ. Constipation and malabsordtion.
Amplificationof exchange processes.
At children the development of spasmes is possible.
Increased temperature of a body results in activation
of herpes virus infection .
Fever and hyperthermia
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Hyperthermia arises under influence of high
temperature of an environment, is especial in a
combination to heavy physical loading. At
thermal impact temperature reaches to 42,2 0 C,
that can result in irreversible damage of a brain.
A fever and hyperthermia differ with that
during a fever the activity hypothalamus and
other mechanisms of the temperature control is
directed on maintenance of high temperature of
a body, and at hyperthermia on its reduction.
Fever and hyperthermia
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Fever is exceeded on infectious processes more
than 40,5-41,00С;
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Hypertermia is a pathological condition springs
up when heat production exceeds emission.
Hyperthermia is characterized by significant
increasing of temperature, it usually is higher
than 41 0 C. Is observed at thermal stroke, and
also at tumours and insults with a defeating of
hypothjalamus.
Basic reasons of fever:
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Infection;
Malignant tumours;
Crush syndrome;
infarction;
Hemorrhagic insult;
Drug allergy;
SLE;
Basic reasons of fever:
(continuation)
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gout;
Acute haemolysis;
Endemic infection;
Fever stage of HIV;
simulated.
Fever causing surgical infections:
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Purulent diseases -felon, furuncules, abscess,
phlegmon, periproctitis, bedsore;
Diseases of vessels - lymphangitis,
lymphadenitis, trombophlebitis (superficial and
deep);
Fever causing surgical infections :
(continuation)
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Acute diseases of the abdominal cavity appendicitis, cholecystitis, peritonitis;
Liver and lung abscess, pilephlebitis, surgical
sepsis;
Fever causing surgical infections :
(continuation)
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At osteomyelitis; at thyrotoxicosis;
gynaecologic diseases - at salpingitis, oophorotis.
skin ranges at surgical
infections
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Surgical department of TMA for GP
SKIN CHANGES MIGHT BE OBSERVED AT
FOLLOWING SURGICAL DISEASES:
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obliterating endarteritis;
lower limb varicose veins dilatation;
thrombophlebitis;
phlebothrombosis;
Jaundice;
SKIN CHANGES MIGHT BE OBSERVED AT
FOLLOWING SURGICAL DISEASES:(continuation)
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Hernia: at an inflammation of a hernial sac ;
gangrene of lower limb;
frostbite;
acute pancreatitis.
Skin ranges at acute pancreatitis:
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Mondor^s symptom - violet spots on the face and
trunk.
Hallstad^s symptom - cyanosis of an abdominal wall.
Lagerlaf^s symptom - generalcyanosis of the face and
limbs.
Gray-Turner^s symptom - cyanosis of abdominal
sides.
Gunweld-Devis^s symptom - abdomunal cyanosis
with , petechia on buttocks and brown colouring
Classification of surgical infections
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By clinical current and pathologic-anatomic changes
distinguished:
А. Acute surgical infection.
1. acute purulent infections
2. acute anaerobic infections
3. acute specific infections (tetanus, Siberian ulcer etc.)
4. an acute putrefactive infection
5. acute purulent asporous infections (an anaerobic non
clostridial infection).
Б. Chronic surgical infection.
1. a chronic nonspecific infection
2. a chronic specific infection (tuberculosis, syphilis etc.)
Classification of surgical infections
(continuation)
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By clinical current:
1. acute purulent infections
a. General(common)
b. Local
2. chronic purulent infections
a. General(common)
b. Local
By localization of process :
a. dermal or hypodermic
b. skull, its contents
c. Necks
d. chest, pleural and lung
Classification of surgical infections
(continuation)
e. mediastinal
f. abdominal cavity
g. pelvic
h. Bones and joints
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by aetiology:
a. staphylacoccic
b. streptococcic
c. pneumococcic
d. e.coli
e. gonococcus etc.
Skin boil (лат. furunculus) — acute purulent inflammatory
diseases of of hair follicles and surrounding connective tissue.
Oftenly caused by staphylacoccus aureus, rarely by light
staphylacoccus.
Groin furuncle
Occipital
furuncle
Carbuncle (lat carbunculus) — acute purulently -
necrotic inflammation of several hair follicles
and sebaceous glands by extensive skin necrosis.
Carbuncle can be generated as a result of
distribution of inflammatory process from one
hair follicle to another with a simultaneous
several follicles lesions , and also by mergence
of separate furuncules.
Scapular region
carbuncle
Occipital carbuncle
Hydradenitis — inflammatory disease sweat apocrine
glands, located in armpit and groin areas.
The contributing factors are: raised sweating, nonobservance of rules of personal hygiene, microtrauma of a
skin.
Pathogenesis: the activator of an infection (more often
st.aureus) will penetrate in glands through ducts, by
lymphatic ways or through small damages of a skin .
Inflammatory infiltrate inside glands further is exposed to
purulent melting, and forme abscess.
Hydradenitis
An erisipelatous inflammation (erysipelas) — infectious illness
described by focal serous or serous-haemorragic inflammation of a
skin, fever and intoxication.
Erysipelas is distributed everywhere. Morbidity in various
climatic zones ranges 12 — 20 of cases for 10 thousand
population per one year. More often women are sick.
Aetiology.
The activator of an infection — beta haemolitic streptococcus of
group A — as a bacterial and in the L-form.
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Abscess (lat. abscessus ) — marginated congestion of pus in
various tissues and organs.
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Aetiopathogenesis:
abscess is caused by a purulent infection, which activators will
penetrate from the outside and also endogenous at distribution of
process or carry of activators of an infection from the next or
remote organs: for example, odontogen, tonsillar, subdiaphragmal,
metastatic abscesses of lungs, brain, kidneys, heart, spleen etc.
Introduction in tissues of the concentrated solutions of medicines,
for example 25 % of a solution of MgSO4, can be accompanied
by aseptic necrosis with the subsequent formation of an abscess.
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Abscess features: presence of a pyogenic membrane internal wall of a purulent cavity created environmental center
of an inflammation, by an environmental center, display of
normal protective reaction ). A pyogen membrane lined by
granulation tissue, it margins purulent - necrotic process and
produces exudate.
The differential diagnosis:
-haematoma; -cyst; -disintegrating tumour. Diagnostic puncture
has an important sisnificamce, which allows also to carry out
bacteriological research — allocation of the activator and
definition of its sensitivity to antibiotics.
abscess
abscess
Abscess of abdominal cavity
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Mastitis — an inflammation parenchymatous and
interstitial tissue of breasts.
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Classification:
Distinguish: acute and chronic mastitis.
Depending on a functional condition of breasts
(presence or absence of lactation) allocated:
-lactational
-nonlactational.
On a share of lactational fits 95 % of cases. Thus
most often (up to 85 %)
arises at primipara women.
Depending on localization of the purulent center allocate:
subareolar
subcutaneous
intramammar
retromammar
In view of current inflammatory process acute
mastitis subdivided:
serous (initial)
infiltrative
infiltrative-purulent (apostematous)
abscess
phlegmon
gangrene
Aetiopathogenesis: the entrance gate of activators of an infection is served of a milk
ducts orifices , cracks and excoriations . There is a distribution of an infection by
haematogenic and lymphogenic ways, less often by endogenous ways.
At 95 % of the patients the activator is patogenic staphylacoccs, often (up to 80 %) not
sensitive to broad spectrum antibiotics.
Paraproctitis
An acute paraproctitis is purulent inflammation of
pararectal fatty tissue .
Distinguish:
subcutaneous;
submucous;
sciatic-rectal;
pelvic-rectal;
retrorectal.
Abscess locations in an acute
paraproctitis.
cross (а) upright(б) срезы.
1 - subcutaneous; 2 – sciatic-rectal; 3 – pelvic-rectal;
4 - subcutaneous; 5 - retrorectal.
Clinical presentation
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Strong throbbing pains;
Difficulties on defecation;
Fever (39-40 С) by chills.
In cases of subcutaneous paraproctitis in anal area
occurs redness, has swelled and infiltrated, which are
distributed on buttocks, quite often to the perineum.
Purulent tissue infiltratis quickly progresses, occurs
fluctuation.
Surgical admissions
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An anaerobic infectious disease is an infection caused by
anaerobic bacteria, existing in anaerobic environment.
Classification:
by aetiology:
clostridial (spore forming)
nonclostridial
bacteroid
leptostreptococcous
phusobacterial
By character of microflorae:
Monoinfection - called by one type
Polyinfection - called by 2 or several types
The mixed infection - called by association aerobic and
anaerobic infections
Clinical features of the anaerobic infection
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Without dependence from the localization of the
process has a numberof general and
characteristic attributes:
An unpleasant putrefactive smelling exudate.
Putrefactive character of a lesion.
Dirty poor exudate
Gas generation(foam of gas from a wound,
crepitation, presence of gas above the level of
pus in an abscess cavity ).
Affinity of development to places of natural
anaerobes.
Treatment of an anaerobic infection
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Prevention of duplication and distribution of
an anaerobic infection:
Surgical d-bridement of wounds without
closure;
Wide drainage;
Necrectomia;
Cleaning wounds oxygen-containing antiseptic
antibacterial therapy
Specific serum (antigangrenous 1SOOOO
ME). Enzymotherapy
Application of HBО-THERAPY.
Fournier's gangrene
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Fournier's gangrene is any gangrenous infectious
process damaging external genitals and perineum.
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Aetiology: often develops owing to distribution of an
infection from urinary ways or directly from pararectal
area.
At an anaerobic infection mixed флора includes
facultative organisms (Е.Соli, Klebsiella, Enterococci)
and anaerobics (Bacteroides, Fusobacterium,
Clostridium).
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Aetiology
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Predisposing factors of development :
Diabetus mellitus,
alcochol abuse,
Local trauma,
paraphimosis,
urine periuretral extravasation
pararectal or perineal infections
Clinic:
At early stages has swelled redness of phallus and scrotum;
Then in superficial layers of the skin appears crepitation ,
which is distributed by fascial Collis^s lengthways up to the
abdominal wall;
The presence of a unpleasant smell specifies presence of
an anaerobic infection;
TETANUS
Specific acute infectious disease caused by
sporous anaerobes (Clostridium tetani),
penetrating in to organism through the
injured skin and mucous coats
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Classification
Distinguish the following types of tetanus.
In a place of introduction of the activator:
-traumatic
-puncture
-burn
-postoperational
- frostbite
-electrotraumas.
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By spreading:
1) General (widespread)tetanus;
а) the primary - general form;
б) the descending form;
в) the ascending form, at which spasm
begins with a site of a
wound and are distributed to separate areas with development of trismus;
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2) Local tetanus;
а) limbs (one or more);
б) head
в) of a trunk
г) a combination of the limited localizations (hand, trunk and ect).
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By clinical current:
Acute, with rough current;
Chronic;
Clearly expressed;
The erased form.
By a degree of weight:
Very heavy;
Heavy;
Average weight;
The mild form.
Treatment
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The main tasks of complex treatment of tetanus:
Reduction and neutralization acting from a
wound tetanus toxins;
Reduction and complete termination tonic and
clonic spasmes;
Improvement of a general condition ,
normalization of a cardiac activity, simplification
of lung ventilation;
Preventive maintenance and elimination of
secondary complications.
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The emergency preventive maintenance of
tetanus at skin injuries, burns and frostbites:
Earlier vaccination by 0,5 ml
cleared anatoxin, antitetanus serum is not
allowed ;
-To nonvaccinated patients in the
beginning enter 1 мл anatoxin, and then,
after dermal test, antitetanus serum by
doze 3000 МЕ.
Thanks
for attention