Chair of the general surgery, children's surgery of medical faculty and
surgical illnesses of mediko-preventive faculty
The Tashkent Medical Academy
Lecture for students of a 3-course of mediko-preventive faculty on a
theme: «the Sharp surgical infection»
The lecturer: д.м.н., professor Ergashev U.J.
Composers: д.м.н., professor Ergashev U.J.
TASHKENT 2007
The lecture purpose:
1.
To Give concepts to students about a sharp surgical infection.
2.
Will acquaint students principal views and classifications of sharp
surgical infections.
3.
Will explain to students main principles of diagnostics,
differential diagnostics and treatments of sharp surgical infections.
One of environment factors causing protective organism reactions is
pathogenic microorganisms.
The majority хирургикческих diseases grows out of organism interaction
чедловека and microorganisms. Than quantity and вирулентность more than
microbes попавщих in an organism, the protective forces of an organism
are weaker, the it is more possibility of development of illness and
наборот.
For hit of microbes in an organism owe a life «entrance collars», i.e.
presence of damages of a skin or mucous membranes.
At the heart of preventive maintenance of a surgical infection lies:
ü
Strengthening of protective forces of an organism
ü
Reduction of pollution of a skin by microflora
ü
Reduction of pollution of mucous membranes
Microflora
ü
The Prevention of various damages
ü
Timely surgical processing of wounds
Treatment of already developed surgical infection spend on the basis:
The Maximum increase иммунобиологических forces of an organism
Creations of adverse conditions for microflora development
Material well-being improvement sanitary-gigenicheskogo population level,
and also wide application of antibiotics at purulent diseases promotes
decrease in frequency of development of a surgical infection.
In due course arise new штаммы the microbes, steady against antibiotics
therefore the increase in the purulent diseases demanding surgical
intervention again is marked.
Last years searches of effective methods of struggle with surgical an
infection have led again to studying of own protective forces of an
organism, their activization and purposeful creation with which the
clinical immunology is engaged.
CLASSIFICATION of a surgical infection:
А a sharp surgical infection:
1.
The Sharp purulent infection
2. Sharp анаэробная an infection
3. A sharp specific infection (a tetanus, the Siberian ulcer, etc.)
4. A sharp putrefactive infection
B. chronic surgical infection:
1.
The Chronic nonspecific infection
2. A chronic specific infection (a tuberculosis, a syphilis, актиномикоз,
etc.)
On a clinical current:
1. A sharp purulent infection:
The general
The local
2. A chronic purulent infection:
The general
The local
On defeat localisation:
Skin and hypodermic клетчатки
Covers of a skull, its contents
Necks
The Chest wall, a pleura, lungs
Sredostenija
Brjushiny and bodies of a belly cavity
The Basin and its bodies
Bones and joints
On an aetiology:
ü
Staphylococcal
ü
Streptococcal
ü
Pnevmokokkovaja
ü
Kolibatsilljarnaja
ü
Sinegnojnaja
ü
Mixed, etc.
At the heart of the organisation of the prevention and struggle against a
sharp surgical infection lies:
Ø
Traumatism preventive maintenance
Ø
First aid and treatment of the victims having open damages
Ø
The Strict observance of laws асептики in all surgical work and in a
life
Ways инфицирование wounds:
v
Endogennyj
v
Ekzogennyj
Sharp purulent (анаэробная) an infection
One of the most frequent kinds of a surgical infection is the sharp
nonspecific purulent infection with a characteristic heavy clinical
current against the expressed purulent intoxication.
Activators surgical infections
Stafilokokki
Streptococci
Pnevmokokki
Gonokokki
The Intestinal stick
Various kinds протея
Group клебсиелл
Sinegnojnaja a stick
Group бактериоидов
Peptokokki
Klostridii
Патогенез and reaction of an organism to a purulent infection
In development of a purulent infection value of a condition of skin and
mucous barriers is great. Intact a skin and mucous are an absolute
obstacle for penetration of microbes into an organism. Influence of
mechanical and other factors causes damages эпидермиса and эпителия
mucous and by that opens «entrance gate» for an infection. Microbes
easily get to an organism even at the most insignificant microtraumas,
get into interfabric spaces, then in lymphatic system, and with a lymph
current - in deeper fabric layers.
The further development of a surgical infection and distribution of
purulent process depend:
- From иммунологического organism conditions
- From вирулентности microbes
In development of a surgical infection the big role plays:
1. Anatomo-physiological features of fabrics
2. Immunobiologichesky features of fabrics
To development of a sharp purulent infection promote:
1. Infringement трофики skin in the field of entrance gate (a hemorrhage,
некроз)
2. A polyinfection (синергическое influence of several kinds of microbic
flora)
3. A superinfection (introduction or drift of new kinds of the microbes,
different expressed вирулентностью).
Local signs of a surgical infection:
Reddenings
The Hypostasis
The Pain
Temperature
Infringement of functions of the amazed fabrics and bodies
Degree of expressiveness of these symptoms depends on reactance of an
organism.
Distinguish following kinds of reaction of an organism on an
inflammation:
- гиперергическую
- нормергическую
- анергическую
Hyperergichesky reaction:
For this reactions fast development of purulent process, a hypostasis
expressed лимфаденит and a thrombosis of blood vessels, surrounding the
inflammation centre is characteristic. These processes are quite often
accompanied by sharp deterioration of the general condition of an
organism and can will end with death.
Normergichesky reaction
At this reaction process proceeds more slowly, is accompanied by moderate
fabric reaction (a moderate hypostasis), rather low temperature and small
лейкоцитозом. Normergichesky reaction successfully gives in to treatment
if it is in due time begun and прапвилно is spent.
Anergichesky reaction
This kind of reaction is characterised слабовыраженной by the general and
local semiology - the inflammation proceeds against almost not expressed
fabric hypostasis, has local character, is accompanied normal or
субфебрильной by temperature. When immunity of an organism is expressed,
diseases easily gives in to therapy or passes spontaneously. If
иммунность an organism it is lowered, process has malignant character.
Each sharp inflammatory process is accompanied also by the general
reaction of an organism which depends:
ü
From вирулентности microflorae
ü
From intensity всасывания products of fabric disintegration
ü
From reactance of a macroorganism
Display of the general reaction of an organism:
Gektichesky temperature
Fever
Headaches
Weakness
Consciousness infringements
Tachycardia
Frustration of function of a liver
Frustration of function of kidneys
Treatment principles
Conservative which it is spent to stages инфильтративного an inflammation
Local treatment:
- Rest
Local applications of antiseptics
Physiotherapeutic procedures
Novokainovye of blockade
The general treatment:
Struggle against a purulent intoxication
Activization of protective properties of an organism
Decrease вирулентности microorganisms
Improvement of functions of vitals
Stimulation of regenerative abilities of fabrics
Struggle against a purulent intoxication:
1.
Evacuation of purulent contents.
2.
Applications of preparations of antitoxic action: физ. A solution, 5
% a glucose solution, лактосоль, a haemomisinformation, поливинол,
желатиноль.
3.
Oksigeno - and витаминотерапия
4.
Improvement of function of a liver and kidneys
Activization of protective forces of an organism:
Ø
Transfusion свежеконцентрированной blood and эритроцитарной weights
Ø
Active immunization: applications анатоксина, special vaccines
Ø
Passive immunization: applications
Staphylococcal
antitoxin, antistaphylococcal plasma or scaleThe globulin specific
бактериофага
Application of antibiotics:
ü
Local application of antibiotics
ü
ü
ü
ü
ü
ü
Intrabone introduction
Intravenous introduction
Intraarterial introduction
Vnutriaortalnoe introduction
Intratrahealnoe introduction
The Combination выщеукзаннных ways
Энзимотерапия
v
Local application
v
By means of inhalation
v
Parenteralnoe introduction
Principles of operative treatment:
Preoperative preparation: гигеническая a bath, an enema, a toilet of an
operational field.
Anaesthesia:
- The local: инфильтрационная, проводниковая
- The general anaesthesia: intravenous, The inhalation
Operational cut:
Owe a life to the wide
It is if necessary supplemented with counterapertures
Follows дренировать an abscess двухпросветными drainage tubes
Local purulent diseases
Фолликулит
The purulent inflammation of a hair sack is called фолликулитом.
At фолликулите round a hair sack the painless purulent vial is formed
Treatment - conservative
The Furuncle
The purulent inflammation of a hair sack and skin sebaceous gland is
called as a furuncle.
The furuncle appears in those places which usually are exposed
травматизации clothes - in the field of a neck, waists, hips, on a back
more often.
Furuncle clinic:
The Skin itch
Pricking pains
Skin Reddening
A skin Hypostasis
Subfebrilnaja temperature
Furuncle complications:
Thrombophlebitis of obverse veins
Thrombophlebitis of brain sine
Лимфаденит
Phlegmon
Purulent arthritis
Sepsis
Furuncle treatment:
Processing of the centre of 70 % by spirit
Shaving of hair around the centre
Obkalyvanie of the centre solutions of antibiotics
The Confinement to bed
The Immobilization of the amazed extremity
Antibiotikoterapija
Sulfanilamidy
Physiotherapeutic procedures: УВЧ, соллюкс, quartz
Bandages with hypertensive solutions
Карбункул
Карбункулом name the sharp inflammation of several hair sacks poured
purulent-nekroticheskoe and sebaceous glands with formation of the
general инфильтрата and некрозом skin and hypodermic клетчатки.
Clinic карбункула:
Appreciable rise in temperature of a body and a fever
-
Occurrence dense, painful inflammatory инфильтрата
The Hypostasis and pressure of a skin
Sine-crimson colouring of a skin
Formation некротической zones in a kind a sieve
The Nausea, vomiting
Headaches
The Sleeplessness
Complications карбункула:
Ø
The Thrombophlebitis and лимфангит
Ø
The Thrombosis пещеристой and сигмовидной bosoms
Ø
The Sepsis
Ø
The Purulent meningitis
Treatment карбункула is spent in stationary conditions which includes:
At an initial stage новокаиновые blockade with antibiotics
The Confinement to bed
The Immobilization
Anesthesia
Antibiotikoterapija and сульфанильамиды
Operative treatment under the general anaesthesia
Гидраденит
The purulent inflammation апокринных потовых glands is called
гидраденитом.
Clinic гидраденита:
1.
Localization: axillary area, sexual and перианальная area, mammary
gland area.
2.
Occurrence of painful knot in hypodermic клетчатке soldered to a
skin.
3.
The Sinevato-pink shade of a skin
Treatment гидраденита:
Ultra-violet therapy
Applications УВЧ
Novokaino-antibiotikovye
инфильтрационные blockade
Rentgenoterapija in small doses
Antibiotics, сульфаниламиды
Autogemoterapija
In cases абсцедирования инфильтрата
The operative is shown
Treatment
Abscess
The limited congestion of pus in fabrics is called as an abscess which
meets in hypodermic клетчатке, muscles, bones, and in an internal (lungs,
a liver, kidneys, and also in a brain.
Abscess clinic:
Ø
Pains of pulsing character
Ø
The Swelling and skin reddening
Ø
Fluctuation (зыбление)
Ø
Body Rise in temperature
Ø
Lejkotsitoz with formula shift to the left
Abscess treatment:
In the beginning it is applied conservative (warming compresses, hotwater bottles, соллюкс, УВЧ, a rest mode) measures to abscess
restriction.
At fluctuation occurrence operative treatment - abscess opening.
Phlegmon
As phlegmon is called the sharp poured inflammation of fabrics which is
observed more often in a friable connecting fabric.
Clinic:
Pains
Fever
High temperature of a body (40оС)
The general an indisposition
Phlegmon Treatment:
Conservative therapy it is admissible only at an initial stage of
disease. At its further development urgent operative intervention is
necessary.
Physiognomy
The physiognomy is a progressing acute inflammation of a skin, is more
rare than the mucous membranes which activator is the streptococcus And.
Physiognomy Clinic
The sudden beginning
High temperature and fever
Headaches
Skin reddening in a kind "tongues of flame"
Hypostasis and morbidity of a skin
Clinical forms of a physiognomy:
Eritematoznaja physiognomy
Буллезная
Флегмонозная or гангренозная
Eritematoznaja a physiognomy
At this form of a physiognomy there are reddenings of a skin and a
hypostasis which in process of process attenuation disappear.
Bulleznaja the physiognomy form
The bulleznaja form of a physiognomy is characterised by occurrence of
skin bubbles which contain yellowish, muddy or геморрагический экссудат.
Flegmonoznaja the physiognomy form
If the purulent infection joins inflammatory process and arises некроз
skin, are formed флегмонозная or гангренозная the form erysipelatous a
skin inflammation.
Physiognomy treatment
Sulfanilamidy (streptocide) in the form of powders местно
Greasing of the amazed sites by diamond greens
Reception сульфаниламидных preparations (streptocide, этазол,
сулфодиметоксин, etc.)
Antibiotics whenever possible эндолимфатическое introduction
Passive immunization application of an antistreptococcal vaccine of
10-20 ml
Vitaminoterapija
Desensibilizirujushchie of means - a Dimedrol, etc.
At флегмонозной to the form opening of the purulent centre
Sharp парапроктит
парапроктитом the purulent inflammation околопрямокишечной клетчатки is
called as sharp
Distinguish: hypodermic, подслизистый, sedalishchno-prjamokishechnyj,
tazovo-prjamokishechnyj and behind-prjamokishechnyj парапроктиты.
Clinic sharp парапроктита:
Strong pulsing pains in the field of an anus
Difficulty дефекации
Gektichesky temperature a fever
Occurrence painful инфильтрата extending to buttock area
Fluctuation
The Cyanotic shade of a skin over инфильтратом
Treatments sharp парапроктита consists urgent operative intervention
under anaesthetic.