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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 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 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 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: 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 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) 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 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 Fever is exceeded on infectious processes more than 40,5-41,00С; 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: Infection; Malignant tumours; Crush syndrome; infarction; Hemorrhagic insult; Drug allergy; SLE; Basic reasons of fever: (continuation) gout; Acute haemolysis; Endemic infection; Fever stage of HIV; simulated. Fever causing surgical infections: Purulent diseases -felon, furuncules, abscess, phlegmon, periproctitis, bedsore; Diseases of vessels - lymphangitis, lymphadenitis, trombophlebitis (superficial and deep); Fever causing surgical infections : (continuation) Acute diseases of the abdominal cavity appendicitis, cholecystitis, peritonitis; Liver and lung abscess, pilephlebitis, surgical sepsis; Fever causing surgical infections : (continuation) At osteomyelitis; at thyrotoxicosis; gynaecologic diseases - at salpingitis, oophorotis. skin ranges at surgical infections Surgical department of TMA for GP SKIN CHANGES MIGHT BE OBSERVED AT FOLLOWING SURGICAL DISEASES: obliterating endarteritis; lower limb varicose veins dilatation; thrombophlebitis; phlebothrombosis; Jaundice; SKIN CHANGES MIGHT BE OBSERVED AT FOLLOWING SURGICAL DISEASES:(continuation) Hernia: at an inflammation of a hernial sac ; gangrene of lower limb; frostbite; acute pancreatitis. Skin ranges at acute pancreatitis: 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 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) 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 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. Abscess (lat. abscessus ) — marginated congestion of pus in various tissues and organs. 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. 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 Mastitis — an inflammation parenchymatous and interstitial tissue of breasts. 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 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 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 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 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 Fournier's gangrene is any gangrenous infectious process damaging external genitals and perineum. 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). Aetiology 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 Classification Distinguish the following types of tetanus. In a place of introduction of the activator: -traumatic -puncture -burn -postoperational - frostbite -electrotraumas. 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; 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). 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 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. 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