IV. Table of contents of teaching.

General etiologic and pathogenetic machineries of development of local festering diseases.

Under a surgical infection the diseases which are caused by living exciters are understood, are characterized by formation of local hearths of inflammation, by the specific reactions of organism on exciter and require surgical medical treatment. They are characterized alongside general features. Foremost for the origin in the organism of hearth of festering inflammation definite terms are needed: microbes exciter, damage of protective barriers and local factors of unspecific resistant, immunodeficiency state.

The first condition is the presence of microbes exciter which getting in an organism, causes festering inflammation. Different microbes can be exciters, but all of them must own definite properties. It is virulence and pathogenicity, that is power to propagate oneself and cause an infectious process in macroorganism, overcoming his protective machineries.

The second condition is the damage of protective barriers and factors of local unspecific resistant of organism. It is known, that fabrics of still human organism constantly contact by different microbes, including absolutely pathogenic. At unclipped normal fabrics the microbes are not able to show the pathogenic properties. However combination of infection with alteration of fabrics, that is by their damage with violation of vital functions enables to the microbes exciter and his toxins to show the pathogenic properties and spread lymphatic, hematogenic or contact way.

The third condition is violation in the immune system of organism with development of the immunodeficiency states. In such cases by the exciters of festering process there can be not only pathogenic but also conditional-pathogenic microorganisms which in a norm are not sufficient characteristics for initiation of disease.

Exciters of local festering surgical diseases very various and take place from different sources. Diseases of skin, hypodermic cellulose can be caused by microflora from an external environment and disease of internal organs - microbes of gastric-intestinal highway, respiratory, urine tracts. After the hit of exciter his reproduction which is accompanied by the inflammatory reaction in fabrics begins in a pathological hearth. At first infiltrate as accumulation of cellular elements with the admixture of blood and lymph appears in fabrics of organism. At making of process to progress suppuration develops, that is formation of pus in the hearth of inflammation.

Local displays of festering infection – furuncle, carbuncle, abscess, phlegmon.

A furuncle is festering inflammation of hair bulb and its oil-glands.

A carbuncle is this purulent-necrotic inflammation simultaneously of a few hair bulbs and oil-glands.

Flow and prognosis of disease which arises up as a result of festering inflammation is determined by power of organism to limitation of inflammatory process and localization of pathological hearth. The capacity of organism for limitation of festering inflammation lies in the basis of determination of two types of pathology - abscess and phlegmon.

An abscess is the local limited accumulation of pus in fabric. At an abscess natural by a barrier, that restrains distribution of suppuration there is a piogenic capsule which connecting fabric of a different degree of maturity enters in the complement of. Abscesses can arise up in different organs and fabrics. They are not specific pathology which strikes concrete anatomic structures only. The reason of penetration of microbes in fabric can be the wound, inflammatory processes, hematoma, necrosis and also hematogenic metastasis of microorganisms at a sepsis. Thus there are the abscesses of hypodermic cellulose, lights, brain, liver, and also other organs and anatomic structures.

A phlegmon is festering inflammation of connecting fabric. Unlike an abscess, development of phlegmon is not accompanied by forming of piogenic capsule and taken place more swiftly and malignantly. The reasons of unlimited distribution of festering infection can be a high invasion and pathogenicity of microorganisms, and also decline of local and general factors of resistant of organism. As well as abscess, a phlegmon is not the specific disease which is caused by a separate microbes exciter, or struck separate organs or anatomic structures. The ways of penetration of microbes exciters at the phlegmon of different are the wounds, inflammatory processes, hematoma, necrosis, hit in fabric of different chemical matters. In clinical practice in place of morphological notion a "phlegmon" is used often term – cellulites. The serum, festering, pus-hemorrhagic, putrid, necrotic forms of cellulites are distinguished. Some their localizations have the special names. So inflammation of fatty round a bud is named paranephron, round a colon – paracolion, round a rectum - paraproctitis, round a pancreas - parapancreatitis, and others like that. Epi - and under fascia phlegmons are distinguished also; the last in same queue divide by between muscle, paravessel and paraosal phlegmons.

Characterizing such pathology as abscesses and phlegmons it follows to memorize the following. Abscesses and phlegmons can to prove not only how independent pathology is, but also to accompany and complicate other types of local festering surgical diseases of the name of which are determined by the staggered organs and anatomic structures.

General and local symptoms of local surgical infection.

Characterizing the symptoms of local surgical infection it should be noted some features of its development. Regardless of type of disease it follows to distinguish the displays peculiar for all types of local festering pathology and specific signs. To the signs which are characteristic for all types of local festering diseases, the local symptoms of inflammation and suppuration belong. Inflammatory infiltrate as accumulation of cellular elements with the admixture of blood and lymph in fabrics of organism develops at first. Macroscopically infiltrate shows up the increase of volume and promoted closeness of the staggered fabrics. The signs of inflammation appear in the area of pathological process - pain, hyperemia, was swollen, local rise of temperature, violation of function. On the early stages of forming of inflammatory infiltrate of expressed exudation as accumulations of pus it still is not a process can have a convertible character at the favorable flow. But complications in the form of abscesses and phlegmons develop in the case of suppuration. That is, appearance of their symptomatic is the characteristic general sign of all types of local surgical infection. In such cases we already have business not simply with a furuncle, lymphadenitis, whitlow, by mastitis et cetera, and with an abscess furuncle by abscess lymphadenitis, adenophlegmon, phlegmon of brush, abscess of milk gland and etc Development of abscess within the limits of fabrics of accessible for a review and palpation is accompanied by the local turn, edema and sickliness, red in the area of defeat. At piling up the symptom of fluctuation can appear in the cavity of abscess of enough body of pus. He turns out at palpation and is characterized by oscillation in the cavity of abscess at pattering on his wall. Unlike abscess development of phlegmon is not accompanied by forming of demarcation areas as a piogenic capsule. Therefore development of this disease is swift and malignant. If phlegmons are superficial, by means the review and palpation it is possible to expose the symptoms of festering inflammation: slight swelling, was swollen, hyperemia, sickliness. The adopted symptoms at phlegmons have a tendency to rapid appearance and progress. Tissue infiltrate has not clear scopes, is quickly increased in sizes. Progress of process is accompanied by appearance of symptom of fluctuation and local softening influence of soft fabrics. Distribution of phlegmon on anatomic structures and cavities is accompanied by complications: by phlebitides, arthritis, lymphadenitis, pleurisies, peritonitis and etc. In the process of development of local festering diseases phlegmons can be transformed in abscesses, and at progress of abscesses the overrun of pus piogenic capsule provokes development of phlegmons.

Regardless of type of local festering diseases, suctions of tissue and microbes toxins festering-septic diseases are accompanied by the symptoms of septic intoxication: by leucocytosis, neutrophilia change of leucogramme (to the left), by the rise of temperature of body, hipoproteinemia, by anemia, general weakness, by the loss of appetite. The signs of functional insufficiency of different organs can appear at the heavy flow of diseases - heart, lights, buds, livers as tachycardia with low blood pressure, tachypnoe, oligo- or anuria, icteruss and etc. In addition there are symptoms what peculiar exactly for the concrete type of local festering diseases. They are determined by localization and anatomic features of the staggered organ or anatomic structure.

Diagnostics of local festering pathology consists in the exposure by anamnesis, review and palpation of transferred by us signs of disease. It is difficult to expose by a review and palpation the signs of suppuration in deep fabrics and cavities of body. In the cavities of peritoneum, skull, thorax, out of peritoneum space to expose thus a septic hearth it is heavy, and sometimes it is impossible simply. In such cases on the first plan the general symptoms of festering intoxication go out. They are not specific and can accompany other disease which is accompanied by festering inflammation. But they force a surgeon to application of more difficult methods of diagnostics, which name instrumental. Puncture rentgenologic, ultrasonic, belong to them, computer-tomography researches. With their help it is possible to confirm the presence of abscess.

Basic principles of complex medical treatment of local infectious surgical diseases

Medical treatment of local infectious surgical diseases is aimed on different links of their pathogeny and consisted in local influence on a pathological hearth and in reduction of negative consequences of general septic intoxication. Achievement of therapeutic effect it is possible by combining of conservative therapy with different types of operative interferences. Conservative medical treatment consists in local application of different methods of antiseptic on a pathological hearth, methods of detoxication and immunocorrection in the case of heavy toxemia. The conservative methods of medical treatment are effective relatively rarely, mainly in the period of forming of inflammatory infiltrate on the early phases of development of furuncles, carbuncles, hydradenitis, lymphadenitis, panaricium, erytematosis and bulosis forms of erysipelas, serum and infiltration forms of mastitis and etc.

It should be remembered that often the flow of local infectious surgical diseases is complicated by development of festering process as abscesses or phlegmons, that requires surgical interference. At formulation of diagnoses the presence of festering complications is indicated in such cases. For example: abscess furuncle, abscess carbuncle, whitlow, complicated by abscesses and phlegmons of fingers and brushes; phlegmon that necrotic forms of erysipelas; phlegmon and gangrenous forms of mastitis and etc For this reason remains absolutely actual, formulated still in old times, basic rule of festering surgery - ubi pus - ibi evace.

Surgical medical treatment of abscesses is carried out by three methods. At favorable anatomic terms it is possible to apply a little invasion interferences as puncture with evacuation of pus and through skin drainage. More frequent it is had to execute interference by opening, finger revision and drainage through the proper operating access. Excision of abscess with a piogenic capsule within the limits of healthy fabrics is assumed on occasion. Surgical operative medical treatment is complemented to conservative antibacterial, desintoxication and contra inflammation therapy.

The basic method of medical treatment of phlegmons is operative. In the relatively rare case of serum cellulites it is possible to apply conservative therapy with a positive effect. Unlike interferences at abscesses, operations at phlegmon, festering processes large on a volume and consist in wide dissections, evacuation of pus, excision of necrotic fabrics and drainage. For phlegmons characteristic there is absence of natural demarcation areas as piogenic capsules. Therefore during the operations, quite often, it is necessary to create a barrier on the way of festering process by additional dissections on the border of healthy and pathologically changed fabrics. Before to complete description of such pathology, how abscesses and phlegmons are, it should be noted that she can be not only by the independent disease, but also to accompany other types of local festering surgical diseases. Therefore it should be remembered - what disease was not, at presence of the formed no drainage hearth of festering inflammation as an abscess or phlegmon it is necessary to apply surgical interference. After the executed operative interference, any type of local festering pathology grows into running sore, which treats oneself in obedience to general principles.