3. PATHOGENESIS
Three phases of inflammation of the cellular
tissue areas
1. Phase serous inflammation
2. Phase infiltration of tissues
3. Phase melting of tissues
4. GENERAL MANIFESTATIONS OF
PURULENT PROCESS
Raising the temperature to hectic digits
Chills
Pouring sweat
Myalgia
Arthralgia
Weakness
5. DIAGNOSIS PHLEGMON CELLULAR TISSUE
AREAS
Laboratory investigation: analysis of blood,
urine, biochemical indicators of endotoxemia
Radiography: the increasing size, the
smoothness of the contours
Ultrasound: edema, infiltration, liquid
Tomography: the increasing size, the
smoothness of the contours, the liquid
6. GENERAL PRINCIPLES OF
TREATMENT
Surgical dissection, excision of
nonviable tissue, drainage of purulent
cavity
Antibiotic therapy under the control of
the sensitivity of microorganisms
Detoxification therapy
Immune therapy
Physical
7. PHLEGMON OF THE NECK
Cellulitis of the neck is a severe disease which
occurs defeat fascial and cellular tissue areas of
the neck. When phlegmon of the neck is filled with
pus or other fascial spaces. It can be superficial
lesion is subcutaneous cellulitis of the neck, and
deep lesions - intermuscular phlegmon of the neck,
fascial phlegmon of the neck. Given the complexity
of the anatomical structures of the neck, phlegmon
of the neck have different localization. Unlike
abscesses developing in the neck, cellulitis of the
neck has elastic walls and restricted fascia.
8.
9. REASONS OF PHLEGMONS OFA NECK
Inflammatory processes of an oral cavity and
throat (tonsillitis, pulpitis, stomatitis)
Inflammatory processes throats (laryngitis),
tracheas (tracheitis)
Injuries of a gullet
Pustulous diseases in ears, cheeks, lips, a chin
10. CLASSIFICATION OF PHLEGMONS OF A NECK
Superficial cellulitis:
1 Subcutaneous cellulitis;
2 Cellulitis aggrading aponeurotic space
3 Cellulitis side of the neck Department
Abscess, cellulitis facial vaginal sternocleidomastoid muscle
(abscess of Betzold)
Phlegmon of the anterior tracheal space (purulent strumitis)
Phlegmon vascular vagina neck (cellulitis Dupuytren)
About esophageal cellulitis and abscess of neck
Abscesses, phlegmon the back of the neck
Festering median and lateral cysts and fistulas of the neck
12. Inflammatory swelling is located in the
submandibular, submental region or in the upper or
lower half of the sternocleidomastoid muscle, that
is where the mortgaged major lymph nodes of the
neck. Swelling initially dense, sometimes slightly
hilly, somewhat mobile. Due to the deep location of
the source under the muscle, the skin above it
hadn't changed and has normal color. In the initial
stages is not observed and swelling.
13. CLINICAL MANIFESTATIONS OF
PHLEGMON OF A NECK
Swelling in the submental area
Sharp pain when chewing and swallowing
Salivation
The inability to open the mouth
Shortness of breath
Spastic torticollis the affected side
14. TREATMENT
Must first be created peace, both General and in
the field of inflammatory focus: patient prescribe
bed rest, use antibiotics is a semi - synthetic
penicillins, cephalosporins, aminoglycosides. Local
heat in the form of a heating pad, a warm
compress, UHF-therapy. Local application of cold
can be recommended only in the earliest stages of
the disease, before the appearance of the
inflammatory infiltrate. In the early stages (stage
serous edema) may be used diadinamophoresis
proteolytic enzymes.
15.
16. All operations of opening of phlegmon of
the neck must end with wound drainage.
Tampons help to stop capillary bleeding in
the depth of the wound, and also protect the
cavity of the abscess from premature (before
rejection of necrotic tissue and the formation
of granulation its adhesion.
19. DEEP CELLULITIS OF THE EXTREMITIES
Deep (subfascial, between fascial) cellulitis
of the extremities - purulent inflammation of
the propagating along the fiber intermuscular,
around vascular spaces.
20. REASONS OF PHLEGMONS OF AN
EXTREMITY
Corn abscess
Infected wounds and abrasions
Pustular diseases of the skin and
subcutaneous tissue
Background diseases (diabetes, occlusive
disease of the arteries)
21. UPPER LIMB
In the shoulder region, deep abscess may be
localized and distributed by sheaths neurovascular
bundle and lodges muscle flexor and extensor. In
the upper part of the shoulder it can be under the
deltoid muscle, in the lower third of the shoulder -
bed m. brachioradialis, extending the forearm, its
lateral part. In addition, the abscess may spread
along fascial spaces of the shoulder along the
radial and ulnar nerves.
22. LOWER LIMB
Superficial cellulitis, located in the femoral triangle, have the
opportunity to spread deep intermuscular spaces and to
form deep phlegmon of the hip. The development of
superficial cellulitis and converting it into a deep possible
through the lymphatic ducts in the direction of the femoral
vein or through the superficial fascia. In addition to the
surface phlegmon, deep phlegmon of the hip can cause a
variety of inflammatory processes in the neighboring areas.
Purulent process can be distributed, for example, on the box
causing the muscles of the pelvic region. On the back of the
thigh can be formed phlegmon gluteal region, inflammatory
process in this case extends from paraproctium.
24. CLINICAL MANIFESTATIONS OF
PHLEGMONS OF EXTREMITIES
Swelling of the limb
Redness of the skin
Infiltration of soft tissues
Sharp pain when moving
Positive symptom fluctuations
25. For deep cellulitis of the extremities characterized
by General symptoms: diffuse pain, increased body
temperature to 39-40 °C, chills, General weakness,
loss of appetite, lethargy, in some cases (in case of
advanced disease) was confused. Onset acute
cellulitis develops quickly. Local symptoms noted
swelling and tension of the tissues, especially the
skin. The limb increases in volume as a result of
violations of the venous outflow. Determined
enlarged painful lymph nodes.
26. TREATMENT
In an infiltrative phase conservative treatment can
be applied: Antibiotiсoterapy, physiotherapeutic
treatment, heat, extremity immobilisation. If
conservative treatment is inefficient and the
disease progresses, resort to surgical treatment.
Make opening of phlegmons, an section of nekrotic
tissues and a dranage. At operation it is necessary
to open all muscular partitions (usually stupid way).
27.
28. Parotitis - purulent inflammation of the parotid gland.
Agents of purulent parotitis are often staphylococci, meets the
Association of microbes, penetrating parotid salivary glands,
usually from the mouth. Favorable conditions for ascending
infection in a gland on the duct of the parotid gland (staronova
channel) is the reduction or termination selection of saliva. The
weakening of the protective forces of the body and impaired
excretion of saliva cause parotitis may develop in dehydrated
patients with common infectious diseases or in the
postoperative period after major surgery. Microorganisms can
penetrate into the parotid gland also lymphogenous or
hematogenous route. Develop inflammation of the ductless
glands, swelling its mucous membrane, impaired outflow of
saliva. Stagnation secret exacerbates the development of
inflammation, which duct passes to the glandular tissue. First
inflammation is in the nature of serous and purulent infiltration
of the lobules.
29. CAUSES OF RETROPERITONEAL PHLEGMON
Injury to retroperitoneum
Acute pancreatitis
Acute appendicitis
Purulent pyelonephritis
Phlegmonous adenitis
Perforation of tumors of the ascending and
descending colon
30. CLINICAL MANIFESTATIONS RETROPERITONEAL
PHLEGMON
Pain in the lumbar region on the affected side
Swelling
Hyperemia
Tenderness to palpation
Determination of infiltration
Pain when lifting leg
Contracture of the hip joint
31. PARAPROCTITIS
Acute paraproctitis (paraproctitis) - purulent
inflammation of paraproctium.
Pathogens paraproctitis often are E. coli,
Staphylococcus and white staphylococci,
anaerobes and other generally determined
by mixed microflora.
32. CAUSES OF PARAPROCTITIS
Hemorrhoids
Fissure of the anus
Wound around the rectal tissue
Tumor lysis of the rectum
35. CLINICAL MANIFESTATIONS OF PARAPROCTITIS
Pain in the anus
Infiltration
Tenderness to palpation
Hyperemia
Swelling
Tenderness on rectal examination
36.
37. TREATMENT
In the initial stage of the disease when there is a small
infiltrate in the perianal region have been using conservative
treatment methods: warm baths with potassium
permanganate solution, lumbar procaine blockade, warmers,
UHF-therapy, and All other heat treatments combined with
antibiotic therapy.
38. Surgical treatment of acute paraproctitis includes
early emergency surgery by opening the abscess
with the removal of pus and necrotic tissue,
examination of the oral ulcer finger, the division of
bridges and drainage of the cavity.
39. PURULENT MEDIASTINITIS
Purulent mediastinitis - purulent inflammation of loose
connective tissue of the mediastinum.
Pathogens - often staphylococci, enterobacteria, less
frequently, Streptococcus, pneumococcus, and mixed
suppurative and putrefactive flora, in some cases
anaerobes. Mediastinitis in most cases (except for
penetrating wounds of the chest) is a disease of the
secondary and is a complication of perforation of
esophagus and trachea, acute purulent processes in
the mouth and fauces, phlegmon of the neck,
pneumonia, suppurative processes in the lungs and
pleura.
40. REASONS OF MEDIASTINITIS
Gullet punching
Trachea punching
Purulent diseases of lungs and pleura
Osteomyelitis of a breast, backbone
41. Acute purulent and putrefactive processes in the
mediastinum usually begin suddenly, often with chills,
significant fever and chest pain. Body temperature is
often hectic nature. Pain radiating to the interscapular
region, the back, neck, epigastric region.
For the front mediastinitis characterized by pain in the
chest, increased retrosternal pain (when we tap on
the chest, tilting his head backwards), swelling in the
neck and in the chest. For the rear mediastinitis
characterized by pain in the interscapular, epigastric
areas of the back. If you are involved in the
inflammatory process of the esophageal wall may
experience pain when swallowing.
42. CLINICAL MANIFESTATIONS OF
MEDIASTINITIS
Pain behind sternum to the front and a pain
in the interscapular area and back to the rear
mediastinitis
Semi sitting position to tilt the head forward
The swelling of the veins of the head and
neck
Shortness of breath
Cyanosis
Tinnitus
43. TREATMENT OF MEDIASTENITIS
At the first sign of acute mediastinitis shown
antibiotic therapy is a semi - synthetic
penicillins, cephalosporins, aminoglycosides.
If mediastinic develops from infected
mediastinal lymph nodes may reverse
development of the inflammatory process
under serous inflammation.
44. There are many ways of operations intended for
drainage of the mediastinum. The most widely neck
mediastinotomy, owing to which we have the ability
to penetrate into the anterior mediastinum of the
incision above the sternum. Apply through sternal
accesses.
Access to the posterior mediastinum is the
posterior extrapleural mediastinotomy. When lower
back mediastinitis exercise transdiaphragmatic
mediastinotomy with sealing tissues around the
drainage introduced into the mediastinum, and the
tabulation of another drainage line sealing seams
on the aperture).
TREATMENT OF MEDIASTENITIS
47. Mastitis - inflammation of the parenchyma and
interstitial tissue of the breast. Acute mastitis occurs
mainly in the first 2 weeks postpartum in lactating
women postpartum (lactational) mastitis, less often
from not feeding women, it is rarely in pregnant
women. The incidence of postpartum mastitis ranges
from 1.5 to 6% (with respect to the number of births).
The occurrence of mastitis promotes change in the
species composition of agents of purulent infection,
their antigenic properties and antibiotic resistance.
Usually mastitis develops in one breast, bilateral
mastitis is rare.
