LIMFANGIIT (lymphangiitis; lat. lympha pure water, moisture + grech, angeion a vessel + - itis; synonym lymphangitis) — the inflammation of absorbent vessels complicating various inflammatory diseases.
On character and degree of manifestation of the inflammatory phenomena distinguish simple (serous) and purulent L.; on a current — acute and chronic; by the form the struck vessels — capillary (mesh) and stem (trunkular) L.
Activators L. are more often staphylococcus, the streptococcus, colibacillus, proteas is more rare, existence of microbic associations is possible (see. Purulent infection ).
Contaminated wounds and grazes, furuncles, an anthrax, abscesses, phlegmons, a felon etc. can be primary center of an infection. The conditions defining development of L., localization and the sizes of primary center of an infection, virulence of microbic flora and anatomo-physiological features of a lymphokinesis are.
Most often L. arises as a complication of pyoinflammatory diseases of extremities that is caused by the big frequency of microtraumas, abundance of microbic flora and features of a lymphokinesis.
The pathogeny and pathological anatomy
Microorganisms and their toxins from the center of an inflammation get into interfabric cracks in the beginning, and then in limf, capillaries and further in the ascending way on the course of vessels with current of a lymph extend in larger absorbent vessels (see) and lymph nodes (see). Involvement of a wall of vessels in inflammatory process is followed by swelling of an endothelium, increase in its permeability, development of exudation. In places of implementation of microflora reactive develops in a wall of vessels inflammation (see) with the phenomena hyperemia (see), hypostasis (see), lymphostasis (see), intravascular thrombogenesis. All this aggravates extent of disturbance of a local lymphokinesis. Progressing of inflammatory process leads to a purulent inflammation with the phenomena of purulent fusion of blood clots. Inflammatory process extends as an endolimfangiit, the panlimfangiita is more rare. Transition of an inflammation to surrounding fabrics leads to a perilimfangiit with involvement in inflammatory process of surrounding fabrics and bodies (blood vessels, joints etc.). Inflammatory process can extend in the ascending way up to a chest channel.
The clinical picture
the Clinical picture is caused by the general and local manifestations of inflammatory process. Typical local signs of an inflammation (pain, local temperature increase, swelling, redness) and general signs (fervescence, oznoba, headache, etc.) are expressed in various degree depending on localization, prevalence of the main inflammatory center, virulence of microbic flora, features of reactivity of an organism.
Accession of acute L. at this or that purulent process points to progressing of a basic disease and aggravates weight of its current. As a rule, temperature increases to 39 — 40 °, being followed by a fever, headaches, the increased perspiration, weakness, a high leukocytosis. At mesh L. the expressed dermahemia similar on erysipelatous, but not having a clear boundary is observed; sometimes it is possible to define the mesh drawing in a zone of intensive redness. At trunk L. the hyperemia has an appearance of the separate strips going from the center of an inflammation to a zone regional limf, nodes — to an axillary pole or an inguinal fold. Along with a hyperemia puffiness of skin appears. At a palpation painful consolidations in the form of tyazhy, «cords» on the course limf, vessels are noted. Early enough joins lymphadenitis (see) — regional limf, nodes are increased in sizes, dense, painful at a palpation. During the involvement in process deep limf, vessels the dermahemia is absent, extremity pains, hypostasis, morbidity at a deep palpation are defined and early emergence of lymphadenitis.
Diagnosis put on the basis of the listed signs in the presence of primary center of an inflammation. Difficulties in diagnosis meet at deep L. Deterioration in the general condition of the patient, pain, hypostasis of an extremity, early accession of lymphadenitis allow to make the diagnosis of a deep limfangiit.
Treatment shall be directed first of all to elimination of primary center — opening of abscess, phlegmon, purulent zatek, rational drainage of abscesses. Antibacterial therapy is appointed taking into account character of microbic flora and its medicinal stability. Creation of rest, sublime position of the struck body is important; for this purpose use an immobilization of an extremity. At the complicated forms L. (abscess, phlegmon) treatment is carried out according to a form and character of a complication.
The forecast and Prevention
the Outcome of a disease is in most cases favorable. But at it is long the existing disease process can pass in chronic, with frustration of a lymphokinesis owing to an obliteration of vessels and development of a lymphostasis that can bring to elephantiasis (see).
Prevention comes down to careful and timely primary surgical treatment of wounds, an immobilization of an extremity, to timely opening and drainage of suppurative focuses, to rational antibacterial therapy.
Bibliography: See bibliogr, to St. Lymphadenitis .
V. I. Struchkov, V. K. Gostishchev.