PHLEBITIS

From Big Medical Encyclopedia

FLEBYT (phlebitis; Greek phleps, phlebos a vein + - itis) — an inflammation of a wall of a vein.

Whether inflammatory changes in a wall of a vein can be localized in its outside cover (iyeriflebit) l in an internal cover (endophlebitis); quite often they take all covers of a vein (pan-phlebitis). Emergence of an endophlebitis and periphlebitis is connected with the prevailing action defined for each of these localizations F. etiological and pathogenetic factors.

The periphlebitis develops usually as a result of transition to an outside cover of a vein of inflammatory process of surrounding fabrics, most often at abscess (see), a burn wound (see Burns), felons (see), phlegmon (see), tubercular defeat, etc. At a nonspecific inflammation in perivascular fabric hypostasis, a plethora of vessels of an adventitia and vasa vasorum, infiltration are observed by polymorphonuclear leukocytes. Hypostasis and infiltration extend then to an average and internal cover of a vein that is followed by destruction of smooth muscle elements of a wall and elastic membrane. Even before emergence in an endothelium of visible changes in a vein pristenochny blood clot is formed (see Thrombosis) and thrombophlebitis develops (see). At a favorable current process comes to an end with development of a phlebosclerosis (see). At tubercular defeat of perivascular fabric specific inflammatory process, passing to a vein, it is most often limited to defeat of its outside cover.

The endophlebitis arises more often owing to an injury of a vein, napr, at long stay of a needle (catheter) in it or introduction to its gleam of hypertensive solutions (so-called injection F.), and also during performing sclerosing therapy at a varicosity of the lower extremities or a gullet when enter the substances causing an inflammation of its wall with the subsequent sklerozirovaniye into a gleam of a vein. Damage of an endothelial cover of a vein, as a rule, involves at once formation of pristenochny blood clot. In trombotichesky masses bacteria are found, fusion of blood clot and destruction of a wall of a vein (flebomalyation) is possible. During the performing sclerosing therapy inflammatory process, as a rule, proceeds aseptically, coming to an end with an obliteration of a gleam of veins. At a tubercular endophlebitis in an internal cover of a vein there are submilparny or miliary hillocks. Merge of the last can lead to education venous tubercular (so-called finger-shaped) a polyp up to 20 cm long with a caseous necrosis in the center.

Special form F. is giant-cell F. not quite clear genesis, characterized by existence in infiltrate of huge multinucleate cells. The picture of sclerosing pan-phlebitis of grudonadchrevny veins with an obliteration of their gleam is observed at Mondor's disease, edges can develop after an injury, inf. diseases, sometimes oyez visible reason.

Wedge, manifestations F. it is possible to observe only at the beginning of a disease, most often at defeat of saphenas of the lower extremities. The patient complains on ostrorazvivshiyesya local pains on the course of a vein where the strip of hyperemic skin is visible and the painful wall of a vein condensed in the form of a cord is probed, and during the involvement in inflammatory process of paravenous cellulose and skin — infiltrate on the course of a vein. From the moment of formation of blood clot the wedge, a picture of thrombophlebitis develops (see).

Characteristic symptom complexes of phlebitis of internals — see Kiari a disease, Metrotrombofle-bit, the Pylephlebitis.

Mondor's disease is clinically shown by existence on the perednebokovy surface of a thorax of a painful shnurovidny tyazh or tyazhy, on the course to-rykh pain and burning sensation is felt. These signs usually disappear in 3 — 4 weeks, but there can be a xanthopathy and a hyperesthesia.

Complications of phlebitis (bleeding, septic embolisms, abscesses, etc.) are connected generally with thrombophlebitis. At infectious F. abscess in paravenous cellulose unlike purulent fusion of blood clot at septic thrombophlebitis can develop.

Diagnosis F. put on the basis a wedge, symptoms and a lab. the data which are quite often indicating hypercoagulation of blood (see Koagulogramm). Mondor's disease is differentiated with limfangiity (see), observed, e.g., at malignant tumors of a mammary gland (cm).

Treatment preferential conservative. Antiinflammatory therapy with use acetilsalicylic to - you (aspirin), Butadionum, Rheopyrinum, and also a vein of dynamic means — Venorutonum (Troxevasinum), Glyvenolum, Anavenolum, Escuzanum is the cornerstone of it. For the purpose of prevention of formation of blood clot use the pharmaceuticals improving rheological properties of blood — trental, curantyl. At infectious F. there are indications to antibacterial therapy. Topical treatment includes imposing of compresses with the ointments containing heparin, Venorutonum, etc., and also use of the warming physiotherapeutic procedures. Anticoagulating and fibrinolitic therapy is carried out only at development of thrombophlebitis. Resort to operational treatment in the presence of the corresponding indications (see Thrombophlebitis). At the expressed symptomatology and persistent disease of Mondor the affected vein is excised.

The forecast at the majority of forms F. favorable. At an inflammation of veins of abdominal organs development of portal hypertensia (see) and abscesses of a liver is possible (see the Liver, diseases). The forecast becomes serious at transformation F. in thrombophlebitis.

Prevention aseptic injection F. consists in observance of the equipment of intravenous injections, replacement (at introduction of large amounts of hypertensive solutions) venipunctures (see) and veiosektion (see) catheterization of the main veins (see Catheterization of veins puncture). Prevention infectious F. timely and full treatment of pyoinflammatory processes is.

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S. V. Lokhvitsky; Century of H. Galaikin (stalemate. An.) „

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