ACUTE SURGICAL INFECTION DR.A.KENSARAH. ACUTE SURGICAL INFECTION Non-Specific Acute Infection...

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Transcript of ACUTE SURGICAL INFECTION DR.A.KENSARAH. ACUTE SURGICAL INFECTION Non-Specific Acute Infection...

  • Slide 1
  • ACUTE SURGICAL INFECTION DR.A.KENSARAH
  • Slide 2
  • ACUTE SURGICAL INFECTION Non-Specific Acute Infection Specific Acute Infection Non-Specific Acute Infection Specific Acute Infection
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  • Non-Specific Acute Infection Postoperative Wound Infection Cellulitis Erysipelas Boil (Furuncle) Carbuncle Hydradenitis Suppurativa Acute Abscess Acute Lymphangitis and Lymphadenitis Bacteraemia and Septicaemia
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  • Specific Acute Infections Tetanus Gas Gangrene Necrotizing Fasciitis
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  • Postoperative Wound Infections Are caused by the presence of contaminating microbes derived from : Endogenous Endogenous OR OR Exogenous Exogenous
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  • Postoperative Wound Infection Predisposing Factors: # General 1- Poor general condition 2- Systemic disease 3- Drugs that cause immunosuppression
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  • Postoperative Wound Infection # Local : 1- Poor blood supply 2- Poor surgical technique 3- Presence of foreign bodies 4- Nature of the operation 5- Defect in sterilization technique in 1- Poor blood supply 2- Poor surgical technique 3- Presence of foreign bodies 4- Nature of the operation 5- Defect in sterilization technique in the operating theatre the operating theatre
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  • Types of surgical wounds Operative wounds are divided into three categories : 1- Clean The risk of infection is 1-2% 2- Clean contaminated The risk of infection 2-5% 3- Contaminated The risk of infection is 5-30%
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  • Pathology Acute inflammatory stage with local vasodilatation and infiltration by polymorph nuclear leucocytes. This is followed by suppuration with purulent discharge
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  • Clinical Picture Wound infection usually appears between the fifth and tenth days postoperative * Fever * Pain in the wound Signs: _ swollen _tenderness _redness _fluctuant * Fever * Pain in the wound Signs: _ swollen _tenderness _redness _fluctuant
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  • Differential Diagnosis Other causes of postoperative fever - chest infection - DVT - UTI Other causes of wound swelling - heamatoma
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  • Prophylaxis * Improve the defense mechanism * Improve the defense mechanism * Control the predisposing factors * Prophylactic antibiotics * In bowel surgery, mechanical and chemical preparation of the bowel * Control the predisposing factors * Prophylactic antibiotics * In bowel surgery, mechanical and chemical preparation of the bowel * Meticulous surgery * Operation in septic areas with heavily contaminated wounds should be left open * Meticulous surgery * Operation in septic areas with heavily contaminated wounds should be left open
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  • Treatment Surgical drainage of the pus Surgical drainage of the pus Antibiotics in invasive infections Antibiotics in invasive infections Look for hospital acquired infection Look for hospital acquired infection
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  • Cellulitis Is an invasive non suppurative infection of the loose connective tissue Is an invasive non suppurative infection of the loose connective tissue Organism : Organism : streptococci [common] staphylococci [occasionally] mix
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  • Clinical picture The affected area is red,indurated,hot and painful The affected area is red,indurated,hot and painful It spreads rapidly with ill defined edge It spreads rapidly with ill defined edge The skin may be the seat of blisters The skin may be the seat of blisters Fever Fever Lymphangitis in the form of red streaks Lymphangitis in the form of red streaks No suppuration No suppuration In severe cases patches of skin necrosis with sloughing of subcutaneous tissues In severe cases patches of skin necrosis with sloughing of subcutaneous tissues
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  • Differetial Diagnosis Contact allergy Contact allergy Chemical inflammation Chemical inflammation DVT DVT
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  • Treatment Rest and elevation of the affected part Rest and elevation of the affected part Antibiotic penicillin iv Antibiotic penicillin iv
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  • Erysipelas Is a rapidly spreading non-suppurative inflammation of the lymphatics of the skin caused by a specific strain of hemolytic streptococci hemolytic streptococci
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  • Clinical Picture Toxemia Toxemia Locally : similar to cellulitis,but there Locally : similar to cellulitis,but there are the following differences: are the following differences: 1. The color of the skin is rose-pink 2. The edge is well defined 3. There may islets of inflammation beyond the spreading margin beyond the spreading margin
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  • Complications 1. Facial erysipelas may lead to cavernous sinus thrombosis 1. Facial erysipelas may lead to cavernous sinus thrombosis 2. Septicemia 2. Septicemia 3. Recurrent erysipelas may block the lymphatics leading to elephantiasis. 3. Recurrent erysipelas may block the lymphatics leading to elephantiasis.
  • Slide 21
  • Treatment Isolation Isolation Similar to cellulitis Similar to cellulitis
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  • Boil [Furuncle] Is a staphylococcal infection of a hair follicle or a sebaceous gland. Is a staphylococcal infection of a hair follicle or a sebaceous gland. The common sites: The common sites: face, neck and axilla. face, neck and axilla. Common in diabetics. Common in diabetics.
  • Slide 23
  • Clinical Picture A small painful indurated swelling which is - red - red - hot - hot - and very tender - and very tender
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  • Treatment 1.Antibiotics. 1.Antibiotics. 2.Antiseptic. 2.Antiseptic.
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  • Carbuncle Is infective gangrene of the subcutaneous tissues usually secondary to infection by Staphylococcus aureus. Is infective gangrene of the subcutaneous tissues usually secondary to infection by Staphylococcus aureus. It is common in immunocompromised patients as in diabetics. It is common in immunocompromised patients as in diabetics. The common sites: The common sites: face, nape of the neck, and the back face, nape of the neck, and the back
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  • Pathology Infection usually starts in a hair follicle Infection usually starts in a hair follicle Extends to the subcutaneous fat where other hair follicles get the infection. Extends to the subcutaneous fat where other hair follicles get the infection. Multiple areas of necrosis and thrombosis of blood vessels occur. Multiple areas of necrosis and thrombosis of blood vessels occur. Patches of skin undergo sloughing and separate from the underlying granulation tissue Patches of skin undergo sloughing and separate from the underlying granulation tissue
  • Slide 27
  • Clinical Picture There is usually sever toxemia. There is usually sever toxemia. Starts as a painful induration of the skin and subcutaneous tissues. Starts as a painful induration of the skin and subcutaneous tissues. The skin is red. The skin is red. Swelling its central part becomes soft. Swelling its central part becomes soft. Multiple areas of skin thin out and separate forming multiple sinuses. Multiple areas of skin thin out and separate forming multiple sinuses.
  • Slide 28
  • Complications Local spread of infection. Local spread of infection. Pyaemia and septicemia. Pyaemia and septicemia. Cavernous sinus thrombosis Cavernous sinus thrombosis Epidural abscess or meningitis Epidural abscess or meningitis
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  • Treatment 1.Antibiotics. 2.culture and sensitivity of the discharge. 3.control of diabetes. 4.surgical excision of sloughs.
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  • Hydradenitis Suppurativa Mixed staph. And streptococcal infection of the apocrine sweat glands, in the perineum or the axilla,produces multiple abscesses and pus discharging sinuses.
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  • Treatment Surgical drainage of abscesses. Surgical drainage of abscesses. Antiseptic and antifungal applications. Antiseptic and antifungal applications. Surgical excision of the apocrine sweat-bearing skin following by skin grafting is essential. Surgical excision of the apocrine sweat-bearing skin following by skin grafting is essential.
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  • Acute Abscess It is a localized suppurative inflammation. It is a localized suppurative inflammation. It is caused by pyogenic organisms. The commonest are staphylococci that produce a coagulase enzyme. It is caused by pyogenic organisms. The commonest are staphylococci that produce a coagulase enzyme.
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  • Pathogenesis The organism reach the tissues by : - direct access through wounds, scratches and abrasions. - direct access through wounds, scratches and abrasions. - local extension from an adjacent focus - local extension from an adjacent focus - lymphatic spread. - lymphatic spread. - blood spread. - blood spread.
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  • Pathology An abscess consists of three zones: 1- A central zone of coagulative necrosis 2- An intermediate zone of granulation tissue. 3- A peripheral zone of acute inflammation.
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  • Sequlea Resolution. Resolution. Pointing and rupture. Pointing and rupture. Spread infection locally Spread infection locally - by lymphatics or blood - by lymphatics or blood Chronicity. Chronicity.
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  • Clinical