The clinical picture embolism

The clinical picture of embolism is diverse and depends on the nature of the main this conclusion was disease, the size and consistency of the pitch, its localization and the features of collateral circulation in the zone of obturated vessel.
Among many varieties embolism (fat, air, gas, textile and so on) have a greatest practical importance embolism, the source of which is a blood clot that has formed in one of the departments of the cardiovascular system. Embolic the obstructions are as venous vessels and blood, most often affects the blood vessels of the brain, especially the middle cerebral artery and its branches.
Embolic strokes usually develop suddenly, apoplectique, without any prodromal phenomena that are different in most cases of hemorrhagic stroke (see) and heart attacks brain embolicescie nature. Neurological symptoms is determined publemozgova and focal symptoms.
The degree of disturbance of consciousness may be different - from short-term aberration to severe cerebral coma with tonic convulsions and massive neurological fallout.
Focal symptoms manifested in the engine, sensitive, speech, and other violations. There anisocoria, nystagmus, mono - and hemiplegia or mono - and hemiparesis. Appear pathological reflexes (Babinski, Rossolimo, Bekhterev).
In severe embolism arteries of the brain appear threatening respiratory disorders and cardiovascular system, aggravating ischemia of brain tissue and requiring immediate active treatment measures.
Embolism renal arteries. Acute obstruction main trunks renal artery is relatively rare. More often obtenida their ramifications, resulting in the formation of single or multiple different values heart attacks renal parenchyma. The clinical picture determined mainly three syndromes: pain, hypertension and bladder. Pain occurs acutely and can be quite intense. Localize in the lumbar region, it is often radiating to the appropriate part of the abdomen. Almost always sharply positive symptom of Pasternatskogo. Unlike kidney cramps, pain, do not apply in the groin and genitals.
Hypertensive syndrome occurs as a rule, when the blockage of the main trunk of the renal artery. When blocking the smaller its branches elevation of blood pressure is also possible, but it is short and not so significant. Urinary syndrome is characterized by oliguria (bilateral embolic occlusion renal artery - anuriei), proteinuria, microhematuria.
Sometimes red blood cells in the urine is not found, but cannot find a free blood pigment that gives it a pinkish color. The overall reaction is expressed by fever, often with nausea and vomiting, leukocytosis with neutrophilic shift formula left and accelerated ROHE.
In addition to clinical data, the diagnosis is based on the use of different methods of separate studies of the kidneys: chromolithography, intravenous urography. Significant support is provided by radioisotope renografii with jothipala. However, with complete certainty of the diagnosis can be made only when aortografii.
Embolism mesenteric arteries with complete blockage of one of the main trunks mezenterialnah of the arteries (usually the top) are accompanied by typical clinical picture with the advent of acute diffuse abdominal pain. Pain concentrated in paraumbilical, right iliac or lumbar regions. They are so intense that sometimes cropped drugs. The nature and strength, they are very similar pain syndrome in acute pancreatitis or perforated ulcer. It is noteworthy that in the first hours, despite severe pain, tension of the abdominal muscles is missing or is expressed very slightly. Saved intestinal noise. About half the time, nausea and vomiting. Stool often detained, but possible, and diarrhea, sometimes with blood in the stool. Increased blood pressure, which some authors attach great diagnostic value when mezenterialnah emboliah is rare.
From the first hours increases leukocytosis with a left shift formula. Further to the initial phenomena join the symptoms of paralytic ileus with characteristic bloating, delay chair and gases, the disappearance of intestinal noise, etc., In this period, with careful palpation sometimes manage to define abdominal elongated testovaty consistency "tumor"which is a bloated inparticularly the bowel with sudden swelling of the walls (the symptom of Mondorf). The final stage is peritonitis, directly associated with necrosis ischemic areas of the intestine.
Embolism splenic artery present in the clinic quite a rare pathology. Small embolic stroke spleen can develop almost totally asymptomatic.
Extensive as heart attacks that occur in the result of acute occlusion of the main stem of the splenic artery or its major branches, accompanied by severe pain in left hypochondrium, a rise in temperature to 38-39°, nausea, vomiting. Sometimes sharp pain, enlarged spleen able to probe, most of its growth is only percutere. In rare cases, there is a local muscle tension and showing signs of peritoneal irritation. Characterized by the absence of leukocytosis, and sometimes even a tendency to radiation. Intercaravan areas of the spleen gradually subcourse, rarely softened with the formation of cysts or abscesses.
Embolism hepatic artery extremely rare. Acute obstruction of the main trunk of the hepatic artery can quickly lead to hepatic coma or severe hepatorenal syndrome. Obturation of its smaller branches causes heart attacks the liver and is accompanied by the appearance of acute pain in the right hypochondrium, sometimes nausea and vomiting. The liver by palpation painful, sometimes defined moderate muscle tension. The disease is accompanied subfebrile temperature, leukocytosis. May develop mild jaundice and bleeding. When embolism small branches of the hepatic artery, the flow can be almost asymptomatic, limited to a gentle dull pain in the liver. In these cases, the true nature of the lesion is hard to establish even on the section.
Of thromboembolism of the pulmonary trunk - see Thromboembolic disease.
Thromboembolism terminal aorta and the arteries of the extremities - see Thrombosis (clinical picture and treatment trombozov and tromboamboliy).