Thrombophlebitis

Thrombophlebitis is inflammation of the walls of veins with blood clot in the lumen.
Etiology and pathogenesis. Occurs as a complication of some contagious diseases (flu, epidemic and abdominal tifa, dysentery, erysipelas), postpartum and abortion, and purulent inflammatory processes (cellulitis, carbuncle, osteomyelitis, and others), and varicose veins (see) of the lower extremities.
An important condition for the formation of a blood clot in the lumen of Vienna is an inflammatory lesions of internal its walls (endothelium) due to the infection of Vienna, directly from the surrounding tissues or hematogenous.
Clots contributes to slowing the blood flow in the veins, varicose their expansion, compression of the tumor, vein damage during operations, injuries. After the puncture of Vienna, as well as by the long stay in the lumen of the needle or cannula with intravenous fluids may occur puncture thrombophlebitis. With the involvement of Vienna in the inflammatory process of the nearby pathological focus changes occur primarily on her outer wall (periflebit); the transfer of bacteria in blood and settling them in Vienna inflammatory process begins with the inner wall (endoplamic). In both cases it causes inflammation of the whole venous wall (see Phlebitis), clearance is formed thrombus (see Thrombosis).
Changes in the veins cause reflex spasm adjacent arteries and lymphatic vessels, hampered the flow of lymph, impaired venous and arterial blood circulation of the corresponding region.
Thrombophlebitis may develop in any part of the body: in the veins of the brain septic processes on the face (anthrax) or in the middle ear (otitis media), in the portal vein when suppurative appendicitis or cholecystitis (see Pereplavit), in the pelvic veins after operations on pelvic organs. More often thrombosis occurs in the veins of the lower extremities and proceeds in acute, subacute and chronic forms. Struck deep and superficial veins.
Clinical picture, diagnosis. The clinical course there are several forms of thrombosis of the lower extremities.
Acute thrombosis of deep veins sudden pain in the affected limb, chills, high fever (up to 38-39 degrees). Feeling limbs in the course of the affected veins sharply painful. By the end of the first day diseased limb sharply swollen, the skin on it, it becomes hard, pale, glossy, colder than in healthy; pulse sharply weakened or is not determined by (spasm of the arteries). Inguinal lymph nodes are enlarged, painful. In the coming days expanding skin collaterals (workarounds), representing a network of veins, acting under the skin on the inner surface of the femur and tibia. The outflow of blood on them getting better slowly, and swelling of a limb lasts 2-3 months. In blood increased numbers of leukocytes (10 000-15 000), accelerated ROHE, high concentrations of fibrinogen (up 410-850 mg%), prothrombin to 150-155%.
After remitting the acute effects of the disease often develops so-called postphlebitic syndrome.
Acute throm superficial veins also starts suddenly. The process more often localized in the system of the great saphenous vein, which is felt in the form of dense, painful heavy with red over it and swollen skin. Gradually develops moderate sick extremity edema, skin takes on a bluish tint. The temperature in the beginning of the disease around 38o, then gradually decreased to normal values.
Acute throm superficial veins may go into purulent melting of Vienna and within it of a blood clot, with the formation of ulcers around Vienna and often spread them in the course of a damaged vessel (ascending thrombophlebitis).
Allocated before subacute and chronic thrombophlebitis currently considered as the chronic venous insufficiency of the lower limbs or postphlebitic syndrome. The essence of it is that in the result of acute thrombosis of deep veins and subsequent recanalization of a blood clot (education in him channels) destroyed the deep vein valves and veins connecting deep and superficial venous system. This breaks the outflow of blood from the lower extremities. The disease appears dull pain and swelling of the legs, increasing towards the end of the day or after a long standing (swollen-painful form), or varicose superficial veins and development of trophic skin changes of the lower third of the Shin up to the development of varicose ulcers (varicose ulcers form).
Migratory (wandering) thrombophlebitis affects the superficial veins of the extremities, often lower. Along the veins suddenly appear small painful lumps, pointing to the formation of blood clots.
The skin above them swell up, blushing. First one occurs, then a few knots along the same vein (usually above on a current of blood), they can occur simultaneously in several veins. The affected vein felt in the form of a tow with dense knots. The resulting bundle is held a few days and gradually dissipates. The General condition of patients varies little, the temperature in most normal cases. Are mostly young men. The disease flows chronically many months and even years, periodically compounded. There tuberculosis, rheumatic lesions, often combined with endarteritis (see) or precedes it.

  • Prognosis treatment and prevention of thrombosis