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| {{SI}} | | __NOTOC__ |
| {{EH}} | | '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' |
| | {{Phlegmon}} |
| | {{CMG}} |
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| '''Phlegmon''' is a spreading [[diffuse]] [[inflammatory]] process with formation of suppurative/purulent [[exudate]] or [[pus]].
| | ==[[Phlegmon overview|Overview]]== |
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| ==Etiology== | | ==[[Phlegmon classification|Classification]]== |
| Commonly by [[bacteria]] - [[staphylococci]], [[streptococci]], [[pneumococci]], spore and non-spore forming [[anaerobes]], etc.
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| Factors affecting the development of phlegmons are virulence of bacteria and human's immunity strength defenses.
| | ==[[Phlegmon pathophysiology|Pathophysiology]]== |
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| ==Classifications== | | ==[[Phlegmon causes|Causes]]== |
| 1)By clinical course:
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| a)acute
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| b)subacute
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| 2)By severity of condition:
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| a)mild
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| b)average
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| c)severe (with spreading to other location(s))
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| 3)By location:
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| I)Superficial
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| a)cutaneous
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| b)subcutaneous
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| c)interstitial tissue
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| d)intramuscular
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| II)Deep
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| e)mediastinal
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| f)retroperitoneal
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| 4)By etiology:
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| a)single
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| b)mix (eg:spore and non-spore forming anaerobes)
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| 5)By pathogenesis:
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| a)per continuitatem (through neighbouring tissues)
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| b)hematogenous (through non-valvular veins like venous plexus of face eg: v. pterygoideus plexus → inflamation of veins ([[phlebitis]]) → thrombus formation in veins → embolization of thrombus into sinus venousus systems)
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| c)odontogenous
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| 6)By exudative character:
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| a)purulent phlegmon
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| b)purulent-hemorrhagic phlegmon
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| c)putrefactive phlegmon
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| 7)By presence of complications:
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| a)with complications (disturbance of mastication, ingestion, speech, cardiovascular and respiratory system, peritonitis, lymphadenitis, loss of conscious if very severe, etc)
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| b)without complication
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| ==Clinical Pictures== | | ==[[Phlegmon differential diagnosis|Differentiating Phlegmon from other Diseases]]== |
| 1)[[Systemic features of infection]] like increased body temperature (up to 38-40°C), general fatigue, chills, sweatings, headache, loss of appetite).
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| 2)Inflammatory signs - [[dolor]](localized pain), [[calor]](increase local tissue temperature), [[rubor]] (skin redness/hyperemia), [[tumor]](either clear or non-clear bordered tissue swelling), [[functio laesa]](diminish affected function).
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| NB: severity of patient condition with phlegmons is directly proportional to the degree of intoxication level i.e the severe the condition, the higher degree of intoxication level.
| | ==[[Phlegmon epidemiology and demographics|Epidemiology and Demographics]]== |
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| ==Diagnostics== | | ==[[Phlegmon risk factors|Risk Factors]]== |
| #Complaints and clinical appearances
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| #Anamnesis
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| #Visual and Palpations
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| #Blood test - [[leucocytosis]] (up to 10-12x109/L), decrease or absence eosinophils level, shift of leucocyte formula to the left (neutrophilos), increase ESR (up to 35-40 mm/hr).
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| #Urine test - presence of bacteria in urine, increase urinary leucocyte counts.
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| #X-ray test
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| #Ultrasound test on pus
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| ==Treatments== | | ==[[Phlegmon natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| The main goal treatment remove the cause of phlegmonous process in order to achieve effective treatment and prevention of residives.
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| If patients condition is mild and the signs of inflammatory process is presence without signs of infiltrates, then conservative treatment with antibiotics is sufficient.
| | ==Diagnosis== |
| | [[Phlegmon history and symptoms|History and Symptoms]] | [[Phlegmon physical examination|Physical Examination]] | [[Phlegmon laboratory findings|Laboratory Findings]] | [[Phlegmon chest x ray|Chest X Ray]] | [[Phlegmon CT|CT]] | [[Phlegmon MRI|MRI]] | [[Phlegmon ultrasound|Ultrasound]] | [[Phlegmon other imaging findings|Other Imaging Findings]] | [[Phlegmon other diagnostic studies|Other Diagnostic Studies]] |
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| In severe condition, immediate operation is necessary with application of drainage system. All of these are done under general anaesthesia. During operation, the cavity or place of phlegmonous process are washed with antiseptic, antibiotic solutions and proteolyic ferments.
| | ==Treatment== |
| | [[Phlegmon medical therapy|Medical Therapy]] | [[Phlegmon surgery|Surgery]] | [[Phlegmon primary prevention|Primary Prevention]] | [[Phlegmon cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Phlegmon future or investigational therapies|Future or Investigational Therapies]] |
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| In post-operative period, i/v drips of detoxification, antibiotics, haemosorbtion, vitaminotherapy. Additionally, the use of i/v or i/m antistaphylococci γ-globulin or anatoxin can be taken as immunotherapy.
| | ==Case Studies== |
| | [[Phlegmon case study one|Case #1]] |
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| During operation of phlegmon dissection at any location, it is important:
| | [[Category:Disease]] |
| #to avoid spreading of pus during operation
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| #take into account the cosmetic value of operating site especially phlegmmonous process of face.
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| #during dissection, avoid damaging nerves especially facial nerves. Use the correct incision line.
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| {{SIB}}
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| [[Category:Inflammations]] | | [[Category:Inflammations]] |
| [[Category:Infectious diseases]]
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| [[de:Phlegmone]]
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| [[et:Flegmoon]]
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| [[fr:Phlegmon]]
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| [[nl:Flegmone]]
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| [[ja:蜂窩織炎]]
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| [[pl:Ropowica]]
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| {{WH}} | | {{WH}} |
| {{WS}} | | {{WS}} |