How to increase the patient's chances of surviving with peelephlebitis?

Pileflebit - purulent inflammation of the portal vein and its branches.

This is a rare but very dangerous disease, the prognosis is extremely unfavorable, the lethality is high.

Even if the therapy of the disease is started in a timely manner, the probability of a lethal outcome is 90%.

Contents

• Classification of the disease
• Etiology of the disease
• Clinical picture
  • Nature of the pain
  • Additional symptoms
• Diagnosis of the disease
• Treatment regimen
• Forecast and lethality

Classification of the disease

Very rarely, the disease appears independently, then they speak of the primary pylephlebitis. As a rule, the pathology develops against the background of the underlying disease. This condition is called "secondary pylephlebitis."

Depending on the course of the disease, a lightning-like form is released( a lethal outcome occurs within 24 hours after the onset of the disease) and a protracted form( death occurs 5-30 days after infection).

Etiology of

The most common pathogens are: Escherichia coli, Shigella, Streptococcus, Staphylococcus, Clostridia, Yersinia, Bacteroides.

Very rarely acute pylephlebitis develops as a result of injury to the walls of the portal vein, for example, when it enters the stomach from a swallowed foreign object.
Usually, the disease develops when the inflammation passes from the neighboring organs of the abdominal cavity to the wall of the portal vein.

The disease can provoke:

• acute inflammation of the vermicular appendix of the cecum( the most common cause of the ailment);
• is an inflammatory lesion of the small intestine;
• ulcerative-necrotic colitis;
• paraectal abscess;
• purulent cholecystitis;
• pancreatitis;
• purulent angiochitis;
• pancreatic necrosis;
• purulent inflammation of the liver;
• abscess of the spleen;
• inflammation of the hemorrhoids;
• piodermal process in the lymphatic system;
• postpartum period in women;
• Infectious inflammation of the umbilical vein in a newborn.

Microorganisms from the diseased organ enter the vascular bed, then with blood flow are transported throughout the body, including the portal vein, and cause an inflammatory process, which is accompanied by a thrombus, resulting in partial or complete blockage of the vessel.

Blood supply to the liver

Clinical picture of

One of the first and persistent symptoms of the disease is hectic fever with tremendous chills. The body temperature can rise to 42 degrees and it falls after the pouring sweat.

The nature of the pain syndrome

In addition, the disease is characterized by severe pain in the abdominal cavity, which are initially localized at the site of the disease.

Then the pains are concentrated in the epigastrium and only with rare exception in some patients the pain syndrome may be absent.

Sometimes pain from the epigastric region can give to the lower and lateral areas of the abdomen, but more often it spreads from behind and up. In some patients, pain can be in the region of the shoulder girdle.

Additional symptoms of

The following phenomena also indicate the disease:

1. In most patients of palpation can be detected by a moderate increase in the liver, which is due to the accumulation of pyodermal foci in it, and sometimes to the defeat of its parenchyma.
2. In the case of attachment of purulent inflammation of the bile ducts, is noted to have a slight icterus .Quite often, because of thrombosis or sepsis, there is an increase in the spleen.
3. Often during visual inspection, you can see on the front wall of the abdomen, the enlarged subcutaneous veins of , which resemble the "jellyfish head".
4. Purulent foci in the kidneys usually flow secretly. Occasionally they manifest as sudden pain in the loin region, leukocyturia .
5. Appetite is absent in patients, sometimes dyspeptic disorders ( diarrhea, nausea, vomiting, intestinal swelling) are observed.
6. When thrombosis of mesenteric veins in the stool can detect impurities of blood .Sometimes blood can be found in the vomit.
7. When the sepsis develops, the patient's eyes fall into orbits, the facial features are sharpened, the skin becomes earthy, weakness, confusion, palpitation, threadlike pulse, hypotension, shallow breathing.
8. There may also be absence of urination, edema of the legs and anterior wall of the peritoneum .
9. A clinical blood test shows neutrophilic leukocytosis with a shift of the leukocyte formula to the left, ESR elevated .When bacteriological studies are carried out on nutrient media, colonies of pathogenic microorganisms grow.

Diagnosis of the disease

For the diagnosis of pylephlebitis, it is necessary that the patient has two main diagnostic aspects:

• detecting inflammation in the blood and revealing the pathogenic microflora that caused the infection;
• portal portal thrombosis.

For this, laboratory tests are carried out:

• clinical blood test , in which leukocytosis, anemia, increased ESR;
• blood culture for the sterility of , which is carried out 3 times, the analysis is considered positive if, although in 1 sample identified pathogenic bacteria;
• clinical analysis of urine , which will show in the field of view an increased number of cells of epithelium, leukocytes and red blood cells.

From instrumental methods of examination apply:

1. ultrasound and computed tomography of abdominal organs .With their help, you can determine the presence of pyodermal foci in the body, determine the rate of circulation of blood along the vascular bed.
2. Angiography ( X-ray examination) of the portal vein. The method allows to detect thrombus, its structure, the degree of occlusion of the vessel, the speed of blood flow in the portal vein.

Scheme of treatment

For pylephlebitis, antibiotics of a broad spectrum of action should be prescribed as early as possible:

• Vancomycin;
• Tetracycline;
• Meronem;
• Ceftazidime;
• Ceftriaxone.

Enter them intravenously in shock doses. They perform infusion-detoxification therapy, put systems with rheopolyglucin, Ringer's solution and glucose.

Substitution therapy is indicated: platelet and erythrocyte mass, donor plasma or albumin are administered. Assign adsorbents( Polysorb, Eonterosgel, Lactofiltrum) and multivitamins.

If the location of the primary purulent focus is known, an emergency operation is performed to remove it and antibiotic treatment is simultaneously shown.

Forecast and Mortality

Without prescribing antibiotics, patients die an average of 14 days from the onset of the disease. Very rarely, with timely and intensive antimicrobial therapy, recovery is observed.

In addition to death in pylephlebitis, the following complications are possible:

• portal vein thrombosis;
• sepsis;
• renal, hepatic and cardiovascular insufficiency;
• coma.

Pilephlebitis is a rare, but rather dangerous disease. At its development the patient needs to be hospitalized as soon as possible and begin therapy.

To prevent purulent inflammation of the portal vein, it is important to treat infectious diseases of the body in time, including surgically.

In addition, every year you need to undergo preventive examinations to identify any pathologies, observe personal hygiene, strengthen the immune system( temper, take vitamin and mineral complexes), eat well, lead a healthy lifestyle, and play sports.