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Chapter XI. SUPPURATIVE INFLAMMATORY DISEASES

CLINICAL MANIFESTATIONS AND PATIENT EXAMINATION AND MANAGEMENT

The clinical manifestations of suppurative-inflammatory diseases are comprised of local and general symptoms. The local features of inflammation reflect the stage of development, the character and localization of the inflammatory process. Hence foci of superficial inflammation (suppurative inflammatory skin diseases, subcutaneous fat, the breasts, muscles etc.) or foci located deep but with the involvement of skin in the inflammatory process are characterized by the classical signs of inflammation - redness (rubor), caused by peristatic hyperemia, edema, swelling (tumor), pain (dolor), increase in local temperature (calor) and organ function disorder (functio laesa).The spread and manifestation of the inflammatory process determine the extent of the local clinical presentation. The inflammatory process of the internal organs has their own specific local clinical signs that differ from organ to organ, for example in purulent pleurisy, peritonitis.

During the process of clinical examination of patients with suppurative-inflammatory disease the stage of the disease process can be identified: when a firm tender mass is palpated in the presence of other signs of inflammation, it is an indication of some inflammatory process in the soft tissue and glandular organ, skin and subcutaneous layer, breast or in the abdominal cavity that is still in its infiltrative phase. Palpation of a soft infiltrate, positive fluctuation sign indicate that the infiltrative phase has moved into the suppurative (purulent) phase. The local clinical signs of progressive suppuration are: zones or stripes of redness in the skin (lymphangitis), firm tender strings of induration along the superficial veins (thrombophlebitis), the appearance of firm tender indurations at the sites of the regional lymph nodes (lymphadenitis). There is always a correlation between the extent of the local presentation and the intensity of general clinical signs of intoxication: a progression of the inflammatory process is accompanied by the progress of both local and general signs of inflammation and intoxication.

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