Determine the symptom of fluctuation. Determination of the presence of free fluid in the abdominal cavity, differences from obesity
The clinical picture consists of local and general manifestations.
Local symptoms
Classic signs of inflammation
The local reaction during acute purulent infection is manifested by symptoms characterizing the development of the inflammatory reaction:
ruber(redness),
color(local heat)
tumor(swelling),
dolor(pain),
functio laesa(dysfunction).
Redness easy to determine upon inspection. It reflects the dilation of blood vessels (arterioles, venules and capillaries), while the blood flow slows down until it almost completely stops - stasis. Such changes are associated with the effect of histamine on blood vessels and metabolic disorders in cells in the inflammatory zone. Otherwise, the described changes are called “hyperemia”.
Local heat associated with increased catabolic reactions releasing energy. A local increase in temperature is determined (usually with the back of the hand, comparing the sensations obtained with the sensations during palpation outside the painful focus).
Tissue swelling is caused by a change in the permeability of the vascular wall for plasma and blood cells, as well as increased hydrostatic pressure in the capillaries. Increased permeability of the vascular wall mainly affects capillaries and small veins. The liquid part of the plasma sweating from the vessels, together with migrating leukocytes, and often erythrocytes released through diapedesis, form an inflammatory exudate. The bulk of it consists of neutrophilic leukocytes. Usually swelling is determined visually. In doubtful cases, measurements are taken (for example, limb circumference).
Pain . The presence of pain and tenderness upon palpation in the focal area is a characteristic sign of purulent diseases. It should be remembered that palpation must be carried out quite carefully so as not to cause negative sensations in the patient.
Dysfunction associated with both the development of pain and swelling. It is most pronounced when the inflammatory process is localized on the limb, especially in the joint area.
Symptoms of the presence of accumulation of pus
To determine the accumulation of pus, use clinical symptoms(symptoms of fluctuation and softening), data additional research methods And diagnostic puncture.
Clinical symptoms
An important method for identifying areas of pus accumulation is the symptom of fluctuation. To determine it, on one side of the pathological process zone, the doctor places his palm (for small lesions - one or more fingers), and on the opposite side with the other palm (or 1-3 fingers) he performs jerking movements (Fig. 12-1).
If there is liquid between the doctor’s palms in the pathological focus (in this case, pus), these shocks will be transmitted from one hand to the other. Usually, a positive symptom of fluctuation, indicating the accumulation of purulent exudate in the tissues, becomes decisive in setting the indications for surgery (opening and draining the abscess).
The symptom of softening has a similar meaning: if, against the background of an inflammatory infiltrate, a softening zone appears in the center (a feeling of emptiness, failure on palpation), this also indicates purulent melting of tissues and accumulation of pus.
Rice. 12-1. Scheme for determining the symptom of fluctuation
Additional research methods
Among special research methods that can determine the accumulation of purulent exudate, ultrasound comes first. The method allows you to accurately determine the accumulation of fluid, the size and location of the cavity.
In some cases, X-ray examination helps diagnosis. There are characteristic radiological signs of accumulation of pus under the diaphragm, lung abscess, etc.
To identify an abscess and determine all its parameters in complex cases, you can perform a CT or MRI.
Diagnostic puncture
The procedure is performed when the diagnosis is unclear. Typically, a thin needle is used to anesthetize the skin, and then a puncture is performed with a thick needle (with a diameter of at least 1.5 mm), constantly creating a vacuum in the syringe.
The appearance of at least a minimal amount of pus in it indicates the presence of its accumulation in the corresponding area, purulent fusion of tissue, which most often requires surgical treatment. For deep purulent processes, ultrasound-guided puncture is highly effective.
Local complications of purulent processes
With the development of purulent diseases, local complications are possible: necrosis, inflammation of lymphatic vessels (lymphangitis) and nodes (lymphadenitis), thrombophlebitis.
The formation of necrosis is associated with the activity of microorganisms, as well as with impaired microcirculation due to the inflammatory process. At the same time, black areas appear in the inflammation zone.
Lymphangitis is a secondary inflammation of the lymphatic vessels, aggravating the course of various inflammatory diseases. With stem lymphangitis, hyperemia is noted in the form of separate stripes running from the source of inflammation to the area of regional lymph nodes - the axillary fossa or inguinal fold. Along with hyperemia, swelling of the skin appears. Upon palpation, painful compactions in the form of strands are revealed along the lymphatic vessels. Lymphadenitis occurs quite early. With inflammation of the intradermal lymphatic vessels, hyperemia in the form of a mesh pattern (multiple bright red intersecting stripes) is observed. The symptoms of lymphangitis can be fleeting and last only for a few hours. At the same time, the development of necrotic lymphangitis with the formation of foci of necrosis along the vessels is also possible.
Lymphadenitis is an inflammation of the lymph nodes that occurs as a complication of various purulent-inflammatory diseases and specific infections (tuberculosis, plague, actinomycosis). Thus, lymphadenitis, as a rule, is a secondary process.
Lymphadenitis begins with pain and enlargement of the lymph nodes. Sometimes, when the main process subsides, lymphadenitis dominates the clinical picture of the disease. With the progression of the disease and the development of periadenitis, these clinical signs are more pronounced; previously clearly palpable lymph nodes, merging with each other and with the surrounding tissues, become immobile. The process can turn into a destructive form up to the development of adenophlegmon.
Thrombophlebitis is inflammation of the veins that provide blood flow from the area of inflammation. This type of thrombophlebitis is called ascending. Usually we are talking about superficial veins. Clinically, a painful infiltrate along the vein is determined, having the shape of a tourniquet or roller. The skin above it is hyperemic and may be slightly raised. Thrombophlebitis requires special treatment. Typically, inflammatory changes are leveled out quickly, but a thrombosed vein can be palpated for quite a long time after this. In some cases, thrombophlebitis is complicated by the development of abscesses (abscess thrombophlebitis), which leads to the need for surgical treatment.
It should be noted that lymphangitis, lymphadenitis and thrombophlebitis are the first signs of generalization of the infectious process.
The location and size of abscesses vary widely. They usually occur in the cavity of purulent inflammation, which served as the starting point for the formation of an abscess (furuncle, lymphadenitis, etc.). Only metastatic abscesses are located away from the main site of infection.
The shape of the cavity varies- from simple rounded to complex with numerous pockets and blind passages. Over the area of the abscess, as a rule, there is clear swelling and hyperemia of the skin. Only when the abscess is deep, these symptoms are absent.
An important sign of an abscess in the presence of other signs of acute inflammation is the symptom of fluctuation, or oscillation. It is explained by the presence of fluid (pus) enclosed in a cavity with elastic walls, which transmits a push in the form of a wave from one wall in all directions. This symptom is absent when the wall is very thick and the abscess cavity is small and deep.
A test puncture of the cavity with a thick needle can provide significant assistance for diagnosis. With a chronic abscess, signs of acute inflammation may be almost completely absent. In these cases, swelling, slight pain, fluctuation symptoms and puncture data allow a diagnosis to be made. It is necessary to differentiate an ordinary abscess from a cold abscess, i.e., an abscess of tuberculous origin. The latter is characterized by the presence of a main focus of tuberculosis, slow development, and the absence of acute inflammatory phenomena.
An abscess should also be differentiated from a hematoma, aneurysm, and vascular tumors. With significant accumulations of pus, there is usually a significant general reaction with fever, general weakness, loss of appetite, insomnia, changes in blood composition, morning and evening temperature fluctuations (up to 2.5 ° C and above).
With metastatic abscesses, as a rule, the severity of the condition is due to the underlying suffering. The course of subcutaneous tissue ulcers is usually favorable; small ulcers can undergo resorption, larger ones evacuate outward, after which a cure occurs. A significant threat is posed by an abscess breaking into any cavity (joint, pleural cavity).
"Guide to purulent surgery",
V.I.Struchkov, V.K.Gostishchev,
Fluctuation I Fluctuation (lat. .
fluctuatio agitation, hesitation) a symptom of the presence of fluid (pus, effusion, blood) in a closed cavity with elastic walls; based on the property of a liquid to transmit pressure evenly in all directions. To identify F., use the fingers of one hand, not with a strong, but with a sharp short movement, to press on the area under study, while feeling the springiness of the palpated surface in the form of a wave that lifts ( rice.
). F. is usually clearly defined with moderate accumulation of fluid in superficially located cavities. However, F. is absent or questionable if the size of the abscess is small and the walls of the cavity are thick, as well as when the abscess is located deep in the tissue. In such a situation, a diagnostic puncture can provide significant assistance. .
With accumulations of pathological fluid in the pelvic area, F. is determined through the rectum. True F. is determined in any mutually perpendicular directions, in contrast to false F., which appears upon palpation of elastic tissues, soft tissue tumors () and is determined only in one direction. A variety of Phlegmon is the phenomenon of the propagation of a shock wave onto the wall of a large cavity through the liquid accumulated in it (large, extensive Phlegmon ,
Ascites) .
Undulation is caused by more vigorous tapping of one hand, while the shock of liquid is felt with the palm of the other. in pathology - vibrations in a cavity filled with fluid (for example, pus, transudate), caused by a push with the fingers of one hand and felt by the fingers of the other hand during two-handed palpation. in genetics - the general name for random fluctuations in the severity of an inherited trait in genetically related individuals.
1. Small medical encyclopedia. - M.: Medical encyclopedia. 1991-96 2. First aid. - M.: Great Russian Encyclopedia. 1994 3. Encyclopedic Dictionary of Medical Terms. - M.: Soviet Encyclopedia. - 1982-1984.
Synonyms:See what “Fluctuation” is in other dictionaries:
- (lat.). Same as fluctuation. Dictionary of foreign words included in the Russian language. Chudinov A.N., 1910. FLUCTUATION - oscillatory movement of liquids; in medicine, a ripple felt by the hand when lightly pressing on cavities filled with... ... Dictionary of foreign words of the Russian language
Exchange rate FLUCTUATION mode. In theory, central banks do not interfere in foreign exchange market operations, but in practice such intervention occurs for political and economic purposes. Dictionary of financial terms... Financial Dictionary
Deviation, fluctuation Dictionary of Russian synonyms. fluctuation noun, number of synonyms: 3 fluctuation (59) ... Synonym dictionary
Fluctuation (English fluctuation) 1) exchange rate fluctuations; 2) repeatedly changing value of a quantity, the range of its fluctuations Raizberg B.A., Lozovsky L.Sh., Starodubtseva E.B.. Modern economic dictionary. 2nd ed., rev. M.: INFRA M. 479... ... Economic dictionary
FLUCTUATION, fluctuations, many. no, female see fluctuation. Ushakov's explanatory dictionary. D.N. Ushakov. 1935 1940 … Ushakov's Explanatory Dictionary
- (from Latin fluctuatio fluctuation) fluctuation in population size and productivity in the form of a wave-like curve; S-shaped growth, then a smooth fall and again growth and fall (Fig. 39). Ecological Dictionary. Alma Ata: "Science". B.A. Bykov. 1983 ... Ecological dictionary
fluctuation- and, f. fluctuation f. lat. fluctuation fluctuation. trans., vol. pl. Hesitation, indecision. If my decision changes, I will cut off all fluctuations by renting a house in Nice. 1867. Hertz. 30 29 (1) 182. Fluctuations in the political atmosphere. Meshchersky Count... ... Historical Dictionary of Gallicisms of the Russian Language
fluctuation- Vibrations in a cavity filled with liquid. [English-Russian glossary of basic terms in vaccinology and immunization. World Health Organization, 2009] Topics vaccinology, immunization EN fluctuationfluid wave ... Technical Translator's Guide
- (fluctuatio; lat. fluctuation; syn. fluctuation) in pathology, fluctuations in a cavity filled with fluid (eg, pus, transudate), caused by a push with the fingers of one hand and felt by the fingers of the other hand during two-handed palpation ... Large medical dictionary
Or ripples serve in medicine as a sign of the existence of a cavity filled with liquid. If you place the index fingers of both hands on the tumor or swelling to be examined at some distance from each other and with one finger... ... Encyclopedic Dictionary F.A. Brockhaus and I.A. Efron
I
(lat. fluctuatio excitement, fluctuation)
a symptom of the presence of fluid (pus, effusion, blood) in a closed cavity with elastic walls; based on the property of a liquid to transmit pressure evenly in all directions. To identify F., use the fingers of one hand, not with a strong, but with a sharp short movement, to press on the area under study, while feeling a ripple in the form of a wave that lifts the fingers - a springy movement of the palpated surface (Fig.). F. is usually clearly defined with moderate accumulation of fluid in superficially located cavities. However, F. is absent or questionable if the size of the abscess is small and the walls of the cavity are thick, as well as when the abscess is located deep in the tissue. In such a situation, a diagnostic puncture can provide significant assistance. With accumulations of pathological fluid in the pelvic area, F. is determined through the vagina and rectum. True F. is determined in any mutually perpendicular directions, in contrast to false F., which appears on palpation of elastic tissues, soft tissue tumors (lipoma) and is determined only in one direction.
View value Fluctuation in other dictionaries
Fluctuation- fluctuations, plural no, w. See fluctuation.
Ushakov's Explanatory Dictionary
Fluctuation — 1)
exchange rate fluctuations
course; 2) a repeatedly changing value of a quantity, the range of its fluctuations.
Economic dictionary
Fluctuation 1— (fluctuatio; lat. “oscillation”; syn. oscillation) in pathology, fluctuations in a cavity filled with fluid (eg, pus, transudate), caused by a push with the fingers of one hand and felt ......
Large medical dictionary
Fluctuation 2 In Genetics- the general name for random fluctuations in the expression of an inherited trait in genetically related individuals.
Large medical dictionary
Attention Fluctuation— The inability to concentrate attention on any one object for a long time, the transition of attention from one object to another, its instability. Characteristic of hypomanic........
Psychological Encyclopedia
Fluctuation, Oscillation- (fluctuation) - a characteristic feeling of wave-like movement that occurs in fluid-filled parts of the body under the fingers of the doctor conducting the examination. If fluctuation........
Psychological Encyclopedia
Fluctuation, Fluctuation- a characteristic feeling of wave-like movement that occurs in fluid-filled parts of the body under the fingers of the doctor conducting the examination. If fluctuation occurs........
Medical dictionary
Bohn's symptom (H. Bohn, b. 1896, German doctor) is a decrease in systolic blood pressure in a standing position after physical activity, observed with patent ductus arteriosus and associated with an increase in pathological arteriovenous discharge of blood....
News about Fluctuation
- Anatoly Nikolaevich Rogoza Dr. biol. Sciences, Ved. scientific co-workers Institute of Cardiology named after. A.L. Myasnikov RKNPK Ministry of Health of the Russian Federation. In the clinical practice of a doctor, non-invasive methods of measuring blood pressure (BP), which are classified depending on the
- MM. Krasnov Moscow, State University Research Institute of Eye Diseases of the Russian Academy of Medical Sciences About intraocular pressure M.M. Krasnov The author gives new views on intraocular pressure, and investigates related conditions. In modern ophthalmological practice (including in our country)
Discussion Fluctuation
- Hello! I am 20 years old, I am concerned about the question: my blood pressure in the evening is almost always 140/80, sometimes 150/90, but it decreases. I am a very emotional person, I study at 2 degrees, I underwent examination: ultrasound of the heart, etc. The doctor diagnosed neurocircular dystonia. Is this pressure normal in mine?
