pus
Pus ( Latin pus , Greek πύον pyon ) is a typically yellowish exudate that occurs as part of a cellular inflammatory reaction in the body of vertebrates . Of the defense cells, the neutrophilic , polymorphonuclear leukocytes play a central role. Most of the time, this form of inflammation arises in response to a bacterial infection . However, there is also pus caused by non-infectious diseases, such as pustular psoriasis . The secretion of pus is called pus orCalled sores .
nature
Pus has a different viscosity (from thin to thick) and different colors (from pale yellow to green and - in the case of Pseudomonas infections - blue-green). The smell also depends on the type of bacteria involved; in E. coli infections, for example, the pus smells like feces.
An encapsulated collection of pus in the tissue is called an abscess , and a collection of pus in body cavities is called empyema . If it occurs in the chest cavity, it is referred to as pleural empyema or pyothorax, in joints as pyarthrosis , and in the renal pelvis as pyonephrosis . The colloquial term “pus bump” can stand for a melted lymph node as well as an abscess, a boil or a carbuncle , but also an acne inversa .
Pathogenesis
The tissue is melted down by the action of proteolytic enzymes that are formed by leukocytes or - in the case of an infectious cause - by pyogenic (pus-forming) pathogens .
Examples of purulent diseases
- superficial (skin):
- Impetigo contagiosa , pyoderma
- Pustules
- Hair follicle: boils , carbuncles
- on the extremities (limbs):
- Finger, finger tendons: panaritium
- Fissures of tissue: phlegmon
- Joints: empyema , pyarthrosis .
- everywhere in the body:
- Body cavities:
- Empyema and specific names such as purulent peritonitis , purulent pleurisy
- purulent organ diseases:
- Pyonephrosis (suppurative hydronephrosis )
- of mucous membranes:
Treatment principles
The aim should almost always be to relieve an accumulation of pus so that the secretion can drain away. " Ubi pus, ibi evacua " - "Where there is pus, empty it there" - this Latin motto attributed to Hippocrates of Kos has a special meaning especially in the jaw and face area: In this area there is a threat from the connection of the veins there with those the brain at risk of cerebral vein thrombosis (cavernous sinus thrombosis); see boils .
In addition to the usual procedures of septic surgery - splitting an abscess , inserting simple drains - irrigation-suction drains are used to clean a wound cavity. In the case of ulcerated bones ( osteomyelitis ), chains made of non-resorbable gentamicin- containing plastic beads were even placed in the cavity, which had to be removed again at a later point in time.
The use of antibiotics with advanced boils or with an abscess in muscle or fat tissue that is sealed off from the body by a granulation wall usually has no healing effect and is considered useless. The drug does not penetrate the suppuration at all.
With other suppurations, however, such as phlegmons , empyema and others, the situation is different - here septic side effects are feared. In the case of multiple small liver abscesses, the sole long-term administration of effective antibiotics is even preferable to surgery, because healing has been observed in many cases. When using it is between local application, z. B. as a powder or ointment ( pull ointment ), and systemic administration of antibiotics. Systemic administration means absorption into the bloodstream via the gastrointestinal tract or infusion. The drug then works all over the body, including the area of the wound.
Like all pathogens, pyogenic germs can develop antibiotic resistance and pass this on to other germs. Due to the concentration of sick people (germ load) on the one hand and the often too generous and untargeted antibiotic therapy (development of resistance without prior germ testing) in the hospital, one fears the selection of in-house multi-resistant problem germs that are resistant to almost all available antibiotics. One speaks of "infectious hospitalism ". The general strategy to combat it is simple, but understandably not always successful: Exemplary hygiene and economical, sensible (only indicated) antibiotic prescriptions that are continuously checked for effectiveness.
history
The term "cable" was in the Middle Ages in addition to the (modern) pathological significance of pus humoralpathologisch for toxic or materiality peccans . In 19th century medicine there was the term pus bonum et laudabile , the so-called "laudable" pus. What was meant here was the so-called “pure”, creamy-yellow staphylococcal pus, without which, according to the opinion of the time, wound healing could not take place.
Individual evidence
- ↑ W. Böcker, H. Denk, PU Heitz, H. Moch (Ed.): Pathology. 4th edition. Elsevier Urban & Fischer, 2008, ISBN 978-3-437-42382-6 .
- ↑ Duden: fester .
- ↑ Repetitorium Palliativmedizin: To prepare for the examination palliative medicine, chap. 8.3.5 in Google Book Search
- ↑ Jürgen Martin: The 'Ulmer Wundarznei'. Introduction - Text - Glossary on a monument to German specialist prose from the 15th century. Königshausen & Neumann, Würzburg 1991 (= Würzburg medical-historical research. Volume 52), ISBN 3-88479-801-4 (also medical dissertation Würzburg 1990), p. 125.
