Manual of Surgery Volume First: General Surgery. Sixth Edition.Thomson, Alexis
Science
Manual of Surgery Volume First: General Surgery. Sixth Edition.
Thomson, Alexis
Surgery
#Embolism.#--The term _embolus_ is applied to any body carried along in
the circulation and ultimately becoming impacted in a blood vessel. This
occurrence is known as _embolism_. The commonest forms of embolus are
portions of thrombi or of fibrinous formations on the valves of the
heart, the latter being usually infected with micro-organisms.
Embolism plays an important part in determining one form of gangrene, as
has already been described. Infective emboli are the direct cause of the
secondary abscesses that occur in pyæmia; and they are sometimes
responsible for the formation of aneurysm.
Portions of malignant tumours also may form emboli, and their impaction
in the vessels may lead to the development of secondary growths in
distant parts of the body.
Fat and air embolism have already been referred to.
ARTERITIS
_Pyogenic._--Non-suppurative inflammation of the coats of an artery may
so soften the wall of the vessel as to lead to aneurysmal dilatation. It
is not uncommon in children, and explains the occurrence of aneurysm in
young subjects.
When suppuration occurs, the vessel wall becomes disintegrated and gives
way, leading to secondary hæmorrhage. If the vessel ruptures into an
abscess cavity, dangerous bleeding may occur when the abscess bursts or
is opened.
_Syphilitic._--The inflammation associated with syphilis results in
thickening of the tunica intima, whereby the lumen of the vessel becomes
narrowed, or even obliterated--_endarteritis obliterans_. The middle
coat usually escapes, but the tunica externa is generally thickened.
These changes cause serious interference with the nutrition of the parts
supplied by the affected arteries. In large trunks, by diminishing the
elasticity of the vessel wall, they are liable to lead to the formation
of aneurysm.
Changes in the arterial walls closely resembling those of syphilitic
arteritis are sometimes met with in _tuberculous_ lesions.
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