Manual of Surgery Volume First: General Surgery. Sixth Edition.Thomson, Alexis
Science
Manual of Surgery Volume First: General Surgery. Sixth Edition.
Thomson, Alexis
Surgery
To relieve the pain, warm fomentations or lead and opium lotion should
be applied. Later, ichthyol-glycerin, or glycerin and belladonna, may be
substituted.
When, at the end of three weeks, the danger of embolism is past,
douching and gentle massage may be employed to disperse the œdema; and
when the patient gets up he should wear a supporting elastic bandage.
The _infective_ form usually begins as a peri-phlebitis arising in
connection with some focus of infection in the adjacent tissues. The
elements of the vessel wall are destroyed by suppuration, and the
thrombus in its lumen becomes infected with pyogenic bacteria and
undergoes softening.
_Occlusion of the inferior vena cava_ as a result of infective
thrombosis is a well-known condition, the thrombosis extending into the
main trunk from some of its tributaries, either from the femoral or
iliac veins below or from the hepatic veins above.
Portions of the softened thrombus are liable to become detached and to
enter the circulating blood, in which they are carried as emboli. These
may lodge in distant parts, and give rise to secondary foci of
suppuration--pyæmic abscesses.
_Clinical Features._--Infective phlebitis is most frequently met with in
the transverse sinus as a sequel to chronic suppuration in the mastoid
antrum and middle ear. It also occurs in relation to the peripheral
veins, but in these it can seldom be recognised as a separate entity,
being merged in the general infective process from which it takes
origin. Its occurrence may be inferred, if in the course of a
suppurative lesion there is a sudden rise of temperature, with pain,
redness, and swelling along the line of a venous trunk, and a rapidly
developed œdema of the limb, with pitting of the skin on pressure. In
rare cases a localised abscess forms in the vein and points towards the
surface.
_Treatment._--Attention must be directed towards the condition with
which the phlebitis is associated. Ligation of the vein on the cardiac
side of the thrombus with a view to preventing embolism is seldom
feasible in the peripheral veins, although, as will be pointed out
later, the jugular vein is ligated with this object in cases of
phlebitis of the transverse sinus.
VARIX--VARICOSE VEINS
The term varix is applied to a condition in which veins are so altered
in structure that they remain permanently dilated, and are at the same
time lengthened and tortuous. Two types are met with: one in which
dilatation of a large superficial vein and its tributaries is the most
obvious feature; the other, in which bunches of distended and tortuous
vessels develop at one or more points in the course of a vein, a
condition to which Virchow applied the term _angioma racemosum venosum_.
The two types may occur in combination.
Any vein in the body may become varicose, but the condition is rare
except in the veins of the lower extremity, in the veins of the
spermatic cord (varicocele), and in the veins of the anal canal
(hæmorrhoids).
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