Serous exudate is easily absorbed. Types of exudates. Serous-purulent and purulent exudate

There is far from one difference between transudate and exudate, although for an ignorant person both of these terms are incomprehensible. But a professional doctor must be able to distinguish one from the other, because these types of effusion fluid require a different approach. Let's try to talk about transudates and exudates in such a way that it is understandable even to a person without a medical education.

What are effusion fluids

Exudative fluids form and accumulate in the serous cavities, which include the pleural, abdominal, pericardial, epicardial, and synovial spaces. In the listed cavities, it is present, which ensures the normal functioning of the corresponding internal organs (lungs, abdominal organs, heart, joints) and prevents them from rubbing against the membranes.

Normally, these cavities should contain only serous fluid. But with the development of pathologies, effusions can also form. Cytologists and histologists are engaged in their research in detail, because a competent diagnosis of transudates and exudates allows prescribing the correct treatment and preventing complications.

transudate

From Latin trans - through, through; sudor - sweat. Effusion of non-inflammatory origin. It can accumulate due to problems with blood circulation and lymph circulation, water-salt metabolism, and also due to increased permeability of the vascular walls. The transudate contains less than 2% protein. These are albumins and globulins that do not react with colloidal proteins. In terms of characteristics and composition, the transudate is close to plasma. It is transparent or has a pale yellow hue, sometimes with cloudy impurities of epithelial cells and lymphocytes.

The occurrence of transudate is usually due to congestion. It can be thrombosis, renal or heart failure, hypertension. The mechanism of formation of this fluid is associated with an increase in internal blood pressure and a decrease in plasma pressure. If at the same time the permeability of the vascular walls is increased, then the transudate begins to be released into the tissues. Some diseases associated with the accumulation of transudates have special names: hydropericardium, abdominal ascites, ascites-peritonitis, hydrothorax.

By the way! With proper treatment, the transudate can resolve, and the disease will go away. If you start it, the extravasation will increase, and over time, the stagnant fluid can become infected and turn into exudate.

Exudate

From Latin exso - go outside sudor - sweat. Formed in small blood vessels as a result of inflammatory processes. The fluid exits through the vascular pores into the tissues, infecting them and contributing to the further development of inflammation. The exudate contains 3 to 8% protein. Also, it may contain blood cells (leukocytes, erythrocytes).

The formation and release of exudate from the vessels is due to the same factors (an increase in blood pressure, an increase in the permeability of the vascular walls), but inflammation in the tissues is additionally present. Because of this, the effusion fluid has a different composition and inflammatory nature, which is more dangerous for the patient. This is the main difference between transudate and exudate: the latter is more dangerous, so more time is devoted to its research.

Important! They try to get rid of the detected exudate as soon as possible. Otherwise, cancer cells may begin to form in it, causing an oncological disease of the organ in the cavity of which the exudate is located.

Exudate and its types

Different types of exudates differ from each other in their composition, the causes of inflammation and its features. It is possible to determine the type of exudative fluid using a puncture, after which the evacuated (pumped out) contents of a particular cavity are sent for laboratory research. Although the doctor can sometimes draw primary conclusions from the appearance of the liquid.

Serous exudate

In fact, a serous effusion is a transudate that has begun to be modified due to infection. Almost completely transparent; the protein content is moderate (up to 5%), there are few leukocytes, no erythrocytes. The name reflects the fact that such an exudate occurs in the serous membranes. It can form as a result of inflammation caused by allergies, infection, deep wounds or burns.

fibrinous exudate

It contains a large amount of fibrinogen - a colorless protein, the increased content of which indicates the presence of acute inflammatory or infectious diseases: influenza, diphtheria, myocardial infarction, pneumonia, cancer. Fibrinous exudate is found in the bronchi, gastrointestinal tract, and trachea. The danger of fibrinous deposits lies in the risk of their germination in the connective tissue and the formation of adhesions.

Purulent exudate

Or just pus. Contains dead or destroyed cells, enzymes, fibrin threads and other elements. Due to their decomposition, such an exudate has a pronounced bad odor and a pathological color for organic liquids: greenish, brownish, bluish. Purulent exudate is also distinguished by increased viscosity, which is due to the content of nucleic acids in it.

A type of pus is putrefactive exudate. It is formed as a result of inflammation caused by anaerobic (oxygen-free) bacteria. It has a more pronounced disgusting smell.

Hemorrhagic exudate

It has a pinkish hue, which is explained by the increased content of red blood cells in it. Hemorrhagic exudate often forms in the pleural cavity as a result of tuberculosis. Some of the fluid may be coughed up.

Other types of exudates (serous, fibrinous, purulent) can be modified into hemorrhagic with a progressive increase in vascular permeability or with their destruction. Other diseases reported by hemorrhagic exudate: smallpox, anthrax, toxic influenza.

Slimy

It contains a large amount of mucin and lysozyme, which provides it with a mucous structure. More often it is formed in inflammatory diseases of the nasopharynx (tonsillitis, pharyngitis, laryngitis).

Chylous exudate

Contains chyle (lymph), as evidenced by its milky color. If chylous exudate stagnates, a more oily layer with lymphocytes, leukocytes, and a small number of erythrocytes forms on its surface. Most often, such an inflammatory effusion is found in the abdominal cavity; less often - in the pleural.

There is also pseudochylous exudate, which is also formed by lymph, but the amount of fat in it is minimal. Occurs with kidney problems.

Cholesterol

Quite thick, with a beige, pinkish or dark brown (in the presence of a large number of erythrocytes) shade. It contains cholesterol crystals, from which it got its name. Cholesterol exudate may be present in any cavity for a long time and be discovered by chance during surgery.

Rare exudates

In exceptional cases, neutrophilic (consists of neutrophils), lymphocytic (from lymphocytes), mononuclear (from monocytes) and eosinophilic (from eosinophils) exudates are found in the cavities. Outwardly, they almost do not differ from those listed earlier, and their composition can be clarified only with the help of chemical analysis.

Laboratory studies of effusion fluids

The importance of determining the type and composition of effusion fluids is evidenced by the fact that their first laboratory studies began in the 19th century. In 1875, the German surgeon Heinrich Quincke pointed out the presence of tumor cells isolated from the fluids of serous cavities. With the development of chemical analysis and the advent of new research methods (in particular, staining of biological fluids), it has also become possible to determine the characteristics of cancer cells. In the USSR, clinical cytology began to develop actively since 1938.

Modern laboratory analysis is based on a specific algorithm. The nature of the effusion fluid is initially clarified: inflammatory or not. This is determined by the content of several indicators:

• protein (key indicator);
• albumins and globulins;
• cholesterol;
• the number of leukocytes;
• absolute amount of liquid (LDH), its density and pH.

A comprehensive study allows you to accurately distinguish exudate from transudate. If the inflammatory nature is determined, then a series of analyzes follows, allowing to determine the composition of the exudate and its appearance. Information enables the doctor to make a diagnosis and prescribe treatment.

Exudate I Exudate (exsudatum; lat. exsudare go out, stand out)

liquid rich in protein and containing; formed during inflammation. The process of moving E. into the surrounding tissues and cavities of the body is called exudation. The latter occurs following damage to cells and tissues in response to mediators (see Inflammation) .

Exudate, serous-hemorrhagic(e. serohaemorrhagicum) - serous E., containing an admixture of erythrocytes.

Serous-fibrinous exudate(e. serofibrinosum) - serous E., containing a significant admixture of fibrin.

Serous exudate(e. serosum) - E., consisting mainly of plasma and poor in blood cells.

Mucous hemorrhagic exudate(e. mucohaemorrhagicum) - mucous E., containing an admixture of erythrocytes.

Mucous exudate(e. mucosum) - E., containing a significant amount of mucin or pseudomucin.

Fibrinous exudate(e. fibrinosum) - E., containing a significant amount of fibrin.

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.

See what "Exudate" is in other dictionaries:

Exudate is a turbid, protein-rich and hematogenous and histogenic fluid that oozes from small blood vessels at the site of inflammation. Contains protein, leukocytes, erythrocytes, minerals, cellular elements ... Wikipedia

- (lat. exsudatio, from proposition ex, and sudare to sweat). Seeping, escaping liquid or condensed matter in the body through the blood vessels or through the pores of the skin, like sweat; sweating. Dictionary of foreign words included in the Russian language. ... ... Dictionary of foreign words of the Russian language

Modern Encyclopedia

- (from Latin exsudo I sweat out), inflammatory effusion is a serous, purulent, bloody or fibrinous fluid that seeps from small blood vessels into tissues or body cavities during inflammation (for example, with exudative pleurisy). Wed… … Big Encyclopedic Dictionary

Muddy, rich in protein and cells of hematogenous and histogenic nature, the fluid is formed at the site of inflammation. Acute inflammation is characterized by a predominance of neutrophils in E., for chronic lymphocytes and monocytes, for allergic ... ... Dictionary of microbiology

Exist., number of synonyms: 1 effusion (3) ASIS synonym dictionary. V.N. Trishin. 2013 ... Synonym dictionary

exudate- and EXUDAT a, m. exsudat m. lat. exsudare to go outside. 1. spec. Fluid that oozes out during inflammation from small vessels in tissues or body cavities; effusion. ALS 1. My illness, which prevented a timely response, was an epileptic, ... ... Historical Dictionary of Gallicisms of the Russian Language

EXSUDATE- English exudate German Exsudat French exsudât see > ... Phytopathological dictionary-reference book

Exudate- (from the Latin exsudo I sweat, exude), an inflammatory effusion is a serous, purulent, bloody or fibrin-like fluid that seeps from small blood vessels into tissues or body cavities during inflammation (for example, with exudative ... ... Illustrated Encyclopedic Dictionary

BUT; m. [from lat. exsudare highlight] Med. Fluid leaking from small blood vessels into tissues or body cavities when inflamed; inflammatory effusion. ◁ Exudative, oh, oh. E. diathesis. E. pleurisy. * * * exudate (from lat. exsudo ... ... encyclopedic Dictionary

- (exsudatum; ex + lat. sudo, sudatum to sweat) a protein-rich liquid containing blood cells that comes out of small veins and capillaries into the surrounding tissues and body cavities during inflammation ... Big Medical Dictionary

Depending on the causes of inflammation and the development of the inflammatory process, the following types of exudates are distinguished:

serous,

fibrinous,

1. hemorrhagic.

Accordingly, serous, fibrinous, purulent and hemorrhagic inflammation is observed. There are also combined types of inflammation: gray-fibrinous, fibrinous-purulent, purulent-hemorrhagic. Any exudate after its infection with putrefactive microbes is called putrefactive. Therefore, the allocation of such exudate to an independent rubric is hardly advisable. Exudates containing a large number of fatty droplets (chyle) are called chylous, or chyloid. It should be noted that the entry of fat droplets is possible in the exudate of any of the above types. It can be caused by the localization of the inflammatory process in the places of accumulation of large lymphatic vessels in the abdominal cavity and other side effects. Therefore, it is also hardly advisable to single out the chylous type of exudate as an independent one. An example of a serous exudate during inflammation is the contents of a bladder from a burn on the skin (burn of the II degree).

An example of fibrinous exudate or inflammation is fibrinous deposits in the pharynx or larynx in diphtheria. Fibrinous exudate is formed in the large intestine with dysentery, in the alveoli of the lungs with lobar inflammation.

Serous exudate. Its properties and formation mechanisms are given in § 126 and Table. 16.

fibrinous exudate. A feature of the chemical composition of fibrinous exudate is the release of fibrinogen and its loss in the form of fibrin in the inflamed tissue. Subsequently, the precipitated fibrin dissolves due to the activation of fibrinolytic processes. Sources of fibrinolysin (plasmin) are both blood plasma and the inflamed tissue itself. An increase in the fibrinolytic activity of blood plasma during fibrinolysis in lobar pneumonia, for example, is easy to see by determining this activity in the exudate of an artificial blister created on the patient's skin. Thus, the process of development of fibrinous exudate in the lung is, as it were, reflected in any other place in the patient's body, where an inflammatory process occurs in one form or another.

Hemorrhagic exudate It is formed during a rapidly developing inflammation with severe damage to the vascular wall, when erythrocytes enter the inflamed tissue. Hemorrhagic exudate is observed in smallpox pustules with the so-called black pox. It occurs with anthrax carbuncle, with allergic inflammation (Arthus phenomenon) and other acutely developing and rapidly occurring inflammatory processes.

Purulent exudate and purulent inflammation are caused by pyogenic microbes (strepto-staphylococci and other pathogenic microbes).

During the development of purulent inflammation, purulent exudate enters the inflamed tissue and leukocytes impregnate, infiltrate it, located in large numbers around the blood vessels and between the own cells of the inflamed tissues. The inflamed tissue at this time is usually dense to the touch. Clinicians define this stage of development of purulent inflammation as the stage of purulent infiltration.

The source of enzymes that cause the destruction (melting) of the inflamed tissue are leukocytes and cells damaged during the inflammatory process. Particularly rich in hydrolytic enzymes are granular leukocytes (neutrophils). Neutrophil granules contain proteases, cathepsin, chymotrypsin, alkaline phosphatase and other enzymes. With the destruction of leukocytes, their granules (lysosomes), enzymes enter the tissue and cause the destruction of its protein, protein-lipoid and other components.

Under the influence of enzymes, the inflamed tissue becomes soft, and clinicians define this stage as the stage of purulent fusion, or purulent softening. A typical and well-marked expression of these stages of development of purulent inflammation is inflammation of the hair follicle of the skin (furuncle) or the fusion of many boils into one inflammatory focus - carbuncle and acute diffuse purulent inflammation of the subcutaneous tissue - phlegmon. Purulent inflammation is not considered complete, “ripened” until purulent tissue fusion occurs. As a result of purulent fusion of tissues, a product of this fusion is formed - pus.

Pus It is usually a thick, creamy, yellow-green liquid with a sweetish taste and a specific odor. When centrifuged, the pus is divided into two parts:

sediment composed of cellular elements,

liquid part - purulent serum. When standing, the purulent serum sometimes coagulates.

The pus cells are called purulent bodies. They are blood leukocytes (neutrophils, lymphocytes, monocytes) in various stages of damage and decay. Damage to the protoplasm of purulent bodies is noticeable in the form of the appearance of a large number of vacuoles in them, violation of the contours of the protoplasm and erasure of the boundaries between the purulent body and its environment. With special stains in purulent bodies, a large amount of glycogen and fat droplets are found. The appearance of free glycogen and fat in purulent bodies is a consequence of a violation of complex polysaccharide and protein-lipoid compounds in the protoplasm of leukocytes. The nuclei of purulent bodies become denser (pycnosis) and fall apart (karyorrhexis). There are also phenomena of swelling and gradual dissolution of the nucleus or its parts in a purulent body (karyolysis). The disintegration of the nuclei of purulent bodies causes a significant increase in the amount of nucleoproteins and nucleic acids in the purulent.

Purulent serum does not differ significantly in composition from blood plasma (Table 17).

The sugar content in exudates in general and in purulent exudates in particular is usually lower than in the blood (0.5-0.6 g/l), due to intensive glycolysis processes. Accordingly, there is much more lactic acid in the purulent exudate (0.9-1.2 g / l and above). Intensive proteolytic processes in the purulent focus cause an increase in the content of polypeptides and amino acids.

- inflammatory reaction of the pleura, proceeding with the accumulation of serous exudate in the pleural cavity. Symptoms of serous pleurisy are characterized by dull pain in the chest, dry cough, shortness of breath, cyanosis, tachycardia, signs of intoxication. Diagnosis of serous pleurisy is based on an assessment of the history, physical examination, thoracocentesis, laboratory examination of pleural effusion, ultrasound, radiography, pleuroscopy. Treatment of serous pleurisy includes etiotropic and symptomatic therapy, therapeutic pleural punctures, drainage of the pleural cavity, physiotherapy, exercise therapy, and massage.

ICD-10

J90 Pleural effusion, not elsewhere classified

General information

Serous pleurisy, along with hemorrhagic and purulent pleurisy (pleural empyema), is a type of exudative pleurisy. The stage of serous effusion usually serves as a continuation of fibrinous (dry) pleurisy. Serous pleurisy in pulmonology is differentiated by etiology (infectious and aseptic), by course (acute, subacute and chronic), by the nature of distribution (diffuse and encysted). Infectious serous pleurisy among themselves are divided according to the type of causative agent of the inflammatory process (viral, pneumococcal, tuberculosis, etc.), aseptic - according to the type of underlying pathology (carcinomatous, rheumatic, traumatic, etc.).

Causes of serous pleurisy

Aseptic serous pleurisy may be due to malignant tumors of the lungs and pleura (pleural mesothelioma, lung cancer) or metastases of tumors in other organs; diffuse connective tissue diseases (rheumatism, rheumatoid arthritis, systemic lupus erythematosus); myocardial infarction, pulmonary infarction, pulmonary embolism, uremia, leukemia and other pathological processes.

The development of serous pleurisy may be the result of injuries and surgical interventions on the chest, taking certain medications (bromocriptine, nitrofurantoin). The provoking factors of serous pleurisy are frequent hypothermia, malnutrition, physical inactivity, overwork, stress, drug hypersensitization, a decrease in general and local reactivity.

Pathogenesis

Serous pleurisy is caused by a pathological protective reaction of the sensitized pleura to infectious-toxic irritation, which is expressed in excessive exudation and reduced absorption of fluid in the pleural cavity. The development of exudative inflammation in serous pleurisy is associated with an increase in the permeability of the blood and lymphatic capillaries of the lungs and pleura. Serous exudate is a clear yellowish liquid consisting of plasma and a small number of blood cells. Most often, a cloudy yellow serous effusion with fibrin flakes, an accumulation of lymphocytes, polymorphonuclear leukocytes, macrophages, mesothelial cells, and eosinophils is noted in the pleural cavity.

Infectious agents can penetrate into the pleural cavity from the primary foci by contact, lymphogenous or hematogenous routes and have a direct effect on the pleura or cause its sensitization with toxins and metabolic products. At the same time, the production of specific antibodies and biologically active substances is accompanied by local microcirculation disorders, damage to the vascular endothelium and the formation of exudate. The accumulation of serous exudate in the pleural cavity is observed in the acute stage of pleurisy, then the effusion can completely resolve, leaving fibrinous deposits (moorings) on the surface of the pleura that contribute to the development of pleurosclerosis. With pleurisy, a further change in the serous nature of the exudate towards purulent or putrefactive is possible.

Symptoms of serous pleurisy

Symptoms of serous pleurisy can complement the clinical manifestations of the underlying disease (pneumonia, tuberculosis, lung cancer, systemic vasculitis, etc.) or dominate over them. The initial stage of serous pleurisy is characterized by intense dull pain in the chest on the affected side, aggravated by inhalation; shallow, rapid breathing; dry cough, asymmetry of respiratory movements of the chest, pleural rub. With the accumulation of exudate in the pleural cavity, the pain gradually subsides, although it may persist, for example, with carcinomatous serous pleurisy. In some cases, polyserositis (pericarditis, pleurisy, and ascites) may develop.

There is heaviness in the side, shortness of breath begins to progress rapidly; with a large amount of effusion, cyanosis develops, tachycardia, swelling of the cervical veins, and sometimes swelling of the intercostal spaces. A patient with serous pleurisy is characterized by a forced position on the affected side. Increased pain during the recovery period may be associated with resorption of the serous fluid and contact of the pleural sheets or with suppuration of the exudate and the development of purulent pleurisy.

With serous pleurisy, there is an increase in intoxication, general weakness, an increase in body temperature to subfebrile, sweating, decreased appetite and disability. The severity of the general condition of a patient with serous pleurisy depends on the severity of intoxication and the rate of accumulation of free effusion. Serous pleurisy of tuberculous etiology is usually manifested by a more pronounced temperature reaction and intoxication.

Diagnostics

For the diagnosis of serous pleurisy, a comprehensive examination is carried out with an assessment of the anamnesis, symptoms, and the results of various laboratory and instrumental studies. In the diagnosis of serous pleurisy, information about the patient's pathology is important: trauma, surgery, pneumonia, tuberculosis, rheumatism, tumors of various localization, allergies, etc. Physical examination reveals an increase in the volume of the chest on the side of the lesion, swelling of the intercostal spaces and swelling of the skin; limitation of respiratory excursion, characteristic of serous pleurisy. Percussion, with the accumulation of pleural fluid in a volume of at least 300-500 ml, a massive dullness of sound is detected, breathing over the zone of dullness is significantly weakened.

In case of serous pleurisy, ultrasound of the pleural cavity is performed, if a background pathology is suspected, an additional examination is used (ECG, hepatography, measurement of venous pressure, tuberculin tests, determination of serum enzymes and protein-sedimentary samples, and other tests). Differential diagnosis is necessary to distinguish between serous pleurisy and lung atelectasis, focal pneumonia, circulatory disorders accompanied by the formation of transudate (with pericarditis, heart disease, liver cirrhosis, nephrotic syndrome).

Treatment of serous pleurisy

In the treatment of serous pleurisy, it is necessary to take into account the general condition of the patient, the presence of an underlying underlying disease. Treatment of serous pleurisy is carried out in a hospital with the appointment of bed rest, a diet with fluid and salt restriction, and complex pathogenetic therapy.

After establishing the cause of serous pleurisy, additional etiotropic treatment may include tuberculostatic agents - with the specific nature of the disease; sulfonamides and broad-spectrum antibiotics - for nonspecific pneumonic pleurisy. With a significant accumulation of pleural exudate, causing respiratory and circulatory disorders, and also because of the threat of empyema, pleural puncture or drainage of the pleural cavity with fluid evacuation is carried out as an emergency. Then antibiotics can be injected into the cavity, and in case of serous pleurisy caused by pleural cancer, antitumor drugs.

Anti-inflammatory and hyposensitizing agents, glucocorticosteroids are shown. Symptomatic therapy of serous pleurisy includes cardiotonic and diuretic drugs. In the absence of contraindications, after resorption of the exudate, physiotherapy (ultrasound and electrophoresis with calcium chloride), active breathing exercises, and massage are prescribed to prevent pleural adhesions in serous pleurisy. With a persistent course of serous pleurisy, its surgical treatment may be required - obliteration of the pleural cavity, thoracoscopic pleurectomy, etc.

Forecast and prevention

The prognosis for serous pleurisy is largely determined by the nature and severity of the underlying disease: usually in the case of timely and rational treatment of pleurisy of infectious etiology, it is favorable. The most severe prognosis is associated with tumor pleurisy, indicating a far advanced oncological process. Prevention consists in the timely detection and treatment of the primary disease that caused the production and accumulation of exudate in the pleural cavity.

Each of us has experienced inflammation of one kind or another. And if its serious forms, such as pneumonia or colitis, happen in special cases, then such minor troubles as a cut or abrasion are commonplace. Many do not pay attention to them at all. But even the most minor injuries can cause exudative inflammation. In fact, this is such a state of the affected area, in which specific fluids collect in it, and then seep through the walls of the capillaries to the outside. This process is quite complex, based on the laws of hydrodynamics and can lead to complications in the course of the disease. In this article, we will analyze in detail what causes exudative inflammation causes. We will also consider the types (outcomes for each of them are unequal) of this kind of inflammatory processes, and along the way we will explain what they depend on, how they proceed, what treatment they require.

Inflammation - good or bad?

Many will say that, of course, inflammation is evil, because it is an integral part of almost any disease and brings suffering to a person. But in fact, in the process of evolution, our body for many years developed the mechanisms of inflammatory processes in itself so that they would help to survive the harmful effects, which are called irritants in medicine. They can be viruses, bacteria, any skin wounds, chemicals (for example, poisons, toxins), adverse environmental factors. Exudative inflammation should protect us from the pathological activity of all these irritants. What it is? If you do not go into details, it is quite simple to explain it. Any irritant, once in the human body, damages its cells. This is called an alteration. It starts the inflammatory process. Its symptoms, depending on the type of irritant and the place of its introduction, may differ. Among the common ones are:

• rise in temperature either throughout the body, or only in the damaged area;
• swelling of the affected area;
• soreness;
• redness of the injured area.

These are the main signs by which you can understand that exudative inflammation has already begun. The photo above clearly demonstrates the manifestation of symptoms - redness, swelling.

On some vessels, fluids (exudate) begin to accumulate. When they penetrate the walls of the capillaries into the intercellular space, the inflammation becomes exudative. At first glance, this seems to be an aggravation of the problem. But in fact, the release of exudate, or, as doctors say, exudation, is also needed. Thanks to it, very important substances enter the tissues from the capillaries - immunoglobulins, kinins, plasma enzymes, leukocytes, which immediately rush to the focus of inflammation in order to eliminate irritants and heal damaged areas there.

Exudation process

Explaining what exudative inflammation is, pathological anatomy (the discipline that studies pathological processes) pays special attention to the process of exudation, the “culprit” of this type of inflammation. It consists of three stages:

1. There has been an alteration. She launched special organic compounds - (kinins, histamines, serotonins, lymphokines and others). Under their action, the channels of microvessels began to expand, and as a result, the permeability of the walls of the vessels increased.
2. In wider sections of the channels, the blood flow began to move more intensively. There was a so-called hyperemia, which, in turn, led to an increase in blood vessels (hydrodynamic) pressure.
3. Under the pressure of fluid from microvessels, exudate began to seep into the tissues through enlarged interendothelial gaps and pores, sometimes reaching the size of tubules. The particles that make it up moved to the focus of inflammation.

Types of exudates

It is more correct to call the exudate fluids leaving the vessels into the tissues, and the same fluids released in the cavity - effusion. But in medicine, these two concepts are often combined. The exudative type of inflammation is determined by the composition of the secret, which can be:

• serous;
• fibrous;
• purulent;
• putrid;
• hemorrhagic;
• slimy;
• chile;
• chyle-like;
• pseudochylous;
• cholesterol;
• neutrophilic;
• eosinophilic;
• lymphocytic;
• mononuclear;
• mixed.

Let us consider in more detail the most common types of exudative inflammation, its causes and symptoms.

Form of serous exudative inflammation

In the human body, the peritoneum, pleura, and pericardium are covered with serous membranes, so named from the Latin word "serum", which means "serum", because they produce and absorb fluids that resemble or are formed from blood serum. The serous membranes in the normal state are smooth, almost transparent, very elastic. When exudative inflammation begins, they become rough and cloudy, and serous exudate appears in tissues and organs. It contains proteins (more than 2%), lymphocytes, leukocytes, epithelial cells.

The causes of exudative inflammation can be:

• injuries of various etiologies (violations of the integrity of the skin, burns, insect bites, frostbite);
• intoxication;
• viral and bacterial infections (tuberculosis, meningitis, herpes, chickenpox and others);
• allergy.

Serous exudate helps to remove toxins and irritants from the focus of inflammation. Along with its positive features, there are also negative ones. So, if serous exudative inflammation occurs, respiratory failure may develop, in the pericardium - heart failure, in the meninges - cerebral edema, in the kidneys - renal failure, in the skin under the epidermis - exfoliation of it from the dermis and the formation of serous blisters. Each disease has its own symptoms. Of the general ones, one can distinguish a rise in temperature and pain. Despite the seemingly very dangerous pathology, the prognosis in the vast majority of cases is favorable, since the exudate resolves without leaving traces, and the serous membranes are restored.

fibrous inflammation

As noted above, all types of exudative inflammation are determined by the composition of the secret released from the microvessels. So, fibrous exudate is obtained when, under the influence of inflammatory stimuli (trauma, infection), an increased amount of fibrinogen protein is formed. Normally, an adult should have 2-4 g / l. In damaged tissues, this substance turns into the same protein, which has a fibrous structure and forms the basis of blood clots. In addition, in the fibrous exudate there are leukocytes, macrophages, monocytes. At some stage of inflammation, necrosis of tissues affected by the irritant develops. They are impregnated with fibrous exudate, as a result of which a fibrous film forms on their surface. Microbes actively develop under it, which complicates the course of the disease. Depending on the localization of the film and on its features, diphtheria and croupous fibrous exudative inflammation are distinguished. Pathological anatomy describes their differences as follows:

1. Diphtheria inflammation can occur in those organs that are covered with a multilayer membrane - in the throat, uterus, vagina, bladder, and gastrointestinal organs. In this case, a thick fibrous film is formed, as if ingrown into the shell of the organs. Therefore, it is difficult to remove, and leaves ulcers behind. Over time, they heal, but scars may remain. There is another evil - under this film, microbes multiply most actively, as a result of which the patient has a high intoxication with the products of their vital activity. The most famous disease of this type of inflammation is diphtheria.
2. Croupous inflammation is formed on mucous organs covered with a single layer: in the bronchi, peritoneum, trachea, pericardium. In this case, the fibrous film turns out to be thin, easily removed, without significant defects in the mucous membranes. However, in some cases, it can create serious problems, for example, with inflammation of the trachea, it can make it difficult for air to enter the lungs.

Exudative purulent inflammation

This pathology is observed when the exudate is pus - a viscous greenish-yellow mass, in most cases having a characteristic odor. Its composition is approximately the following: leukocytes, most of which are destroyed, albumins, fibrin threads, enzymes of microbial origin, cholesterol, fats, DNA fragments, lecithin, globulins. These substances form purulent serum. In addition to it, purulent exudate contains tissue detritus, live and / or degenerated microorganisms, purulent bodies. Purulent inflammation can occur in any organs. The "culprits" of suppuration are most often pyogenic bacteria (various cocci, E. coli, Proteus), as well as Candida, Shigella, Salmonella, Brucella. Forms of exudative inflammation of a purulent nature are as follows:

1. Abscess. It is a focus with a barrier capsule that prevents pus from entering neighboring tissues. In the cavity of the focus, purulent exudate accumulates, entering there through the capillaries of the barrier capsule.
2. Phlegmon. With this form, there are no clear boundaries at the focus of inflammation, and purulent exudate spreads into neighboring tissues and cavities. Such a picture can be observed in the subcutaneous layers, for example, in fatty tissue, in the retroperitoneal and perirenal zones, wherever the morphological structure of the tissues allows pus to go beyond the focus of inflammation.
3. Empyema. This form is similar to an abscess and is observed in the cavities, next to which there is a focus of inflammation.

If there are many degenerative neutrophils in the pus, the exudate is called purulent neutrophilic. In general, the role of neutrophils is to destroy bacteria and fungi. They, like brave guards, are the very first to rush at the enemies that have penetrated our body. Therefore, at the initial stage of inflammation, most neutrophils are intact, undestroyed, and the exudate is called micropurulent. As the disease progresses, leukocytes are destroyed, and in pus most of them are already degenerated.

If putrefactive microorganisms (in most cases anaerobic bacteria) enter the inflammatory focus, the purulent exudate develops into putrefactive. It has a characteristic odor and color and contributes to the decomposition of tissues. This is fraught with high intoxication of the body and has a very unfavorable outcome.

Treatment of purulent inflammation is based on the use of antibiotics and ensuring the outflow of secretions from the focus. Sometimes this requires surgery. Prevention of such inflammation is the disinfection of wounds. Treatment of this pathology can have a favorable outcome only with intensive chemotherapy with simultaneous surgical removal of rotting fragments.

Hemorrhagic inflammation

In some very dangerous diseases, such as smallpox, plague, toxic influenza, hemorrhagic exudative inflammation is diagnosed. The reasons for it are the increasing permeability of microvessels up to their ruptures. In this case, the exudate is dominated by erythrocytes, due to which its color varies from pink to dark red. The external manifestation of hemorrhagic inflammation is similar to hemorrhage, but, unlike the latter, not only erythrocytes are found in the exudate, but also a small proportion of neutrophils with macrophages. Treatment of hemorrhagic exudative inflammation is prescribed taking into account the type of microorganisms that led to it. The outcome of the disease can be extremely unfavorable if therapy is started out of time and if the patient's body does not have enough strength to resist the disease.

Catarrh

A feature of this pathology is that the exudate with it can be serous, purulent, and hemorrhagic, but always with mucus. In such cases, a mucous secretion is formed. Unlike serous, it contains more mucin, the antibacterial agent lysozyme, and A-class immunoglobulins. It is formed for the following reasons:

• viral or bacterial infections;
• exposure to the body of chemicals, high temperatures;
• metabolic disorders;
• allergic reactions (for example, allergic rhinitis).

Catarrhal exudative inflammation is diagnosed with bronchitis, catarrh, rhinitis, gastritis, catarrhal colitis, acute respiratory infections, pharyngitis and can occur in acute and chronic forms. In the first case, it is completely cured in 2-3 weeks. In the second, changes occur in the mucosa - atrophy, in which the membrane becomes thinner, or hypertrophy, in which, on the contrary, the mucosa becomes thickened and can protrude into the cavity of the organ.

The role of mucous exudate is twofold. On the one hand, it helps fight infection, and on the other hand, its accumulation in the cavities leads to additional pathological processes, for example, mucus in the sinuses contributes to the development of sinusitis.

Treatment of catarrhal exudative inflammation is carried out with antibacterial drugs, physiotherapeutic procedures and folk methods, such as heating, rinsing with various solutions, ingestion of infusions and decoctions of herbs.

Exudative inflammation: characterization of specific exudative fluids

Above mentioned chylous and pseudochylous exudates that appear with injuries of the lymphatic vessels. For example, in the chest, this may be when ruptured. Chylous exudate is white in color due to the presence of an increased amount of fat in it.

Pseudochylous also has a whitish tint, but it contains no more than 0.15% fat, but there are mucoid substances, protein bodies, nucleins, lecithins. It is observed in lipoid nephrosis.

White color and chyle-like exudate, only it is given color by decomposed degenerate cells. It is formed during chronic inflammation of the serous membranes. In the abdominal cavity, this happens with cirrhosis of the liver, in the pleural cavity - with tuberculosis, pleural cancer, syphilis.

If there are too many lymphocytes in the exudate (more than 90%), it is called lymphocytic. It is released from the vessels when cholesterol is present in the secret, by analogy it is called cholesterol. It has a thick consistency, yellowish or brownish color and can be formed from any other exudative fluid, provided that water and mineral particles are reabsorbed from the cavity in which it accumulates for a long time.

As you can see, there are many types of exudates, each of which is characteristic of a certain type of exudative inflammation. There are also cases when, in any one disease, mixed exudative inflammation is diagnosed, for example, serous-fibrous or serous-purulent.

Acute and chronic forms

Exudative inflammation can occur in acute or chronic form. In the first case, it is an instant response to a stimulus and is designed to eliminate this stimulus. There can be many reasons for this form of inflammation. Most common:

• injury;
• infections;
• violations of the work of any organs and systems.

Acute exudative inflammation is characterized by redness and swelling of the injured area, pain, fever. Sometimes, especially due to infection, patients have symptoms of autonomic disorders and intoxication.

Acute inflammation takes a relatively short time, and if the therapy is carried out correctly, it is completely cured.

Chronic exudative inflammation can last for years. It is represented by purulent and catarrhal types of the inflammatory process. At the same time, tissue destruction develops simultaneously with healing. And although in the stage of remission chronic inflammation of the patient almost does not bother, it can ultimately lead to exhaustion (cachexia), sclerotic changes in the vessels, irreversible disruption of the organs and even to the formation of tumors. Treatment is mainly aimed at maintaining the remission phase. In this case, great importance is attached to the right lifestyle, diet, strengthening the immune system.