Risk during surgery on the superior mesenteric artery. Branches of the inferior mesenteric artery. What kind of disease is this

Syndrome endogenous intoxication (SEI) - pathological condition the body with damage to its organs and systems, caused by the accumulation of endogenous toxins in tissues and biological fluids.

Endogenous toxins(endotoxins) - substances that have an effect on the body toxic effect, and are either natural products of its vital activity, which accumulated in large quantities during various pathologies, or obviously aggressive components.

Endotoxemia- a pathology in which endotoxins accumulate directly in the blood.

Endotoxicosis- an extreme degree of SEI, which causes a critical state of the body, expressed in its inability to independently compensate for emerging homeostasis disorders.

Causes of SEI:

purulent inflammatory processes: peritonitis, cholecystitis, pancreatitis, etc.;
severe injuries: long-term compartment syndrome;
endocrine diseases: diabetes mellitus, thyrotoxic goiter;
poisoning

Such nosological forms, different in etiology, at a certain stage of the disease are united by a common pathological cascade, including toxemia, tissue hypoxia, inhibition of the functions of the body’s own detoxifying and protective systems.

Toxemia develops against the background of the accumulation of endotoxins in the body, which cause the destruction of proteins and lipids of cells and block synthetic and oxidative processes.

Classification of endotoxins by groups:

products of natural metabolism in high concentrations;
activated enzymes that can damage tissue;
biologically active substances (BAS);
class of medium molecular substances of different nature;
peroxide products;
the ingredients of non-viable tissues are heterogeneous in composition;
aggressive complement components;
bacterial toxins.

The process of intoxication develops as follows:

endotoxins from the sites of formation enter the bloodstream;
endotoxins are transported through the bloodstream to organs of fixation and biotransformation: liver, lungs, immune system;
organs for excreting pathological substances: liver, kidneys, lungs, skin, gastrointestinal tract;
into organs and tissues where pathological substances are deposited: fat, bone, nerve tissue, endocrine system, lymphoid tissue.

SEI develops when the amount of natural waste products of the body that appear in large quantities in biological environments, or obviously aggressive components, exceeds the capabilities of their biotransformation.

Tissue hypoxia develops as a result of the pathological action of endotoxins, which disrupt the processes of oxygen absorption at the tissue level. The severity of hypoxia is assessed by the partial pressure of oxygen in arterial blood.

Inhibition of the functions of organs and natural detoxification systems:

development of insufficient detoxification, excretory and synthetic functions of the liver;
excretory function of the kidneys;
non-respiratory functions of the lungs.

Inhibition of the body's defense systems:

secondary immunological deficiency;
inhibition of natural resistance systems;
inhibition of antioxidant protection.

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> Intoxication of the body

This information cannot be used for self-medication!
Consultation with a specialist is required!

What is intoxication?

Intoxication of the body is a pathological condition caused by negative impact various toxic substances that can enter the body from the outside or form within it as a result of the development individual diseases. Depending on how the poison entered the body, exogenous and endogenous intoxication are distinguished.

Exogenous poisoning

Exogenous intoxication is also called general poisoning. This condition occurs and develops when poisons and toxic substances enter the human body: arsenic, selenium, beryllium, heavy metals, fluorine, chlorine, iodine. The poisonous substance may be toxins poisonous plants, microorganisms or animals. The poison can enter the body through the skin, mucous membranes, through the digestive tract and Airways. Sometimes the cause of general poisoning is not the toxic substance itself, but the products of its transformation. The most common is exogenous intoxication, caused by an overdose of alcohol or drugs.

Endogenous intoxication

Endogenous intoxication is designated by the terms “endotoxicosis”, “autointoxication”. This condition develops as a result of a violation of the removal of metabolic products from the body in certain diseases. Endogenous intoxication is always observed when malignant neoplasms, infectious diseases, in case of impaired functioning of the kidneys and intestines. Self-poisoning can develop if biologically active substances (hormones) are produced in excess quantities and accumulate in the body. thyroid gland, adrenaline, etc.). Endogenous intoxication is accompanied by burns and serious injuries of various origins. Endotoxicosis occurs when rheumatoid arthritis, acute pancreatitis, sepsis and other pathologies.

Clinical manifestations

Clinical manifestations of intoxication are quite wide. It all depends on the nature and concentration of the toxic substance, as well as the degree of poisoning. Acute intoxication manifests itself with the following symptoms: heat, strong pain in joints and muscles, vomiting, diarrhea. If the toxins are very poisonous, loss of consciousness and even coma may occur.

They talk about the state of subacute intoxication low-grade fever(up to 38 degrees), headache and muscle pain, disturbances in the functioning of the gastrointestinal tract, drowsiness and a constant feeling of fatigue.

Chronic intoxication develops as a result of acute poisoning that is not fully treated or when there is a violation of the excretion of metabolic products from the body and is characterized by the following symptoms: irritability, depressive states, insomnia, general weakness, chronic headaches, weight changes, serious gastrointestinal problems (flatulence, diarrhea, constipation).

Intoxication in most cases has a negative impact on the immune system and skin. An unpleasant body odor appears, various skin diseases(dermatitis, furunculosis, acne), allergic reactions appear, the body's resistance to viruses and bacteria is significantly reduced, and sometimes autoimmune pathologies develop.

Treatment of intoxication

When treating intoxication, the main efforts are aimed at neutralizing toxic substances through the use of antidotes (vaseline oil, Activated carbon, sodium hypochlorite, potassium permanganate) or antitoxic serums. The next step is to accelerate the removal of toxins from the body (rinsing the cavities, drinking plenty of fluids, using laxatives and diuretics medicines, oxygen therapy, transfusion of blood substitutes). Anyway correct treatment can only be prescribed by an experienced doctor, so at the first symptoms of poisoning you must seek help without delay. Self-medication is dangerous for health, and sometimes even for human life.

. Endogenous intoxication is a syndrome based on the massive intake of various toxins into the internal environment of the body.

Normally, a number of organs and systems are responsible for the removal and inactivation of endogenous toxins: the immune system, liver and intestines, kidneys, lungs. In case of pathology of any of the listed organs, other normally functioning organs take over part of its lost functions. This partially compensates for the toxemia, but makes them work harder.

With failure of one organ or system, the mortality rate is 23-40%, with failure of two organs – 5360%, three or more organs – 73-89%. The universal pathogenetic factor for such progression of the disease is endotoxicosis.

Intoxication- clinical manifestation a pathological condition resulting from the action of substances of endogenous or exogenous origin on the body. From a biochemical point of view, endogenous intoxication is the body's metabolic response to any aggressive factor. Toxic substances or toxins are compounds of various natures and chemical structure, capable of causing disease or death when entering the body. Toxemia is the presence of toxins in the blood. This physiological state, associated with the transport of toxic substances in the blood to the organs of detoxification and excretion (elimination). Toxicosis is a pathological syndrome caused by the action of toxins, accompanied by pronounced morphological and functional changes at the level of organs and body systems

The biochemical substrate of endogenous intoxication is a medium-molecular pool of substances, which includes products of final metabolism in high concentrations, products of intermediate metabolism and products of altered metabolism.

The substances that make up the medium molecular weight pool are usually divided into substances mainly of non-protein origin and oligopeptides with a molecular weight of 10 -15 kD (kilo Dalton). Medium molecular substances of non-protein origin are represented by substances of various natures: 1. urea, creatine, uric acid, amino sugars, lactic and other organic acids, amino acids, fatty acids, bilirubin, cholesterol, phospholipids and their derivatives, products of intermediate metabolism, free radical oxidation, and other products. 2. High concentrations of intermediate metabolites (ammonia, aldehydes, ketones); 3. Substances of abnormal metabolism (alcohols, carboxylic acids) and toxic components of the body’s cavity media (phenol, skatole, indole, putrescine, cadaverine).

Olyropeptide component of the medium molecular pool of substances: Regulatory peptides - hormones that play an important role in the process of life, in ensuring homeostasis and pathogenesis various diseases. Among them, neurotensins, neurokinins, vasoactive intestinal peptide, somatostatin, somatomedin, substance P, endorphins, enkephalins and other biologically active substances were identified. Non-regulatory peptides are biologically active substances formed from toxins received from outside (bacterial, burn, intestinal) and products formed inside the body (due to autolysis, ischemia, organ hypoxia, inorganic proteolysis processes), peptides with unregulated content and unpredictable properties.

“Endogenous intoxication syndrome” is a pathological condition based on damage to organs and body systems caused by the accumulation of endogenous toxins in tissues and biological fluids.

Endotoxicosis should be understood as an extreme degree of endogenous intoxication syndrome, causing a critical condition of the body. A critical state of the body is characterized by the fact that the body cannot independently compensate for the resulting homeostasis disorders.

ETIOLOGY AND PATHOGENESIS. The triggering factor can be represented by a focus of traumatic, ischemic or inflammatory tissue destruction. Endogenous intoxication syndrome occurs with peritonitis, cholecystitis, pancreatitis, jaundice, phlegmon, severe tissue crushing (crash syndrome), diabetes mellitus, thyrotoxic goiter, etc., various poisonings. All of these diseases are characterized by a combination of toxemia, tissue hypoxia, and inhibition of the function of the body’s own detoxifying and protective systems.

Tissue hypoxia leads to intensification of lipid peroxidation and anaerobic transformation of glycolysis with the formation of lactates and acidosis. The intensification of lipid peroxidation occurs as a result of the transition from conventional oxidation to oxygenase oxidation, which results in the formation of toxic substances: superoxide anion and hydrogen peroxide. These processes lead to damage to all types of biological membranes.

Medium-weight molecules have an inhibitory effect on a number of metabolic processes: mitochondrial respiration, DNA synthesis in alveolar macrophages and lymphocytes, inhibit the processes of intracellular glucose utilization, inhibit hemoglobin synthesis, reduce the activity of a number of cellular enzymes, have a vasoconstrictor effect, and cause hyperosmolar syndrome. Even a slight increase in MSM content can have serious consequences for the body and determine the severity of clinical condition. This is due to the fact that MSM freely penetrates the blood-brain barrier, disrupting the regulation of autonomic functions of the brain and producing a psycho- and neurotropic effect. High concentrations of MSM inhibit myocardial contractility and excretory function of primarily uncompromised kidneys.

In 1941, Kal-Kalif proposed a leukocyte index of intoxication: Norm 1+ 0.6. LII = (4 monocytes + 3 young + 2 stab + segmented) (pl. cells + 1) (monocytes + lymphocytes) (eosinophils + 1) Number neutrophil shift is the main criterion characterizing the severity of the inflammatory process and the degree of intoxication. The degree of shift is determined by the formula: M + Yu + P C, where M are myelocytes, Yu are young, P are band neutrophils, C are segmented neutrophils. Normally, this value is 0.05 – 0.08.

A severe inflammatory process, accompanied by severe intoxication, occurs with a shift from 1 to 2. A process of moderate severity with a shift of 0.3 - 0.5. With a mild degree, less than 0.25. With an extreme degree of severity, pathological granularity of neutrophils, vacuolization of the cytoplasm and their nuclei, violation of the integrity of cell membranes. Pathological granularity is determined long before the appearance of a band shift and is a good test for determining the presence of nonspecific inflammation (Kassirsky I.A. 1970).

In 1980 -1981, B. A. Reis and co-authors found that most active in a purulent-septic process, there are a number of plasma substances whose molecular weight lies in the range of 1000 - 5000 Daltons. It was found that substances of average molecular weight play a certain role in the pathogenesis of the development of renal and liver failure. In 1983, Gabrielian proposed a laboratory test to determine the content of medium molecules in plasma. The method is not complicated and gives a very realistic approximate picture of the content of toxic substances in the plasma. It is currently most commonly used to evaluate endotoxemia. Norm 0.24 + 0.02 cu. e.

To date, it has been shown that determining the concentration of molecules of average mass in plasma allows one to assess the level of endogenous intoxication, studying the sorption capacity of erythrocytes, determining the effective concentration of albumin and albumin indices allows assessing the level of the system of temporary binding and transport of toxins, calculating leukocyte intoxication indices allows assessing the body's response to endogenous intoxication syndrome.

The state of cell membranes may reflect the degree of intoxication, as an indicator of the influence of membrane-damaging factors on the cell. High degree correlations between changes in the properties of erythrocyte membranes and cell membranes internal organs allows the use of biological membranes of erythrocytes to study general membrane characteristics.

The triggering factor in the development of endotoxemia can be represented by a focus of traumatic, ischemic or inflammatory tissue destruction. It has been established that at the initial stages of the development of endotoxemia, the main mechanism of its formation is production-resorption against the background of instability of the main systems of detoxification and biotransformation of toxins. During this period, there is an active accumulation and production of toxins with their subsequent resorption into the active bloodstream from the site of destruction. This period corresponds to the stage of toxemia. At this stage of development of endotoxemia, there is no clinical and laboratory involvement of other organs and systems in the process. The patient’s body at this stage copes with toxemia, which does not go beyond the hemic spectrum.

The next stage of development of endotoxemia is the stage of tension of detoxifying systems, in which endotoxemia leads to the development of organopathies. This stage of endotoxemia is characterized by the inability of the pulmonary protective barrier to cope with increased venous toxemia. Here the processes of disruption of the elimination and biotransformation of toxins already predominate.

The next stage is the most formidable - the stage of multiple organ failure. Here, circulatory hypoxic processes predominate, which lead to the creation of a block of peripheral microcirculation. The body seems to be trying, by centralizing hemodynamics and removing toxins into the interstitium, to protect life as much as possible. important organs from toxic hematogenous load.

The optimal point for applying extracorporeal detoxification, which will be discussed further, is the tension stage functional system detoxification, when endotoxemia as a process has already gone beyond the hemic spectrum, but has not yet reached the stage of multiple organ failure.

TREATMENT - Surgical debridement of the source of infection. - Correction of microcirculatory disorders of blood circulation, lymph circulation. Preventive and rational antibacterial therapy. - Reducing endotoxemia - as a prevention of multiple organ and systemic failure. - Immunocorrection. Energy supply.

biological transformation of toxic substances in the liver. In the body, this function is performed by the monoamine oxidase system of the liver, the cytochrome P-450 system. . In efferent therapy, this mechanism is modeled by the following operations: indirect electrochemical oxidation of blood, oxygenation of blood, perfusion of blood through xenoorgans and cell suspensions, photomodification of blood (laser and ultraviolet irradiation of blood).

Dilution and binding of toxic substances: In the body, this is realized by autohemodilution, the function immune system. In efferent therapy, this mechanism is modeled by: - hemosorption, - plasma sorption, - lymphosorption.

Elimination (removal) of toxic substances. In the body, this is realized by the functioning of the liver, kidneys, lungs, gastrointestinal tract, and skin. In efferent therapy, this mechanism is modeled by: peritoneal dialysis, plasmapheresis, enterosorption, hemodialysis, hemofiltration.

Indications for extracorporeal detoxification methods: high blood toxicity at the height of the disease; lack of effect from routine detoxification therapy in combination with extensive tissue destruction; severe intoxication due to intolerance to antibiotics; rapid growth of the endotoxicosis clinic in postoperative period. -

Effects of extracorporeal hemocorrection A prerequisite for extracorporeal detoxification is radical sanitation of the focus of purulent destruction. “Bartyrin's syndrome” involves the entry of toxins from tissue depots into the central bloodstream. To prevent this syndrome, immediately before perfusion, it is recommended to create “imposed toxinemia” as a result of improving the rheological properties of blood, to carry out lymphostimulation, and to use pre-perfusion photomodification of blood.

Extracorporeal hemocorrection provides complex impact on the body. The diverse effects that arise can be divided into three groups: specific, nonspecific, additional. The main specific effects of extracorporeal hemocorrection are detoxification, immunocorrection, rheocorrection. Nonspecific effects of extracorporeal hemocorrection are determined by contact with the surfaces of lines and mass transfer devices. This may include temperature reactions, hemodynamic reactions caused by the redistribution of fluid and blood cells. Additional effects associated with the use during surgery of both mandatory and special medications. They are associated with the use of special transfusion and drug programs carried out in parallel with extracorporeal hemocorrection.

According to the criterion of removing toxins from the body, efferent extracorporeal methods are divided into: non-selective, semi-selective and selective. The most specific methods for removing strictly defined substances are immunosorption methods, biospecific sorption of blood or its components. The less selectively the elimination of blood components occurs, the greater the adverse effects of these procedures. These include electrolyte imbalance during hemodialysis and plasmapheresis, disturbances in the hormonal profile of the blood (removal of catecholamines and glucocorticoids) - collaptoid reactions during plasmapheresis and hypoglycemic reactions are associated with this.

Characteristics of individual methods of efferent therapy. Hemodialysis is a method of intravital liberation of blood from low and medium molecular weight substances through selective diffusion using the “Artificial Kidney” apparatus. It is based on the mechanism of molecular diffusion and ultrafiltration. There is a diffusion exchange and filtration transfer of low molecular weight substances and water through a semi-permeable membrane from extracorporeally circulating blood into the dialysate solution. Azotemia, electrolyte imbalance, and acid-base imbalance are corrected.

The main indications for the use of hemodialysis: end-stage chronic renal failure; acute renal failure of any origin; acute poisoning with alcohols, technical liquids; hyperkalemia, azotemia due to renal failure.

Enterosorption is a method based on detoxification through the absorption of toxins in the intestines on ether sorbent (lignin derivatives - polyphepam, enterosgel). The action of enterosorption is carried out in 2 directions: - reverse passage of toxins from the blood into the intestines with its further binding on sorbents; -cleaning chyme from its toxic products; Hemosorption is a method of extracorporeal hemocorrection based on the removal of toxic substances from the patient’s blood by extracorporeal perfusion through a sorbent. Indications for this operation for Lately have decreased significantly, mainly because preference is given to less traumatic operations: plasmapheresis and enterosorption. The only absolute indication for hemosorption remains acute poisoning. The volume of perfusion in acute endotoxicosis is 1.5 - 2.5 bcc, in acute exotoxicosis - 10 -12 bcc.

Plasmapheresis and plasmafiltration are a method of extracorporeal hemocorrection based on replacing the patient's blood plasma with components, blood products or blood substitutes. Plasmafiltration is a variant of plasmapheresis in which membrane technology is used to separate plasma. Depending on the volume of plasma removed, the method is divided into: plasmapheresis, which removes up to 70% of the plasma; plasma exchange, - this removes 70-150% of the CP; massive plasma exchange - this removes more than 150% of the CP. During plasmapheresis with the removal of up to 50% of the VCP, plasma loss can only be replenished with crystalloid solutions in a volume 50-100% greater than exfusion. With more voluminous plasmapheresis, the plasma loss compensation program includes colloidal plasma substitutes and crystalloid solutions in a volume of 70% of the removed plasma. .

Main indications for plasmapheresis: severe decompensated stages of endotoxicosis of various origins; severe generalized forms infectious diseases; chronic autoimmune diseases ( bronchial asthma, systemic diseases connective tissue, hematological diseases); chronic endotoxicosis in diseases of the liver, kidneys, lungs; total hemolysis during myolysis in case of poisoning with hemolytic poisons, long-term compartment syndrome).

Xenoperfusion is a method of extracorporeal hemocorrection based on modification of blood or plasma upon contact with living xenogeneic tissues. The donor animal, as a rule, is a pig. Most often in our country, xenoperfusion is carried out in the form of plasma perfusion through a suspension of isolated hepatocytes. This procedure carried out in an “artificial liver” apparatus. According to domestic researchers, the absolute indication for this operation is fulminant liver failure, hepatic coma, decompensated endotoxicosis during liver transplantation.

After infusion of sodium hypochlorite, the sensitivity to antibiotics of previously resistant microbial flora is restored. Nathium hypochlorite also has an immunomodulatory effect, improves microcirculation and rheological properties of blood.

Photomodification of blood is a method of hemocorrection based on the effect on blood outside the body or in the vascular bed of photons - quanta of optical radiation in the ultraviolet, visible and infrared ranges available in the solar spectrum. Therapeutic effect photomodification of blood is due to immunocorrection, improvement of rheological properties of blood, improvement of microcirculation, stimulation of erythropoiesis, increase oxygen capacity blood, stimulation of regenerative and metabolic processes. New possibilities for photomodification of blood is a photophoresis method used in oncology and hematology. The essence of this method is to administer to the patient a photosensitizer (8 methoxypsoralen), which, after long-wave ultraviolet irradiation, is activated and binds to DNA, causing damage to rapidly dividing cells. Damage to pathological cells increases their immunogenicity and causes a powerful immune response towards them.

Efferent therapy is a continuously developing branch of medicine and we are still learning a lot of interesting things about its achievements.

Harm to humans is caused not only by poisons coming from environment. Endogenous intoxication is a pathological condition in which dangerous compounds are formed directly in the body. Various factors provoke the release of toxins into the bloodstream, but the main cause is acute and chronic forms diseases. After medication or surgical treatment negative symptoms disappear, all vital systems begin to function actively.

Distinctive features of the pathology

Endogenous intoxication of the body, or endotoxicosis, develops as a result of the accumulation of excess amounts of endo- and exotoxins in tissues and cells. The disease occurs against the background of an inflammatory process and causes numerous irreversible disorders in the absence of therapy. Endogenous toxins decompose neighboring tissues, causing poisoning and its rapid spread throughout the body. As a rule, the pathological focus is formed in abdominal cavity, and then covers the structural elements of the kidneys, hepatocytes, cardiovascular and nervous systems.

Diagnosis often reveals inflammation at the stage of toxic-dystrophic tissue decomposition, which requires the use of all principles of its correction. Poisoning occurs in several stages, but the main source of the disease is always the organ that was initially affected. This is based on the greater concentration of toxins in its tissues.

If a person has high resistance to pathogenic microorganisms, the risk of developing endogenous intoxication is reduced. People whose immune system leaves much to be desired are exposed to poisoning.

The following systems are involved in the process of intoxication:

barriers biological origin, which should prevent the release of toxic compounds from the inflammatory focus;
neutralizing substances that destroy or neutralize endotoxins.

The triggering factor is rarely one substance, the mechanism of endogenous intoxication involves several compounds that poison the body at once penetrating into the bloodstream and plasma. This condition occurs when poisons enter the bloodstream and spread through the vessels of the affected organ. But there is another way - tissue fluid and (or) lymph.

Main stages of endotoxin poisoning

Endogenous intoxication includes three stages. At the initial stage, it is difficult to identify pathology, but biochemical tests may show a slight increase in the concentration of leukocytes and protein breakdown products. Poisoning with toxins of internal origin at this stage can occur under the influence of traumatic injuries or in the presence of an inflammatory focus caused by pathogenic microorganisms.

The second stage, or the stage of severe toxemia, develops after endogenous toxins are released from the bloodstream and overcome the hematological barrier. Their concentration reaches a maximum level, toxic compounds spread throughout the body through the flow of biological fluid, penetrating into cells and tissues. The progression of this stage of poisoning is directly dependent on a person’s resistance:

Compressed phase. Under the influence of toxins, disruptions in the functioning of internal organs, tissue degeneration, and a decrease or increase in blood supply occur. This is necessary for the ability of vital systems to fully carry out their functions.
Decompensated phase. Pathological changes, the body’s attempts to adapt to them do not bring tangible results. Organs cannot cope with the increased load, stop working or function only partially.

During endogenous intoxication, an organism with a strong immune system launches compensation mechanisms. The volume and speed of blood flow increases, T-lymphocytes (killer cells) are activated to destroy toxic foreign proteins.

Lack of treatment leads to the development of severe disorders at the third stage of endotoxin poisoning. Multiorgan dysfunction is accompanied by damage to all body systems in the presence of functional decompensation. A huge amount of toxins and metabolic products are found in the blood. The kidneys are unable to filter harmful compounds and eliminate them in the urine.

By binding to red blood cells, endogenous toxins do not allow them to react with molecular oxygen and deliver it to the brain. The regulation of all vital systems stops, resulting in cardiac and respiratory arrest. At this stage, even carrying out urgent resuscitation measures cannot save a person's life.

Sources of internal intoxication

Regular use pharmacological drugs people with chronic diseases is a necessity. Pathologies occur against the background of constant production of endotoxins by damaged tissues, which destroy neighboring organs, especially the liver. Such toxic compounds include:

high concentrations of metabolic products (bilirubin, uric acid and its salts);
substances that accumulate due to improper metabolism (free ammonia, aldehydes);
compounds formed during cell breakdown when tissue integrity is violated (protein cations, indoles, lipase);
substances involved in the regulation of all vital systems in excess concentration (activated enzymes);
oxidation products of fat-soluble compounds;

Some poisons that enter the human body from the outside may be classified as endotoxins. They become a source of formation of an inflammatory focus, poisoning neighboring areas of internal organs with the products of their metabolism.

In case of malfunction endocrine system overproduction occurs biologically active substances. A high concentration of hormones contributes to disturbances in the functional activity of other systems, provokes tissue damage, and reduces the body's resistance. Often this condition is accompanied by the formation of one or more inflammatory foci.

Causes of endotoxin poisoning

Endogenous intoxication syndrome is more typical for surgery, since diseases that cause tissue decomposition are most often treated with surgery. Self-poisoning occurs in the following pathologies:

Extensive burns.
Injuries from prolonged compression or bruises.
Pancreatitis in the acute stage.
Inflammation of the peritoneal layers.
Malignant or benign neoplasms.

Poisoning of the body with endotoxins can occur directly during surgery open method. The intervention is usually carried out against the background of respiratory problems, significant blood loss, and anesthetic procedures.

Endogenous intoxication sometimes occurs during organ transplant surgery. The transplant is rejected by the human body as a foreign body. An inflammatory process develops, accompanied by destructive changes in the donor organ.

Detoxification of cells and tissues will not be complete if E. coli enters the human body through the ascending path or from the outside. Favorable factors for its active reproduction with the release of toxins include burn disease or grass with open wound surface. With radiation injury, lipid metabolism is disrupted. The resulting products have a strong toxic effect on the cells and tissues of internal organs.

Mechanisms of the pathological process

When diagnosing using modern instrumental techniques and conducting studies of biological fluids, the mechanisms of action of endotoxins were identified. Usually, intoxication occurs when they are combined or when one action is replaced by another. The developments of domestic specialists describe the following mechanisms of poisoning by endogenous toxins produced in the human body:

Productive toxinemia. A significant change in the composition of biological fluids provokes changes in metabolism. Typically, this condition occurs when the endocrine system malfunctions, lack of vitamins and minerals, oxygen starvation tissues, their degeneration and decomposition.
Retention toxinemia. Develops as a result of a violation of the excretion of metabolic products from the body. For example, if pulmonary gas exchange decreases, then the concentration of carbon dioxide in the bloodstream increases, causing endogenous intoxication.
Resorption toxinemia. When tissues decompose, protein breakdown products enter the internal cavities. This mechanism is characterized by rapid progression with deformation of bones, skin surfaces, mucous membranes, and soft tissues.

To determine endogenous intoxication, it is important not only to determine the provoking factor and species, but also the ability of harmful compounds to accumulate in the affected areas.

Some types of poisoning provoke necrotic tissue damage, which will not be restored even with timely medical care. But most toxins shift the balance in the body at the cellular level, which subsequently causes disturbances in the functional activity of one of the systems. Such changes are reversible after urgent therapy.

Clinical picture of body poisoning with endotoxins

Despite a large number of diseases that occur with the production of endotoxins, in surgery there is a commonality of signs of intoxication. The severity of symptoms depends on the stage of poisoning:

Spicy.
Subacute.
Chronic.

On acute stage endogenous intoxication is diagnosed by an increased concentration of harmful compounds inside the bloodstream. They bind most of the red blood cells, molecular oxygen circulates freely, and its deficiency occurs in the brain tissue. The following symptoms are characteristic of this stage:

severe disturbances of the gastrointestinal tract: nausea, vomiting, bloating, diarrhea or constipation;
increased sweating, cold sweat, chills;
hyperthermia, complicated by a feverish state;
painful spasms localized in various parts of the body;
tremor of the upper and lower extremities;
arterial hypertension, which is replaced by a sharp drop in pressure to lower levels.

The increased toxicity of endogenous toxins causes convulsions, paralysis, severe joint and muscle pain. There is a high probability of loss of consciousness, coma, pulmonary and cerebral edema.

The subacute stage occurs with a slight increase in the concentration of toxic compounds. All vital systems are actively functioning, negative changes are just beginning to gain momentum. When examining patients, doctors identify the following signs of intoxication:

The temperature has increased to low-grade levels.
Nausea, indigestion, lack of appetite, and weight loss occur.
A person feels tired, dizzy, drowsy, and apathetic.
During the day, the pressure rises sharply and then decreases.
The victim suffers from headaches, which may give way to migraines.

Chronic stage endogenous intoxication occurs most often. It develops against the background of untreated poisoning of various etiologies, disruption of the urinary system, and a decrease in the functional activity of the liver to cleanse the blood of toxins. Patients experience the following symptoms:

stomach upset, duodenum, small and large intestines;
emotional instability: depression, sudden mood swings, weakness, fatigue, lethargy;
headache that takes a chronic course;
pallor, dry skin;
weight loss;
arrhythmias, arterial hypotension or hypertension.

Chronic endogenous intoxication negatively affects a person’s appearance. Rashes appear on the skin, hair falls out profusely, and nails become split. Improper metabolism provokes increased secretion of sebaceous glands.

TO characteristic features This stage of poisoning includes a significant decrease in the body’s resistance to bacterial or viral infections. Manifestation is activated allergic reactions with the development of autoimmune pathologies. Urinary disorders often occur: incontinence, urine leakage.

Diagnosis and treatment of pathology

Diagnostics is based on examining the patient and studying the results laboratory tests blood and urine. A huge number of diseases that cause endogenous intoxication require an individual approach to examination. But in the vast majority of cases, doctors use the following instrumental methods:

Magnetic resonance imaging.
Ultrasonography.
X-ray.

At the first stage of treatment, detoxification therapy is carried out using solutions of salts and glucose. If necessary, patients are prescribed procedures to cleanse the blood of endotoxins: hemosorption, hemodialysis. If the poison accumulates in gastrointestinal tract, then rinsing with a probe, taking adsorbents or enterosorbents is required. At chronic intoxication It is recommended to use enemas with Vaseline oil.

After eliminating the symptoms of poisoning, treatment of the underlying pathology begins. Usually, all inflammatory processes are complicated by the addition of a secondary bacterial infection Therefore, patients are treated with antibiotics. To prevent complications, patients are prescribed vitamins, microminerals, probiotics, and immunostimulants.