Omphalitis
Introduction
Introduction to Umbilitis Omphalitis is a bacterial infection of the umbilical stump. According to the age of onset, there may be adult umbilical inflammation and neonatal umbilical inflammation. According to the pathological process, there are two types of acute omphalitis (acuteomphalitis) and chronic umbilical inflammation (chronicomphalitis). Acute umbilical inflammation is an acute cellulitis of the umbilical cord tissue. If the infection progresses, it may be complicated by abdominal cellulitis, or it may develop into a peri-umbilical abscess, and there is a risk of complicated peritonitis and sepsis. The pathogen is Staphylococcus aureus and the like. Chronic umbilical inflammation is a kind of chronic inflammatory manifestation of umbilical cord caused by irregular treatment of acute umbilical inflammation, long-term unhealed or leftover undamaged wounds and local foreign body irritation. basic knowledge The proportion of illness: 0.3% - 0.5% Susceptible people: no specific population Mode of infection: non-infectious Complications: cellulitis, peritonitis, liver abscess, shock, thrombosis
Cause
Cause of umbilical inflammation
(1) Causes of the disease
1. Pathogenic bacteria are the most common pathogens of staphylococcus, followed by Escherichia coli and hemolytic streptococcus. It is reported that the main pathogen of socially acquired infections is Gram-positive cocci (67.2%); Among the cases of hospital-acquired infections, Gram-negative bacilli were the main pathogens (56.8%).
2. Causes of infection
(1) Acute navel inflammation:
1 neonatal umbilical corditis: the main causes of umbilical cord infection in newborns are: contamination after ligation of the umbilical cord after birth or dressing before the umbilical cord falls off the feces, urine pollution; premature rupture of the amniotic membrane, umbilical cord is contaminated before birth; umbilical cord is produced during childbirth Bacterial contamination in the tract; contaminated by urinary tract or yolk sputum effluent; infection secondary to umbilical cord or umbilical sinus.
2 adult umbilical corditis: the umbilical fossa is deep and the skin on the underside is wrinkled. The dirt and sebum remain, which is not easy to be cleaned locally, or inadvertently scratched during descaling, causing bacteria to invade and cause infection.
(2) Chronic umbilical inflammation: acute umbilical inflammation is not cured, prolonged to chronic umbilical inflammation and umbilical granuloma; umbilical cord premature detachment leaves unhealed wounds; long-term chronic stimulation of foreign bodies (such as talcum powder) in umbilical fossa can cause Umbilical inflammation is delayed and forms umbilical granuloma.
(two) pathogenesis
After the pathogen invades the umbilicus, the early stage is limited to local infection. If the inflammation is not controlled, the range of inflammation is enlarged, and the abdominal wall cellulitis is spread. The infection along the lymphatic vein may cause widespread infection of the upper and lower abdominal wall and even the lower chest. Umbilical abscess, such as deep invasion can cause peritonitis, neonatal infection can still pass the umbilical cord, the vein enters the blood, portal vein embolism, portal vein embolism or sepsis, such as thrombus extension to the portal vein can lead to portal vein obstruction, resulting in liver External portal hypertension, if the local wound healing is poor after the umbilical cord is broken, leaving small granuloma, there is often secretion, which is chronic umbilical inflammation.
Prevention
Umbilitis prevention
The umbilical cord is strictly disinfected and kept dry locally, which can effectively prevent the occurrence of umbilical inflammation. The adult umbilical fossa can clean the umbilicus folds with cotton wool and ethanol, eliminate the moist liquid in the deep umbilical fossa, remove the peeling epidermis, and Dry.
Complication
Umbilical inflammatory complications Complications Cellulitis Peritonitis Liver abscess Shock thrombosis
Neonatal immunity is low, umbilical inflammation can not be controlled, can spread to the umbilical cord to form abdominal wall cellulitis or spread along the lymphatic vessels, leading to a wide range of infection of the abdominal wall, and even extend to the lower chest wall; deep diffusion can cause peritonitis, Through the umbilical movement that has not been blocked, the vein may cause deep infection of the abdominal wall, or directly enter the blood circulation to cause liver abscess, sepsis, toxic shock, and may also cause umbilical vein thrombosis. If the thrombus extends to the portal vein, it may cause portal vein obstruction. Later developed into extrahepatic portal hypertension.
Symptom
Umbilical symptoms of umbilical symptoms Common symptoms of umbilical cord redness and swelling, hard congestion, lymph node enlargement, dyspnea, peritonitis, umbilical cord redness, umbilical cord, wet umbilical cord, sakura red... umbilical cord detachment after wound... umbilical circumference swelling
Acute ointment
(1) neonatal umbilical inflammation: the initial symptom is that the wound is delayed and there is an overflow after the umbilical cord falls off, sometimes there is redness and swelling of the umbilical cord, and there is a small amount of mucus or purulent secretion in the small granulation surface or umbilical stump in the umbilical recess. In severe cases, there may be symptoms of cellulitis such as redness, swelling, heat, and pain. When the infection is more serious, the umbilical cord is obviously red and swollen and hard, and there are more purulent secretions. The umbilical cord is lightly pressed, and pus flows out from the umbilicus. It has a bad smell. Generally, the systemic symptoms are mild. If the infection spreads to the peritoneum and causes peritonitis, the patient often has different degrees of fever and increased white blood cells. If sepsis is caused by blood vessel spread, irritability, paleness, and refusal may occur. Difficulty breathing, liver and spleen and other performance.
(2) adult umbilical inflammation: acute phase manifested as pain in the umbilical fossa or ring umbilical, hyperemia, edema, often with odorous serous secretions, physical examination of the umbilical fossa moist, umbilical swelling, tenderness, serious The empyema in the umbilical fossa is accompanied by fever, and there may be lymph nodes in the groin, which may spread to the periphery of the umbilicus, and may be infected with deep infection, cellulitis and systemic symptoms.
2. Chronic omphalitis
The umbilical fossa is moist, swollen, oozing and smelly. It may be purulent or mixed with blood. The secretion may stimulate the surrounding skin to cause eczema-like changes and even erosion. Adults or older children report itchiness, often with hands. Scratching the umbilicus, the body can be seen in the umbilical fossa granulation tissue hyperplasia, dark red color, convex, no mucous membrane on the surface, bleeding, most of the disease is longer, prolonged unhealed.
Examine
Examination of umbilical inflammation
Blood test
Leukocytes are normal or elevated, and the total number of white blood cells and neutrophils are elevated with symptoms of systemic infection.
2. Bacteriology examination
It is advisable to use smear staining or bacteriological culture for wound secretion, as a guide for clinical medication, and blood culture examination is feasible when sepsis is suspected.
Diagnosis
Diagnosis and differentiation of umbilical inflammation
diagnosis
The diagnosis of umbilical inflammation is not difficult, according to the umbilical redness, secretions, and sometimes granuloma, long-term secretion can be diagnosed, the total number of peripheral blood leukocytes and neutrophils can support the diagnosis, such as suspected of umbilical inflammation In the case of sepsis, it can be supplemented with blood culture examination.
Differential diagnosis
Neonatal umbilical inflammation needs to be differentiated from the following diseases.
1. The umbilical sinus is caused by the umbilical end of the yolk tube.
2. Umbilical intestinal fistula (the yolk tube is not closed) A bright red mucosa with a rounded protrusion is visible in the umbilicus. There is a mouth in the middle, there is a odor discharge or liquid feces, oral charcoal or a contrast agent is injected into the umbilicus. X-ray examination can confirm the diagnosis and requires surgery.
3. Umbilical urethral fistula (ursal ureteral obstruction) The umbilicus often has clear liquid outflow, local injection of contrast agent can enter the bladder or bladder retrograde angiography to reach the skin, injecting methylene blue to the umbilicus to discharge blue urine, need Surgical treatment.
