BURNS 2

Evaluation of the Patient

The  first examination of the patient with burn injury has to  be

complete and should focus on

-Airway, breathing and circulation.

-Evaluation  are  specific with regard to,  inhalation  injury  to

lungs

-Burn  injured patient may have multiple system injury and  should

examined for these.

We  shall  deal  primarily  with recent  thermal  burns  in  this

post, since this occur frequently and in passing touch upon the

important  features of chemical and electric burns in so  far  as

they affect the treatment.

Type of Injury

The  patho-physiology involved in the wounds of a patient  with  a

burn injury is basically the same regardless of the cause.

In the superficial area of injury, coagulative necrosis occurs. 

In  this zone protein is irreversibly denatured and cellular integrity  is

lost.

Adjacent  to this zone is the zone of stasis in which  tissue  is

viable  but subject to further necrosis as the wound evolves  due

oedema and inflammation.

A third zone has been recognized below the zone of stasis and  is

characterized as a zone of hyperemia.

The depth of the coagulative necrosis that occurs in burns  which

are  caused by scalding, flame, or contact with a hot  object  is

directly  related  to  the  temperature,  duration  of  exposure,

thickness  of  the tissue, and state of the blood supply  in  the

tissue

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BURNS 1

BURNS

1.  Intact human skin must be looked upon as a highly efficient

FUNCTIONING organ of the human body.

The complete unbroken skin envelop is ascribed four main

functions:

1.1   It is capable of maintaining the internal environment

      through limiting the loss of water and electrolytes from

      the body surface.

1.2   Provides very efficient barriers to invasion by bacteria on

      its surface and in the surrounding atmosphere.

1.3   It provides an efficient apparatus for maintenance of body

      temperature, both through direct radiation of heat through

      the vast vascular bed in the skin, and through evaporation of

      sweat from the surface of the skin.       

1.4   Through its vast surface sensory nerve network, provides  

      an apparatus for detecting injurious agents and withdrawing

      the part from their vicinity.

2.  A  burn is a combination of dis-integrative,and copulative

necrosis of skin, and deeper structures, brought about by  any  of

the causes listed below:

THERMAL

   a)  Dry heat (open fire)

   b)  Moist heat (steam + hot liquids)

   CHEMICALS (ACIDS + ALKALIES)

   ELECTRIC BURNS (TOUCHING LIVE ELECTRIC WIRES)

   FLASH BURNS (HIGH TEMPERATURE SHORT DURATION)

   LIGHTNING.

   ULTRA VIOLET RAYS.

   RADIATION BURNS

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TROPICAL DISEASE 21

6.3.3 INVESTIGATIO

TB GIT

- There is a mild anaemia in about 80% of patients. 

- Hypoalbuninaemia may be present. 

- The ESR is elevated in over 90%of patients. 

- There is a relative neutropaenia with a relative lymphocytosis in

about one-third of patients. 

- Tuberculin test is positive in over 90% of patients.

6.3.4 SURGICAL TREATMENT

With  modern antituberculous drugs complete cure and  improvement

of  symptoms  occurs  in about 90%  of  patients  with  abdominal

tuberculosis.  

Surgery   is  reserved  for  the   treatment   of

complications namely:

   *  Bowel OBSTRUCTION.

   *  Peforation of an ulcer with PERITONITIS or combined with

      FISTULA formation of adjoining loops.

   *  Massive HAEMORRHAGE. The presence of an ileo-caecal mass of

      uncertain origin is an additional indication

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TROPICAL DISEASE 20

T.B.
DIGESTIVE TRACT





6.3.2 CLINICAL FEATURES

The most frequent symptoms is abdominal pain.

- There may be accompanying weight loss, abdominal distension and

vomiting.

-  Another  group  of  patients may  present  with  weight  loss,

anorexia, diarrhoea and fever. 

-  The pain intensity depends upon the site, duration and  extent

of the lesion and the presence of complications.

-  It is most frequently present in the umbical region which  may

become generalised or localised to the right iliac fossa.

-  The pain is often colicky in nature with nausea  and  vomiting

and visible peristalsis with lesions like  stricture,hypertrophic

lesions or adhesions producing intestinal obstruction.

- Abdominal tenderness is frequently seen and can be elicited  in

two-thirds  of the patients, indicating extension of the  disease

to the peritoneum and lymph nodes.

-  A palpable mass, and visible peristalsis can be seen  in  over

one-third of the patients.

- The mass can be due to hypertrophic ileoceacal tuberculosis  or

enlargement  of  lymph nodes and matting of loops  of  the  small

bowel.

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