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First-pass effect



   

[Intro]

First pass effect refers to the administration of certain drugs by the gastrointestinal tract, has not yet absorbed into the blood circulation in the intestinal mucosa and liver metabolism, leaving the prototype dose into the blood circulation to reduce the phenomenon, also known as the first hurdle effect. After oral administration of certain drugs through the intestinal mucosa and liver and subjected to inactivate metabolic, drug into the systemic circulation is reduced, reduce the efficacy effect. The phenomenon of drug effect due to the route of administration make the difference in the treatment of science is important.


Introduction

first pass effect


first pass effect (First Pass Effect) also known as the first hurdle effect, the first pass effect. The absorption of all oral drugs to go through the gastrointestinal wall, and then into the portal vein. Some drugs are almost no metabolism, while others in the gastrointestinal wall or the liver is extensively metabolized, eliminate, to first-pass effect. A role to make enhance the metabolism, reducing the absorption of the treatment effect decreased. Parenteral administration such as injection, subcutaneous or sublingual administration to avoid first pass effect. Large doses of oral drugs can intestines, liver metabolism is saturated, it is assumed to absorb completely, when the dose of the oral and parenteral administration of the same blood concentration, the same effect varied widely, and intravenous injection of the same dose in the urine drug metabolism things big, that the first had occurred. cirrhosis of the liver and the portal vena cava anastomosis in patients with the role of reduced, increase drug bioavailability. This is called first-pass effect.

Overview

first pass effect, administration of certain drugs by the gastrointestinal tract has not yet absorbed into the blood circulation in the intestinal mucosa and liver metabolism, leaving to enter the blood

first pass effect


loop prototype drug reduced the phenomenon, also known as the first hurdle effect. After oral administration of certain drugs through the intestinal mucosa and liver and subjected to inactivate metabolic, drug into the systemic circulation is reduced, reduce the efficacy effect. The phenomenon of drug effect due to the route of administration make the difference in the treatment of science is important. Enter the large cycle of drugs reduced oral drugs through the intestine, intestinal or liver metabolism, known as the first pass effect, also known as first pass metabolism. Parts of the intestine, intestinal and liver first pass effect. Intestine, digestive juices, digestive enzymes, and even the enzyme produced by the intestinal flora can make certain drugs inactivation, such as oral insulin by protein hydrolysis enzyme is almost completely inactivating the intestinal wall because of the role of monoamine oxidase allows the tyramine failure in the intestinal wall, and if isoproterenol oral, a phenomenon known as the first-pass effect. the first pass effect by the enzyme concentration and blood velocity impact, the higher the concentration of enzyme in the liver, the blood flow faster, the first pass effect more obvious. first-pass effect is stronger, less to enter the drug in the blood. Oral medication absorbed in the gastrointestinal tract to the liver through the portal vein, some easily metabolic inactivation of drugs through the intestinal mucosa, most of the destruction of the first through the liver into the blood circulation of the effective dose to reduce, lower efficacy, which kinds of phenomena called first pass effect. Therefore, the drug in the intestinal mucosa by the inactivation of the enzyme after oral administration via the portal vein to both cases, the liver is converted to first-pass effect. acid damage to the drug occurred prior to absorption changes; drugs to plasma proteins was reversible combination, the combination of drugs biological effects without metabolic excretion, temporary storage in the blood. When the plasma concentration decreases, the combination of drugs can release the free drug, both in dynamic equilibrium; subcutaneous or intramuscular injection, the drug first along the connective tissue proliferation into the blood circulation via the capillaries and lymphatic endothelial cells.

influencing factors

drug "first pass effect" also known as the first pass effect, the drug is absorbed reaches the systemic circulation jibei of metabolism. Can be divided into three types:

first pass effect


1, hepatic first pass effect. Can occur after oral medication, intravenous or sublingual administration can be avoided.
2, intestinal first-pass effect.
3, pulmonary first pass effect, very few drugs, such as chloroform.
double most of the oral medication will occur simultaneously digestive tract and liver first pass effect. Such as nitroglycerin, oral completely absorbed by the liver, 90% of glutathione and organic nitrate ester reductase system inactivated. nitroglycerin sublingually, it can be directly absorbed by the oral mucosa into the superior vena cava, and then to the systemic circulation, rather than the liver can play a curative effect. Sublingually 1 to 2 minutes therapeutic effect.
chlorpromazine intramuscular After, the plasma concentration than oral administration of the same dose of chlorpromazine is 3-10 times higher. The reason is because after the oral administration of chlorpromazine, the first pass by the gastrointestinal mucosa. By the first pass on the clinical, but also significantly reduce the bioavailability of the drug nitroglycerin, reserpine, propranolol, lidocaine, America metoprolol, salbutamol, Ritalin, morphine, meperidine. Aspirin, cortisone, and imipramine hydrochloride and so on.

avoid method

use a model to characterize the physiological significance in vivo after intravenous and oral administration of propranolol disposal, successfully simulated after oral administration, first-pass effect on the the impact of drugs in vivo disposal process of the people the discovery of the biological use of degree significantly lower, and under certain conditions, in the propranolol oral absorption of the first pass process of its doors vein in the concentration of liver metabolic enzymes may be will generate transient ( part of) the role of saturation, nonlinear dynamics observed in the past, people of this saturation mechanism of the Department of propranolol oral reason, and this transient and saturation effects propranolol dose and dosage forms. To avoid first-pass effect:

first pass effect


① to change the route of administration. Such as by first pass metabolism of oral nitroglycerin about 90%, so the poor efficacy, the use of bypassing the first pass effect, sublingual use, directly absorbed by the sublingual mucosa into the blood, drugs destroy less. Certain drugs also can be absorbed by passive transport through the anus enema or suppository, due to the small contact surface, the absorption less than oral absorption pathway through the liver, fewer drugs undermine the role faster.
② Select the appropriate dosing schedules, such as eating, medication can reduce the metabolism of drugs in the liver, improve the bioavailability.
③ dose was doubled for the first time, to offset the metabolism of the liver drug metabolizing enzyme, some drugs can be used for the first time daily dose taken once. first-pass effect of drug bioavailability reduced, thus affecting the efficacy of the drug. the first pass effect of drugs: propranolol, nitroglycerin, lidocaine, isoproterenol, guanethidine, levodopa, neostigmine, morphine and meperidine, etc.. After oral administration in the gastrointestinal absorption of drugs from the portal vein into the liver inactivated in the liver metabolism of drugs largely destroyed, and thus enter the blood circulation of the effective dose to reduce the reduce the efficacy of the phenomenon. The known chlorpromazine, acetyl salicylic acid, isopropyl adrenal significant first pass effect.

basic knowledge

people say that an injection medication works, so the injections really is the best medication? In actual fact, different delivery methods for different clinical conditions selected, and no better or worse. Relative to the body's own immune function, drug support units to defend human health, to combat the disease. Whenever people plagued by the disease, this reinforcements will come forward to attack. With the development of science and technology, social progress, the force's combat capability has become increasingly powerful, and arms more and more diverse. For different disease, select the best drug landing approach in the human body, will be victorious in combat with the disease. The formulations of the drug is designed on the basis of medical needs, as combat troops to choose different arms depending on the enemy. Such as emergency patients, the effect quickly, should take the injection, suppositories, soups, and sublingual tablets. The need for sustained drug action, the delay can be pills, extended-release tablets. Some drugs made in different forms, you can show different therapeutic effects, such as magnesium sulfate made solution doses of oral diarrheogenic made of injection, compared with anticonvulsants.
the

oral drug Tianqian

enter the body

drugs into the human body, play a pharmacophore can be through many ways, the most common, most familiar, of course, is oral administration. The old saying: "Good medicine tastes bitter to the mouth," said this oral administration. Ordinary oral tablets, capsules, oral liquid, etc. through the mouth into the stomach, esophagus play a pharmacodynamics. The benefits of oral medications is that it can be convenient to take, do not like injections, suppositories, etc., in addition to the administration trouble, but also bring patients the pain, especially in children Most of the drug tablets, capsules swallowed , disintegration in the stomach, and then further dissolved in the gastric juice, came to the small intestine, especially the duodenum, would be absorbed by the villi. Few drugs are not absorbed by the body to remain in the gastrointestinal tract play a role, such as antacids stay in the stomach and gastric acid, laxatives and antidiarrheal agents in the small intestine, mainly in the large intestine, some produce efficacy. before

blood circulation

oral drugs into the systemic blood circulation, after the destruction of the gastrointestinal tract, digestive juices and mucous membranes, destruction of liver enzymes, and some drugs may even be destroyed, more than half, known as the first pass effect ". Make the drug's efficacy is greatly reduced. Some drugs "first pass effect" will be serious enough to absorption by the gastrointestinal tract after oral administration almost completely annihilated, but to take other means of intravenous injection in the human body "landing". As everyone familiar with the diabetes drug insulin is more serious because the "first pass effect", while the multi-injection. Today, technological development, the development of oral medication is extremely rapid, wide variety, but the speed of onset of drug, but also undoubtedly the injection. Injection, sharply, immediately into the blood, there is no first pass effect of this barrier, so effective much more quickly than oral. Such as emergency medicine is often the injection, never orally. Intravenous injection, not require oral medication disintegration, dissolution, absorption and other steps, you can directly enter the blood circulation, all delivery methods among the fastest efficacy, but the risk is relatively high. strict disinfection, improper operation and drip too fast will cause adverse transfusion reactions. Into the blood of drugs will continue to play a role throughout the organization, such as cardiac stimulant to the heart, and analgesics to the nervous system and antihypertensive agents to blood vessels, heart and kidneys, etc. to the trachea and the lungs, asthma medicine, some drugs (such as sedation) will pass through the blood-brain barrier into the brain, Efficacy of each drug where it should go play, but sometimes went we do not want it to go places, causing side effects or adverse reactions. The intramuscular injection is slowly into the bloodstream from the muscle layer, the richer the parts of the blood vessels, the faster drug absorption, while the subcutaneous injection of blood from the subcutaneous tissue to reach, such as the above-mentioned insulin injection.

transdermal absorption

transdermal absorption of the principles of traditional plaster is applied, the skin preparations is mainly used for coating on the skin surface, penetrate the skin, the stratum corneum to reach the patient site to play efficacy. Also absorbed through the skin drug delivery to produce systemic effects, such as the clinical use of 2% nitroglycerin ointment can be absorbed through transdermal treatment of angina pectoris; scopolamine film former is affixed to the skin behind the ear to prevent motion sickness. Oral absorption, such as nitroglycerin sublingual tablets, the use of it in your sublingual directly absorbed from the sublingual mucosa into the bloodstream quickly to play efficacy. The oral mucosa distribution of many blood vessels, the drug is absorbed through the mouth, through the jugular vein to reach the heart with blood circulation to the systemic distribution. Rectal absorption such as anal suppositories from the rectal mucosa directly absorbed, rectum close to the anal side of the blood vessels is extremely rich, some pharmaceutical such as suppositories, enemas can be through the rectum absorbed into the veins, some not suitable for oral, encounter stomach acid or have contraindications of the drug can use of suppositories, enema administration, contrast enema is absorbed quickly and completely the advantages of absorption irregular, may affect the absorption effect and disadvantages of the stool in the rectum.

otherwise

In addition, the drugs enter the body in many ways, such as direct inhalation of aerosol of the lungs, instillation of eye, nose, ear, eye drops, nasal drops, ear drops and so on. Select the appropriate dosage forms, and select the appropriate drug formulations with, can effectively defend the body's health, to drive away the disease.

affected large pharmaceutical

drug "first pass effect" also known as the first pass effect, the drug is absorbed reaches the systemic circulation jibei of metabolism. Can be divided into three: ① liver first pass effect. Can occur after oral medication, intravenous or sublingual administration can be avoided. ② intestinal first-pass effect. The ③ pulmonary first pass effect, very few drugs, such as chloroform and other.
double most of the oral medication will occur simultaneously digestive tract and liver first pass effect. Such as nitroglycerin, oral completely absorbed by the liver, 90% of glutathione and organic nitrate ester reductase system inactivated. nitroglycerin sublingually, it can be directly absorbed by the oral mucosa into the superior vena cava, and then to the systemic circulation, rather than the liver can play a curative effect. Sublingually 1 to 2 minutes therapeutic effect.
chlorpromazine intramuscular After, the plasma concentration than oral administration of the same dose of chlorpromazine is 3-10 times higher. The reason is because after the oral administration of chlorpromazine, the first pass by the gastrointestinal mucosa. By the first pass on the clinical, but also significantly reduce the bioavailability of the drug nitroglycerin, reserpine, propranolol, lidocaine, America metoprolol, salbutamol, Ritalin, morphine, pethidine, aspirin, cortisone, and imipramine hydrochloride and so on.

simulation

use a model to characterize the physiological significance in vivo after intravenous and oral administration of propranolol disposal process successfully simulated after oral administration, first-pass effect the impact of drugs in vivo disposal process of the people the discovery of the biological use of degree significantly lower, and under certain conditions, in the propranolol oral absorption of the first pass process of its doors vein in the concentration of liver metabolic enzymes may be will generate transient ( part of) the role of saturation, nonlinear dynamics observed in the past, people of this saturation mechanism of the Department of propranolol oral reason, and this transient and saturation effects propranolol dose and dosage forms.


[Cause]

boil is caused by what the?

infection and skin dirty, scratches, high ambient temperature or lower the body resistance to infection-related. Boils can occur in any follicles of the skin area, often to the head, face, neck, armpits and buttocks so often by the friction of the parts is more common.

(a) causes

boil the pathogenic bacteria Staphylococcus aureus based, Streptococcus, Staphylococcus epidermidis, are also caused by the disease. Local and systemic skin's resistance to infection is reduced mainly due to Benbingfasheng, so infants, malnutrition, diabetes is a good risk of this disease. Dirty skin, skin abrasions, high ambient temperatures often lead to local infection such as the direct cause.

(B) the pathogenesis

bacteria invade the hair follicle and their sebaceous glands and sweat glands, in hair follicles and surrounding tissue multiply rapidly, producing toxins, causing local tissue degeneration, necrosis, and the center of the formation of boils, the performance of local congestion, exudation, induration. Aggregation of neutrophils to the damaged body tissue cells and bacteria to be destroyed, and he gradually necrosis and dissolution, the formation of abscesses in the dermis. Due to Staphylococcus aureus, coagulase contain toxins, so the formation of pus bolt, protruding outward. Swelling and induration clinically visible in the center of a yellow-white pus plug. This is Staphylococcus aureus infected lesion characteristics. Ulceration after discharge pus, abscess gradually by the new fibrous tissue repair and healing.

[Sign]

boil the early symptoms?

1. redness, swelling, heat, pain summary, cylindrical cone.

2. inflammation to the development of nodules increases, the pain intensified.

3. A few days later nodules central necrosis, abscess formation, dissolution, soft induration, pain relief, the central pus head most of the self-rupture, discharge pus, inflammation subsided recovery.

4. furuncle usually no obvious symptoms, but if the blood flow occurred in the rich parts of the body resistance weakened, it can cause discomfort, chills, fever, headache and loss of appetite and other symptoms of toxemia.

5. Facial Boil such as intracranial infection, facial swelling and severe, may be associated with chills, fever, headache, sinus infections and other embolization.

boil because of location, severity of different clinical manifestations may vary.

local swelling and pain sclerosis: no systemic symptoms of early disease and more, only infection redness, swelling, pain, range of not more than 2cm in diameter, small nodules gradually enlarged, as papules bulge. A few days later lesions extended about 3 ~ 5cm, nodules gradually softened, the center was white, a slight touch of the fluctuations; then ulceration pus, and the emergence of yellow-white pus plug. Pus bolt off, pus shed, the inflammation subsides and healing. There is no pus boil bolt (the so-called headless boil), since the collapse a bit late, need to find ways to promote its pus discharge (Figure 2 ).

fever, swollen lymph nodes: furuncle serious infection, the local area of ​​the lymph nodes, tenderness, and may be associated with body heat, and sometimes lymph node abscess formation.

nose, upper lip and around (called "dangerous triangle") of the surface boil, add or pushed in touch, the bacteria via the angular vein, ophthalmic vein into the brain, causing intracranial suppurative infection. At this point may have fever, headache, vomiting, consciousness disorders.

early follicular redness, swelling, heat, pain, induration. After the white purulent center, there is volatility. May be associated with systemic fever, elevated white blood cell count and differential count.

[Aftertreat]

boil ate?

therapeutic side:

1. composed of: a single head of garlic, honey, 9 grams. Usage: pound evenly wrap the affected area.

2. consists of: single head of garlic amount. Usage: Peel and slice into 2 to 3 mm, with the first affected area with warm salt water when dry wash, and then sticking garlic, and gently massage the 10 to 20 minutes, 2 or 3 times a day, 2 3 There is no more. Indications: Boil, folliculitis. Note: In severe cases, such as local irritation may reduce the massage time, a serious condition should be added to serve anti-inflammatory drugs.

3 . composed of: tea 2 grams of dried honeysuckle 1 gram. Usage: boiling water 6 minutes after each meal drink in a cup. Indications: Boil, exogenous heat.

4. composed of: fresh Malan first 100 grams, the amount of liquor. Usage: Add a little salt before blindly smashed wine Ban Cheng paste, coating the surface of the skin furuncle carbuncle. Indications: furuncle, carbuncle.

5. Composition: rosin 10 grams of white wine. Usage: rosin research to fine tune white wine into a paste, resisting heat, wrap the affected area after dissolution, for the degree of responsibility to cover all of the above and then covered with wax paper and tape securely, to enhance efficacy, can drop a few drops of wine, rosin to keep moist. Indications: furuncle, carbuncle, folliculitis.

6. smashed topical papaya leaves, swollen boil carbuncle treatment drug.

7. fresh peach leaf, plug smashed the lesion, treatment of nasal furuncle.

8. rhizome or fresh banana leaves smashed Jiao Zhi, coating the surface of the skin, cure carbuncles, boils, swelling.

9. almond powder with sesame oil paint, heat treatment boil.

10. Purple cane coal deposit of the skin, powder, paint the affected area or sesame oil dressing, boil carbuncle treatment, stomatitis , eczema.

11. raw taro add a little salt, smashed drunk wrap the affected area twice a day replacement, bones can cure pain, swelling of unknown drugs, pediatric head hot boil, finger boil.

12. raw loofah (or leaf), smashed juice, coated surface of the skin, soak sore treatment days, yellow water sores, heat boils, urticaria .

13. mung bean sugar kelp: seaweed 60 grams, shredded, green beans, 150 grams, with the soup, add brown sugar to taste food. There Sedative, diuretic, soft-kin, Phlegm, scattered gall tumor effect. For hypertension, beriberi edema, neck lymphadenopathy, simple goiter, prickly heat boils hot summer day in children poison, phlegm cough embolism.

14. yi melon soup: melon (not peeled) 500-600 g, yi 50-100 grams of soup. Can be flavored with sugar or salt, on behalf of the tea used, heat, hot weather, diuretic, dehumidification effect. Drugs for Rush boils, eczema athlete's foot, yellow urine deficient.

15. Daozhi raw turnip, vinegar and rub the affected area transfer, heat treatment boil.

16. green beans 30 grams of powder, each 10 grams, water delivery service, boils cure breast swelling and pain.

17. failure to adopt the open rose 3 - 5 朵 wash, add water, two pregnant, suffering from a cup of low heat, ice sugar 30 grams, made of rose soup, until the temperature dose, to cure blood stasis amenorrhea, boils Chung pain, traumatic swelling and pain.

18. boils and pus ulceration of the skin sore or eczema, rinse with water, tea, allow the wound clean and promote healing.

19. a white sweet potato, peeled and chopped, smashed, can also be added with the same amount of fresh Houttuynia smashed, spreads in the affected area, apply to the local heating that line replace (about two three hours long), and even apply a few days more, boils cure mastitis.

20. soybeans amount, turn on the water immersed soft, add a little alum were smashed drunk, external surface of the skin, swollen boils boil treatment.

21. adzuki beans with water until soft, mash with water or vinegar, or honey or egg amount, into a paste, external surface of the skin, cure mumps, hot boil.

22. Kapok 30 - 50 grams of sugar amount, fry a bowl with water and drink two bowls and a half. Favorable moisture, heat effect. For enteritis, urethritis, eczema, summer boil embolism.

23. fresh buckwheat leaves 60 grams, Shuijianbi day one; or fried yellow noodles with the vinegar into a paste, applied to the lesion, sooner or later be replaced. Governance sore, swollen boils, erysipelas, mastitis, and swelling of unknown drugs.

appropriate patients to eat what?

1, edible grapes plus zinc salt or zinc, other foods such as soy, sunflower seeds, wheat bran, yeast, brown sugar and so on.

2, Yi Shi taste light, the cold food, such as Malan head, purslane, melon, red and white radish, bitter gourd, sponge gourd, mung bean, red bean, lily, chrysanthemum brain and celery.

patients unfit to eat what?

not eat ginger, pepper and other spicy foods , as well as mustard, yellow croaker, shrimp, crab, chicken head, goose, Zhu Tourou so fat objects.

should avoid fried foods and meat, edible oil cans.

data only refer to the specific, please ask a doctor.

[Prevent]

how to prevent boils?

boil is born of acute suppurative superficial skin disorders, widely available health, children, young people more common. "Surgical management case" that: "boil persons, birth processes, floating red rootless feet, swollen found in the skin, only the width of an inch, there is less pain, a few days later Microsoft, thin peel, the beginning of the blue water, the latter from breaking the pus out of. "The disease occurs in the summer and autumn, protruding roots shallow, swelling potential limitations, lift the red pain, mostly in the range of about 3cm, easily swollen, easy to collapse, Yi Lian. Early can be divided into a head, without the first two kinds of general light and easy to cure the symptoms, so the saying goes, "no boil the size of a pus like." ;;; ;;;;; ;;;;; ;;;;; But also due to the formation of improper treatment or care "mole cricket boils," or repeated seizures, lack of disunion. Multiple furunculosis ", is difficult to cure.

[Treat]

boil precautions before treatment?

attention to the skin clean, timely replacement of underwear and avoid skin injuries, especially in the summer, to bathe, wash your hair, hair, changing clothes, nails, children in particular should pay attention. With honeysuckle and wild chrysanthemum Jiantang tea. Boil the surrounding skin should be kept clean and coated with 70% alcohol to prevent infection spread to nearby hair follicles.

boil Chinese medicine treatment methods

total boil caused by the toxic heat treatment to detoxify the basic principles.

A Differential Treatment:

1. Heat toxin Accumulation card: lesion processes, such as cone, burning pain, or fever, thirst, tongue pink, yellow fur, rapid pulse. Detoxification. Flavors disinfection decoction.

2. Shushi heat Melancholia: seen in summer and autumn, the affected area, such as agglomeration cone, single or multiple, burning pain, chest tightness, anorexia, deficient urination, red tongue, greasy or yellowish, veins slippery. Qingshu dampness, detoxification swelling. Qingshu Decoction.

3. Is virtual evil love cards: distributed in the body, local color dark red, pus scarce, one after another, delayed healing, with fever, irritability, thirst, or fatigue, limb soft, red tongue thin yellow, rapid pulse. Righting detoxification. Liu Wei Di Huang Decoction.

Second, external treatment and other treatment:

1. The beginning of detoxification should be swelling, moderate to henbane, water reconcile, wrap the affected area. Or wishful golden powder for external application. Or green cream Waicha.

2. Pus, the clip bolt out the pus.

3. Unhealed after the collapse, sores can be a little ninety-one Dan to drugs or drug line twist into sores, topical berberine gauze.

4. Oral Meihuadianshe Dan, Niuhuangjiedu, Fang Feng Tong Sheng Wan, Liushen other medicine.

5. Unilateral prescription: Silver Flower 30g, licorice 10g, decoction, on behalf of the tea.

Western boil treatment

1. Local treatment, such as heat, physical therapy, 10% ichthyol coated ointment. Facial Boil should rest in bed should not squeeze or prick Boil, so as not to spread to the brain.

2. Swelling or have a large range of obvious symptoms, should give systemic antibiotics (third-generation cephalosporin antibiotics).

3. The formation of abscess, incision and drainage should be timely but should be avoided Boil the face cut.

(a) treatment

1. The principles of early treatment to promote inflammation subsided, after early drain purulent pus; timely elimination of systemic adverse reactions.

2. Local treatment

(1) Physical therapy: early, ultraviolet micro-irradiation, can promote local anti-inflammatory, to prevent proliferation. Swelling stage, the selection of FM, infrared and other heat, promote Boil liquid. 2 to 3 times / d, 20 ~ 30min / times.

(2) Drug eraser: 0.5% povidone-iodine scrub, the drug not only for skin irritation, and the role of long-lasting, no pigmentation. Can also be used erythromycin, tetracycline ointment.

(3) topical cream: local swelling and a small pustules, use ichthyol, wishful golden powder, Gyokuro powder and so on.

(4) incision and drainage: Boil into pus, nodules soften, a sense of volatility, you can make a small incision drainage or fire needle drainage. Taboo squeeze purulent lesions.

(5) to keep local clean and dry: adhere to local skin cleaning, daily showers are the best conditions. Young children with skin, topical lip after taking a bath in summer, to avoid the formation of multiple Boil.

3. Systemic treatment usually does not require systemic treatment of boils. But facial boils or accompanied by chills, fever, headache, general malaise, etc., should be given antibiotics. Clinical observations and experimental results show that the efficacy of penicillin, cephalothin, cefazolin and amikacin better effect.

(B) the prognosis

generally good prognosis after active treatment, without sequelae.

[Examine]

boil should be how?

1. Peripheral blood

(1) white blood cell count: fever, elevated WBC count may have.

(2) white blood cell count: white blood cell count was elevated often accompanied by increased neutrophils .

2. diabetes check

(1) fasting plasma glucose measurement: two fasting blood glucose were increased, should consider the possibility of diabetes.

(2) glycated serum protein: This clinical trial is not the impact of fluctuations in blood glucose higher than normal to help the diagnosis of diabetes.

(3) glycosylated hemoglobin: glycosylated hemoglobin and blood glucose were positively correlated, and the irreversible reaction. Diabetes is often higher than the normal 2 to 3 times.

3. bacteriologic

(1) bacterial culture: the multiple, repeated infections, abscesses can be extracted directly pus for bacterial culture, positive results will help the diagnosis of pathogens.

(2) drug susceptibility testing: bacterial culture in the pus, while line drug susceptibility testing can provide the scientific basis of clinical drug treatment.

[Diff]

boil diseases easily confused?

1. Multiple sweat gland abscesses are summer disease, more common in infants and young children and frail mother's head, forehead, etc .. Lesions of multiple subcutaneous abscesses. Surface tenderness, inflammation lighter. No pus bolt, left scars. Usually accompanied by a lot of prickly heat. Generally known as prickly heat poison. It was also known as pseudo furunculosis (Pseudofurunculosis).

2. Hidradenitis suppurativa common in young women, lesions of the skin induration. Subcutaneous abscess formation, followed by skin redness, swelling, heat, pain, ulceration scarring. Lesions occur in the armpits, groin, genital and perianal, umbilical, etc.

3. acne acne mild infection, red, swollen, painful, but the disease is small, the top a little bit like creamy.

4. sebaceous cysts sebaceous cyst infection are redness, swelling, pain, but the previous round has been painless mass over an extended period , the epidermis as usual.

5. carbuncle carbuncle with redness, swelling, pain, but there are several hair follicle infection, lesions larger than the boil.

[Disease]

hump-related diseases

juvenile osteochondrosis of vertebral osteoporosis youth sexual hump sore scoliosis ankylosing spondylitis vitamin D deficiency disease

more back symptoms

small blisters appear back back pain back spasms, back pain does not have subtle linen spine back pain sinus pain Road with sensory ataxia spinal nerve root damage spinal cord hemisection syndrome, spinal cord lesions of hemorrhagic infiltration of the spinal cord injury spinal cord infarction, cauda equina involvement across the spinal cord within the spinal cord gliosis in the spinal cord anterior horn of the spinal cord lesion cavity formed spinal thalamic tract compression


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