Edema of the quinta in the larynx
Laryngeal edema is a manifestation of pathological processes and various diseases, but not an independent disease.
Depending on the reason, distinguish:
- non-inflammatory laryngeal edema.
Inflammatory edema of the larynx, or edematic laryngitis in adults,is more common on the eve of the larynx, in children - in the underlayment space. The disease is due mainly to toxins produced by streptococci, it usually affects people who are weakened by certain common diseases (diabetes, uremia, beriberi, cachexia of various origin), as well as a common infection (influenza, scarlet fever, etc.).
Non-inflammatory Laryngeal edema occurs with allergies to varioussubstances (medicinal, cosmetic, food). This group can include swelling of the Quincke in the larynx. Such a laryngeal edema is combined with edema of the face and neck.
With laryngoscopy visible limited or diffuse, intense jelly tumor-like formation of pale pink color. The contours of the anatomical details of the larynx in the region of the edema disappear.
Treatment: The patient is given a semi-sitting or sitting position,prescribe fast-acting diuretics (furosemide), antihistamines, sedatives and tranquilizing (sibazone) drugs, antihypoxants and antioxidants, hot foot baths, mustard plasters to the gastrocnemius muscles, oxygen. Some authors recommend swallowing ice slices and an ice pack on the larynx, others, on the contrary, warming compresses on the neck area. It should be refrained because both the cold, being a powerful vasoconstrictor, causing a vasospasm, prevents the resorption of not only inflammatory infiltrates, but edema of non-inflammatory nature, besides cooling the larynx can lead to activation of the opportunistic microbiota and cause a secondary inflammatory reaction in the form of catarrhal inflammation and its complications. On the other hand, the warming compress and other thermal procedures cause vasodilation, not justified by the pathogenesis of the edema, a decrease in their permeability, increased blood flow, which can not but contribute to an increase in edema. Among other measures, inhalations of the adrenaline solution 1:10 000, 3% solution of ephedrine hydrochloride, hydrocortisone are shown. The diet includes liquid and semi-liquid vegetarian food, room temperature, devoid of spices, vinegar and other spicy condiments. Limit drinking. With edema of the larynx caused by common diseases or intoxications, along with respiratory rehabilitation measures of the larynx and medicinal antihypoxic treatment, adequate treatment of the disease that provoked, as a risk factor, laryngeal edema.
With inflammatory edema, an intensiveantibacterial therapy (penicillin, streptomycin, etc.). Sulfanilamidy appoint carefully, because they can adversely affect the excretory function of the nights.
Often the acute inflammatory and non-inflammatory swelling of the larynx develops very quickly, sometimes lightning fast, which leads to the danger of acute asphyxia requiring immediate tracheotomy.
Angioedema (edema of Quincke) - sharply developing, rapidly passing swelling of the skin and subcutaneous tissue or mucous membranes. The disease can be caused by both immune and non-immune mechanisms.
Angioedema appears in combination withhives, or without it, can develop on any part of the body, often as a component of a generalized anaphylactic reaction (anaphylactic shock). The greatest threat to life is the swelling of the larynx and the resulting asphyxia (acute shortage of air).
Edema Quincke - is the most dangerous, as manifested by edema not only of the skin and mucous membranes, but also of the larynx, trachea and large bronchi, as a result of which asphyxia can develop.
Allocate: allergic - develops as a manifestation of sensitization (sensitivity) to medicines (more often antibiotics), food products and additives, venom stinging insects (bees, wasps and hornets); pseudoallergic - as a consequence of direct non-immunehistamine-releasing effects of certain drugs (salicylates and other non-steroidal anti-inflammatory drugs, ACE inhibitors, dextrans, etc.), foods or supplements;complement-dependent - can be inherited or acquired (asrule, in patients with lymphoproliferative malignancies), which is associated with an acceleration of metabolism 2-3 times the inhibitor of esterase C1 of the complement component; idiopathic - the cause is unclear (can be combined).
The main manifestation is, as a rule, painless, fastincreasing, limited edema of the skin, subcutaneous adipose tissue and / or mucous membrane, sometimes accompanied by a feeling of flushing of the skin. The edema is dense and when pressed on it with a finger leaves no traces, the skin over the edema retains its original color. Often (20-25% of cases) is associated with swelling of the larynx, trachea and large bronchi. The patient is worried by increasing shortness of breath, a feeling of lack of air, breathing becomes wheezing, a barking cough appears. If you do not provide timely help, then such a patient may die from the laryngeal edema and block the access of air to the lungs. In addition, severe angioedema can be the beginning of an even more severe immediate allergic reaction - anaphylactic shock.
First medical aid is the introduction of free antihistamineagents (eg, suprastin or diphenhydramine) to relieve swelling. If the swelling spreads very quickly and the patient has breathing disorders, then glucocorticoid hormones are introduced. The patient is necessarily transported to the hospital and there, if necessary, he is assisted in a specialized ENT department.
Patients who have undergone Quincke's edema are prescribed a hypoallergenic diet (excluding food allergens in the form of eggs, milk and wheat, fish, nuts, tomatoes, chocolate, citrus fruits, etc.)
The basis of treatment of the hereditary form of the edema of Quincke are medicinal preparations that enhance the production of the missing C1 inhibitor in the body.