Abscess

Localization of the infection and presence of pus in a cavity and

May occurs in any part of the body.

When abscess forms the tiny capillaries closed so the infection kept
localized.

Number of organisms may be pyogenic in action (staphylococci,

streptococci, corynebactrium pyogenes)

When the MO enters the tissue, acute inflammatory reaction occurs and
the cells in the center killed and liquefied by proteolytic enzymes. Body
defenses became active and leucocytes surrounding the infected area
(polymorphic nuclei) (macrophages)

The polymorphic nuclei remain with the necrotic cavity and these
together with cellular debris, lymph and serum produce suppuration or
formation of pus

The wall of the cavity is composed of granulation tissue that contain

polymorphic nuclei, leukocyte, lymphocyte, fibrocyte and endothelial
cells.

Chronic abscess or end of infection phagocytosis is more than WBC.

Acute abscess 3-5days the pus go to the area less sensitive.

Blood vessels protect by fibrous sheath resistant to infection.

In case of severe infection the clots may be destroyed and septic emboli
carried to other part of body producing abscess, pyemia and septic
pyemia.

Etiology

• Breach of surface of skin or mucosa membrane that allow

entrance pus-forming microorganism to the tissues.

• Intramuscular injection by using non sterile needle.

 • Punctured wound ,penetrated wound or perforated wound
caused by contaminated object.

• Lymphatic born infection (e.g. caseous lymphadnitis).

Blood born infection cause abscess in any place in the body by

transmission of septic emboli through blood circulation from site of
infection to other site and cause abscess (e.g. tuberculosis, strangle).

Signs of acute abscess

1- Superficial abscess

a- Acute inflammation

b- Swelling the inflamed area hard and painful when palpation

c- Center of the swelling soft, fluctuating (pointing of the

swelling) rupture and some pus get out

2- Deep abscess

a- Feverish signs and may be no local signs

b- Interfere with the movement of the organ

c- Edema

d- The deep abscess reaches the surface and sign of superficial

abscess

Abscess in pharynx, larynx, rectum, spinal cord and effect on the

function of the organ.

Treatment

1- Mature the abscess. Hot application, blister.

2- Open the abscess. The point fluctuation, open by scalpel at the

lower part of the swelling in the fluctuating point.

Know the anatomy of the area. Nerve and blood vessels. The incision
should be parallel to the long axis.
Deep abscess

1- Open the skin

2- Push artery forceps through the tissue until enter the abscess
cavity to allow pus go out. Or by enter curved scissor with blunt
end to the abscess cavity then pull it with open the two jaw , this
will allow all the tissue laterally and increase the opening of the
abscess with good protection to new blood vessels.

3- Open the deep abscess by finger, trocarazation or blades.

Check the cavity of abscess from foreign body or necrotic tissue.

Full the cavity with gauze or bandage to drainage and prevent adhesion.

Antibiotics. Cephalosporin, trimethoprim, cloxacilline, sulfadimethoxine

7-10 days.

Using of one of antiseptic to wash the cavity.

Differential diagnosis of abscess from

1- Cyst

2- Hematoma

3- Inflamed and distended synovial bursa

4- Hernia

5- Neoplasm

Make trocarazation or aspiration to differentiate the abscess from the

others.

Cold and chronic abscess

Little inflammatory reaction or not, little or no pain, hard or cyst

swelling, may be soften gradually or rupture the abscess,
Types of abscess

1- Chronic and primary abscess (continuous irritant, trauma, bed

sores, sleep on one side)

2- Chronic and local abscess (lymphangitis, inflammation of veins)

3- General and secondary abscess (Glanders, strangles)

4- Cold abscess (the wall of fibrous, contain dry pus or little)

5- Soft chronic abscess (soft wall, lot of pus, like cyst slight increase
in temperature, differentiated from cyst by trocarazation)

Treatment of chronic abscess

Same in acute abscess remove the pus and debris by curettes and
treat the disease.