Abscess

Synonyms:
abscess, abscesses, boils, carbuncles, furuncles, hidradenitis
suppurative, pustules, whiteheads

An abscess (Latin: abscessus) is a collection of pus that has accumulated

within a tissue because of an inflammatory process in response to either an
infectious process (usually caused by bacteria or parasites) or other foreign
materials (e.g., splinters, bullet wounds, or injecting needles).
 Abscess
It is a defensive reaction of the tissue to prevent the spread of
infectious materials to other parts of the body. The organisms or
foreign materials kill the local cells, resulting in the release of
cytokines. The cytokines trigger an inflammatory response, which
draws large numbers of white blood cells to the area and increases
the regional blood flow. The final structure of the abscess is an
abscess wall, or capsule, that is formed by the adjacent healthy
cells in an attempt to keep the pus from infecting neighboring
structures. However, such encapsulation tends to prevent immune
cells from attacking bacteria in the pus, or from reaching the
causative organism or foreign object.
Pus formation
1-Tissue debris. 2- R.B.C. 3- Lymph.
4- Accumulation of macrophage and mononuclear cell.

The abscess classification: -

A- according to site:-
1.Superficial abscess:-found on the body surface of animal.
2. Deep abscess: - found in the internal organ or cavity.

Liver Abscesses
-:B- according to the course of lesion

Acute abscess: - its occur within (3-5) days after infection also called hot -1

.abscess. Its symptom as in acute inflammation

Chronic abscess:- its take long period and some time disappear and re occur -2

.then. Its symptom as in chronic inflammation

-:C- according to causative agent

.Primary abscess: - its occur when there is direct infection to the affected tissue-1

secondary abscess:- its occur as a symptom in the-2

coarse of some disease ex. Glanders, lymphadenitis

Symptom:
It is vary depending on the type of abscess and the situation.
Hot superficial abscess characterized by:
1-More or less circumscribed inflammatory swelling.
2-Painful on manipulation.
3-The center of swelling gradually become softer while the periphery remain firm
when the center become very thin , the abscess is said to be pointing.
4- Fluctuating
5- Hot (painful, hot fluctuation and edema at border).

In case of chronic (cold):

1- Painless or slightly painful.
2- No fluctuation except in case of soft have the appearance of cyst.
3- Cold (or fibrotic) in case of hard cold abscess and there is no edema.
 Diagnosis of Abscess
1- By symptoms.
2- Expletory puncture:

Treatment of abscess
A- Treatment Acute abscess
1-Prepare the swelling by clipping and sheaving of hair at the swelling area and
clean it by soap and water after that applied antiseptic solution.
2-after prepare the area surgically; open the swelling from the lower part (soft area)
& the open should be large enough & away from main blood vessels.

3- To evacuate the cavity from its content by applied pressure by your finger from up
to down.
4- clean the cavity by mild antiseptic solution by using special syringe and inject this
solution inside the cavity and repeat this cleaning more than one time to be sure
complete cleaning the cavity from its content .
5- Use the accurate to destroy the pyogenic membrane which lining cavity and
remove all dead necrotic tissue and reclean the cavity with antiseptic solution.
6- Packed the cavity with gauze saturated with tincture iodine.
The tincture iodine act: -
a- destroyed the causative M.O.
b- It will stimulate the formation of granulation tissue.
7- This gauze should be removed after 48 Hrs.
8- Antibiotic systemically.

B- Treatment Chronic abscess

Should be change the chronic abscess by applied counter irritant (iodine) this
will increase circulation in the area to change the abscess from chronic to acute.

Counter Opening: - it's an opening above our incision in the abscess through

which we can inject the antiseptic solution for cleaning the cavity.
- :Differential diagnosis of abscess
Cyst:-its abnormal closed cavity (swelling) containing fluid or semi fluid and the -1
.cavity lining from inside by epithelial or endothelial cell

2- Hematoma: - its abnormal closed cavity accumulation of blood sub cut (under
the skin) due to rupture of small blood vessel.

3- Hygroma: - swelling on the joint due to distension of synovial sheath or bursa.

4- Hernia:- its a passage of internal organ through natural or acquired opening in
the body wall and accumulated under the skin (peritoneum and skin still intact )
 Hematoma
is an extensive collection of blood beneath the skin, and may sometimes extend
into muscular tissue, resulted from rupture of a blood vessel (mainly vein) (due
to trauma, bruising due to fighting between animals). It is not necessary for skin
to show evidence of injury.
Symptoms: swelling are hot and painful in early evidence, cold, organized, and
fibrosis in late stages.
 Treatment:
1- If the hematoma is small application of iodine ointment induce the absorption
of part of the fluid contents of the swelling and may eventually disappear.
2- Large hematoma
A- must be incised and evacuate it content after 7-10 days from occurrence of
the trauma. If swelling is open earlier serious hemorrhage may happen. If opened
later than 10 days the blood will be organize into fibrous tissue and can be
remove only with difficult and bleeding.
b- the inside of the cavity is then washed with mild antiseptic and swabbed with
tincture iodine.
c- many necessary to pack the cavity with sterile gauze.
 Sinus & Fistula
Sinus: - blind purulent tract show no tendency to heal.
Fistula: - abnormal opening or passage between two cavities or ducts or between
cavity and surface.
 Classification of fistula:-

1. Congenital fistula ex. cleft palate. between buccal cavity and nasal cavity)

2. Acquired fistula: - occur due to trauma, pathological condition. There are type :-

a- purulent fistula: -characterized by discharge of pus ex, dental fistula.

b- Excretory fistula: - characterized by excretion of the contain of the cavity to the

out side of the body ex, rumenal fistula, rectovaginal fistula.

C- Secretory fistula: -ex, salivary fistula, milk or teat fistula

 Etiology : causes
1- due to delayed opening an abscess/ or opening not in the most dependent point.
2- presence of foreign body or necrotic tissue in the depth of the lesion.
3- existence of a specific lesion in the e.g. carcinoma, tuberculosis.

Symptoms :
1- the orifice may be very narrow and only admit a probe.
2- the tract may be simple or bifurcated.
3- the tissue surrounding the tract is generally fibrosed.
4- the pus may be thick or serious grayish or reddish and may contain occasionally
portions of necrotic tissue.
5- usually have fetid odor and there may be marked inflammatory symptoms
associated with the sinus.
 Treatment:-

Provide good drench and removal all the necrotic and fibrous tissue which

Lining the duct (sinus) from inside. This can be done by using of caustic

materials by fairing by application of hot iron .if medical treated is not effected

complete surgical excision of the lesion is done and then suture the tissue to take

its normal position and shape.

While to fistula after cleaning and refreshing the tissue we closed this abnormal

opening by suturing.