ABSCESS

• An abscess is a localised collection of pus (dead and dying neutrophils plus

proteinaceous exudate)

• CLASSIFICATION
• 1. Pyogenic abscess: It is the commonest form of an abscess. It can be
subcutaneous, deep or can occur within the viscera such as liver or kidney
• 2. Pyaemic abscess: Occurs due to circulation of pyaemic emboli in the
blood (pyaemia)
• 3. Cold abscess: Usually refers to tubercular abscess due to involvement of
either lymph nodes or spine
 PYOGENIC ABSCESS
It is usually produced by Staphylococcal infections. The organisms enter
soft tissues through an external wound, minor or major. It can also be due to
haematogenous spread from a distant focus such as tonsillitis or caries tooth.
Pyogenic abscess can also be due to cellulitis.

• Pathophysiology: Following an injury, there is inflammation of the part

brought about by the organism such as Staphylococcus. The end-result is
production of pus which is composed of dead leukocytes, bacteria and
necrotic tissue. The area around the abscess is encircled by fibrin products
and it is infiltrated with leukocytes and bacteria. It is called pyogenic
membrane.
• SIGN AND SYMPTOMS: throbbing pain, fever, swelling and all the signs of
inflammation, cellulitis like appearance around the foci. Tenderness and
fluctuation can be seen.
• DIAGNOSIS: clinical diagnosis, USG of the region, CBC, pus culture.
• TREATMENT: Untreated abscess tends to point spontaneously along the
area of least resistance to the nearest epithelial surface, e.g. skin, gut, oral
cavity. However, deep-seated abscess such as breast abscess may cause much
tissue destruction before pointing.

Incision and drainage (I&D) under general anaesthesia. General anaesthesia

is preferred because in the presence of infection, local anaesthesia may not act
and it is difficult to break all the loculi of an abscess without causing pain.
Supportive treatment consist of antibiotics, analgesics, and dressing
 PYAEMIC ABSCESS
• This is due to pus-producing organisms in the circulation (pyaemia). It is the
systemic effect of sepsis. It commonly occurs in diabetics and patients
receiving chemotherapy and
• radiotherapy. Pyaemic abscess is characterised by following features:
• multiple
• deep-seated
• Tenderness is minimal
• Local rise of temperature is not present.
• Hence, it is called nonreactive abscess to differentiate it from pyogenic
abscess. This is treated by multiple incisions over the abscess site and drainage
(like a pyogenic abscess) with antibiotic cover.
 COLD ABSCESS

• Even though it is a chronic abscess due to a chronic disease (tuberculosis),

for the completeness of the chapter on abscess and for the convenience of
reading, it is discussed here.
• Cold abscess means an abscess which has no signs of inflammation.
Usually, it is due to tuberculosis, e.g. following tubercular lymphadenitis or
due to tuberculosis of spine. However, other chronic diseases such as
leprosy, actinomycosis and madura foot also produce abscesses which are
'cold' in nature.