Surgery - Abscesses
Introduction An abscess is a mass of necrotic tissue that is encircled by a layer of inflammatory exudate and contains both dead and living neutrophils suspended in tissue breakdown products (pus). Etiology An attempt is made to wall off the area in order to prevent the infection from spreading further if a penetrating injury, local infection, or the migration of normal flora to sterile sections of the body break the tissue barrier. Staphylococcus, streptococci, enteric bacteria (like Escherichia coli), various coliforms, and anaerobes (like Bacteroides spp.) are examples of common bacteria. Traditionally, TB leads to "cold" abscesses. Please refer to Associations/Risk Factors and Pathology/Pathogenesis. Risk Factors Local: A hernia repair mesh, embedded hair, splinters, tissue necrosis, an underperfused area, or a foreign body that serves as an infection focal point. Systemic: diabetes, immunosuppression (may prevent pus from forming, though). Epidemiology prevalent across all age groups. H HISTORY The patient may report systemic symptoms like fever and feeling under the weather, or local symptoms like pain, swelling, heat, redness, and decreased function of the area where the abscess is present (dolor, tumor, calor, rubor, and functio laesa, the Celsian signs of acute inflammation). Examination At the location of the abscess, the aforementioned signs of acute inflammation are noticeable. The only indication that the condition is present within an organ (such as the liver, lung, or body cavity) could be a swinging pyrexia, which is brought on by the intermittent release of inflammatory mediators or bacteria into the bloodstream and should prompt the search for an infected collection. An old proverb states that pus is under the diaphragm (subphrenic abscess) if pus is both anywhere and nowhere. Pathogenesis When pus, a mixture of bacteria and cell debris, forms, it triggers a severe acute inflammatory response. An abscess develops when fibrinous exudate and granulation tissue (fibroblasts and macrophages) encircle it, followed by collagen deposition and walling off. Mycobacterium-containing clusters of caseating necrosis are known as "cold abscesses" because they do not elicit an immediate inflammatory reaction. Investigational studies FBC ("neutrophils") in blood. Imaging: To locate the location of a collection or abscess, imaging techniques such as ultrasound, CT, MRI, or even 67Ga white cell scanning may be employed. Aspiration: Pus is acidic and low in glucose. Pus culture for the purpose of determining antibiotic sensitivity. Management Prevention: If administered early in an infection, preventive antibiotics (e.g., during procedures). Usually ineffective after an abscess develops. In general: Pus drainage, foreign material and necrotic material removal, antimicrobial cover, and predisposing cause repair are among the guiding principles involved. Surgery: To remove pus, an incision is made, the cavity is debrided, and then the cavity is allowed to empty freely using either packing (if the cavity is shallow) or drains (if the cavity is deep). Interventional radiology: An abscess's contents can be located and aspirated using ultrasound or CT guidance. Complications Skin cellulitis or bacteremia combined with systemic sepsis may arise from spread. A discharging sinus, fistula, or persistent abscess may develop if the infection's focal point is not removed. Antibiotics can occasionally permeate and cause an antibioma, or sterile collection, to form. In the event where slow expansion is restricted by strong facial planes, the surrounding tissues may experience pressure necrosis. Tissue that is typically functioning may be destroyed by abscesses (liver or nephric abscess, for example). Prognosis Good if predisposing cause is eliminated and sufficiently drained. Abscesses may spontaneously empty themselves and have a tendency to "point" to the closest epithelial surface if left untreated. Deep abscesses could experience dystrophic calcification and turn chronic.
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