Abscess

BASICS OF ABSCESS

1. ABSCESS DR. GAURAV SANGAM

2. DEFINATION: An  abscess  is a collection of  pus  that has built up within the  tissue  of the body. An abscess is a circumscribed area of inflammation or an abnormal cavity that contains pus if matured.

3. TYPES: There are 3 types of abscess: 1. Pyogenic abscess 2. Pyaemic abscess 3. Cold abscess

4. PYOGENIC ABSCESS This is a collection of pus, resulting from infection by Pyogenic organisms.

5. ENTRY OF ORGANISMS: Direct infection from outside due to penetrating wound Local exension from adjacent focus of infection Lymphatics Blood stream or haematogenous

6. Infection of pyogenic organisms Pus formed by liquefaction of tissues (caused by proteolytic enzyme) Leads to death and liquefaction

7. Commonest precursors of pyogenic abscess: Cellulitis Acute lymphadenitis

8. FATE Tension inside the abscess cavity gradullay rises owing to exudation of plasma, and the abscess spreads along the paths of least resistance The surface of the body A hollow viscus , into which it ruptures.

9. FATE 2. Body resistance, aided by antibiotics Kills bacteria before the abscess finds its way to the surface Fibrosis occur Fluids is then gradually reabsorbed Cavity persists and contains thick,sterile pus ( antibioma )

10. CLINICAL FREATURES: 1. Features of acute inflammation are present Calor Rubor Dolor Tumor 2. Presence of pus is elected by: For superficial pus - Fluctuation For deep seated pus - Brawny edema, pitting under pressure, with induration 3. Fever

11. FEW OF THE PYOGENIC ABSCESS Axillary abscess Inguinal abscess Popliteal abscess Gluteal abscess Thigh abscess Deltoid abscess Sole abscess / Heel abscess

12. Treatment in pyogenic abscess In early cases – where pus is still to form Conservative management Rest and elevation of the part Antibiotic cover As presence of pus is diagnosed Incision and drainage

13. PYAEMIC ABSCESS: Pyaemic absceses , caused by infective emboli in cases of pyaemia . Pyaemia is a condition in which infective emboli, consisting of clumps of organisms, infected clots, or vegetation, circulate in the blood stream. ( In conditions like acute osteomyelitis , infected compound fracture, acute inflammation of an intracranial sinus.)

14. FEATURES: They are multiple Can occur on Is fatal if present in brain and heart The surface , commonly on subfascial plane Present as swelling In viscera like spleen and kidney Non reacting Little pain Little or no sign of inflammation

15. TREATMENT OF PYAEMIC ABSCESS: Identify the source, if detectable Antibiotics preferably choosen by culture sensitivity test Incision and drainage

16. COLD ABSCESS These denote tuberculous abscess Most commonly arising in lymph nodes, bones or joints Non reacting, with no cardinal features of acute inflammation (sometimes present)

17. HOW TO DIAGNOSE? Are diagnosed by their characteristic positions where important sets of nodes are present Eg - neck, axilla , groin On palpation – characteristic features of tuberculous lymphadenitis, i.e soft and matted nodes Cold abscess have tendency to travel to long distances along definite anatomical planes (Tracing nerve, sometimes vessels)

18. SPECIAL INVESTIGATIONS Blood examination X-ray chest Mantoux text ELISA test Aspiraion – culture sensitivity

19. TREATMENT OF COLD ABSCESS 1. Full Anti-tuberculosis treatment 2. Treatment for primary focus 3. For abscess itself – Repeated aspiration with local instillation of INH ( Isoniazid ) solution Complete excision of the abscess with its wall, together with focus origin Eg - group of nodes3

20. Incision and Drainage A. Anesthesia B. Incison Free or Liberal Incision Hilton’s Method C. Exploration D. Counter-incision E. Drainage F. Post Opeartive Care

21. A. Anesthesia Superficial abscesses may be drained with surface anesthesia Deep abscesses require General Anesthesia (LA might spread infection to neighbouring tissues)

22. B. Incision: Free/Liberal Incision: Made on mostly prominent part It causes minimum damage to the surrounding healthy tissue Principle of incision – Should ensure adequate drainage Parallel to important vessels, nerves, tendons Muscle should be incisied along the line of fibers

23. Incision Hiltons method: Chosen when there are plenty of important structures like nerves and vessels Employed in places like neck, axilla , groin

24. Incision in Hiltons Method: Skin and subcutaneous tissue are incisied On most prominent part/ most dependent part Forcep is taken out with jaws open A finger is introduced to explore the abscess cavity Artery forcep /Sinus forcep forced in cavity through deep fascia Blades are gradually open and pus drained

25. C. Exploration A fnger is introduced into the abscess cavity To define its limit To break any septum inside, thus making all loculi into one cavity, for complete drainage

26. 4. Counter incision Abscess will drain better if there is counter incision Where original incision is not the most dependent part, here counter incision helps in draining cavity A sinus forcep passed in cavity till most dependent part, a small nick is made on the skin over the forceps to make the counter opening

27. E. Drainage: A corrugated rain or wick of gauze Where walls of abscess is very vascular, a tight packing of the cavity is required to achieve hemostasis

28. F. Post opeartive care Rest to the part Antibiotics preferably chosen by culture sensitivity test Regular dressing – if the cavity has been packed, the packing should Drains are removed after 48hrs

29. Cruciate Incision:

30. Blades and handle Handles : 3 & 4 : shorter and wider 5 & 7 : longer but breadth is less Blades : 11 – stab incisions (drainage of abscess) 15 – plastic surgery, pediatric surgery 23 – skin and deeper incision Handle Blade 3 11 & 15 4 22

31. THANK YOU…..