6 abscesses Flashcards
(162 cards)
1
Q
abscess
A
a swollen, inflamed area in body tissues, in which pus gathers and would presumably drain from
2
Q
what determines the pathogens within the abscess
A
flora of the region
3
Q
what determines the site of the abscess?
A
- head and neck anatomy
- syndromes you must recognize
- therapeutic principles/guidelines
4
Q
how can organisms involved in abscesses reach a normally sterile internal area?
A
blood borne
penetration/trauma
extension from a nearby non-sterile area, such as a mucosal surface
5
Q
blood borne
A
hematogenous spread
6
Q
penetration/trauma
A
knife wound
7
Q
extension from a nearby non-sterile area such as a
A
mucosal surface
8
Q
most brain abscesses are from
A
oral focus
9
Q
eusobacterium
A
oral flora that can spread to brain tissue
10
Q
commensal
A
normal flora
11
Q
streptococcus pyogenes
A
group A strep
12
Q
what adheres well to oral epithelial cells and
A
strep pyogenes (group A strep)
13
Q
S salivarius and veillonella species colonize
A
tongue + buccal mucosa
14
Q
S mutans + mitis and actinomyces viscosus colonize
A
dental surfaces
15
Q
staphylococcus aureus is present on
A
skin and nares
16
Q
pelvic abscess is an extension of an
A
intestinal wall infection (diverticulitis) + contains a mixture of bacteria that originated in the large intestine
17
Q
abdominal abscesses
A
aeropic organisms + anaerobes
18
Q
aerobic organisms of abdominal abscesses
A
e. coli which tolerate anoxic conditions
19
Q
anaerobes of abdominal abscesses such as bacteroides
A
not killed by tiny doses of oxygen, and have enzymes such as superoxide dismutase to detoxify oxygen radicals and catalase to break down hydrogen peroxide
20
Q
anaerobes
A
clostridia, anaerobic and facultative anaerope, strep
21
Q
strict anaerobe
A
22
Q
facultative anaerobe
A
2-8% oxygen
23
Q
abscesses in gluteus muscle
A
cardiac infection (endocarditis) allowed bacteria to spread to the butt via the bloodstream
24
Q
what causes cardiact valve infections?
A
staphylococcus + streptococcus
25
distant site abscess is a pure culture of the
single organism
26
hematogenous spread= bacteremia common with
skin infections, pneumonia, uti/kidney infections
27
secondary sites of hematogenous spread
large joints (hips, elbows), bones, lungs, liver, spleen`
28
bacteriology of the abscess may be anticipated from
the microbial flora of the originating focus
29
most abscesses originate from
teeth, dental crevices
30
most abscesses harbor
harbor four or five organisms, mainly oral anaerobes
31
infections arise from the pharynx contain oral anaerobes and
strep pyogenes + staph aureus
32
polymicrobial synergy
typical deep neck ifnections + abscesses include on average 5 or 6 bacterial species
-synergy between a # of species renders the whole pathogenic
33
upper airway harbors large numbers of what kind of bacteria?
anaerobic bacteria of limited virulence unless allowed entry into sterile areas
34
some pathogens need no assistance! no polymicrobial synergy
staph + strep fusobacterium
35
how do polymicrobibal synergistic infection species work?
add something necessary but not sufficient
36
pyrosequencing
many uncultured species
37
example of pyrosequencing
bacteroids fragilis has a capsular polysaccharide complex (CPD) with (+) and (-) charges promoting abscesses; without CPD, no abscess is formed
38
with polymicrobial synergistic infections, tx has to be aimed at
different kinds of bacteria, not just one
39
abcesses can be
polymicrobial
40
how are organisms introduced during abscess formation
trauma or via bloodstream (local)
41
what can narrow the mixture of organisms?
early presence of oxygen and then later, the lack of oxygen
42
host response to abscess
walls off organisms with fibrin deposition, eventually thick-walled fibrous collagen capsule
43
inside an abscess
live/dead cells, bacteria, debris
44
healthy tissue is well oxygenated unless you have
- interruption of blood flow (surgery + trauma)
- ischemic necrosis from tumors
- adjacent infection
45
adjacent infections produce
cytotoxic and necrotizing factors extending infection; organisms can consume oxygen rednering tissue anaerobic, which means dead tissue
46
are most oral infections anaerobic or aerobic?
anaerobic (oral abscesses, periodiontal lesions, pulp, periapical lesions0
47
oxygen tolerance varies from species to species
-requires low [02] and reduced oxidation-reduction potential
48
anaerobes outnumber aerobes by how much in the oral cavity and skin
10:1
49
anaerobes outnumber aerobes by how much in the colon
1,000 : 1
50
few anaerobes by themselves are very virulen
fusobacterium, clostridium, + bacteroides
51
what presents on gram negs, and have a strong correlation with pulp + periodontal damage and endotoxin?
endotoxin; metabolites (hydrogen sulfide, ammonia) and injurious enzymes are made
52
host neutrophils require oxygen for their
metabolic burst but is lacking
53
beta- lactamases mediate
penicillin resistance
54
bacteria have acquired antibiotic resistance like
beta lactamase + penicilin lactamase
55
anaerobic infections characteristics
- polymicrobial, usually endogenous + opportunistic
- occur in closed spaces
- smell foul (cadavers)
- accompanied by thrombophlebitis
56
thrombophlebitis
bacterial enzymes promote clot formation; gram neg endotoxins activate clotting cascade, bad since clotted vessels lead to death
57
why are abscesses often biphasic
phase 1 acute inflammation phase 2 local abscess formation
58
resurgent infection
some anaerobes (bacteroides) are resistant to antibiotics, so initial tx with antibiotics may kill off bacteria, but not the bacteroides, leading to resurgent infection
59
resurgent infection
kils of bacteria that are sensitive to antibiotics, but the ones that aren't still survive, so youthink people are fine, but they are in fact still sick
60
cervical fascia
muscles, vessels, and visceral structure of the neck are eveloped in fascia
61
interfascial spaces
potential areas where abscesses can sit
62
what are borders for infections
fascia
63
pediatric neck abscessse commonly in
submandibular and posterior triangle and submental
64
superficial fascia
subcutaneous tissues of neck which are continuous with platysma anteriorly; begins at nuchal line
65
what does the superficial fascia enclose
```
trapezius
SCM
strap mmms
submaxillary glands
parotid glands
```
66
middle or pretracheal fascia
often involved in dental infections that have extended from site of origin
67
infection in what artery with compromise blood flow to brain
carotid
68
second spaces
within submental + submandibular triangles, between mucosa of floor of mouth and superficial layer of deep fascia
69
what divides the second spaces
myelohyoid mucsle into submandibular + sublingual spaces
70
clinical syndromes
- peritonisillar, parotid, parapharyngeal and submandibular abscesses
- parapharyngeal space abscess
- pterygopalatine, infratemporal, + temporal fossa abscesses
- retropharyngeal abscesses
- lung abscesses
71
*sore throat and trismus is sean in
peritonsillar , parotid, parapahryngeal, and submandibular abscesses
72
trismus
inability to open the jaw; pressure or infection of the muscles of mastication
73
trismus involves motor branch of which nerve
trigeminal
74
dysphagia (can't eat) + odynophagia (can't swallow
inflammation of cricoarytenoid joint
75
dysphonia + hoarseness
- neck infection (10th cranial nerve)
| - unilateral tongue paresis (12th cranial nerve
76
stridor + dypsnea
local pressure or spread of infection to mediastinum
77
unilateral tongue paresis
nerve problems
78
patients w/ peritonsillar, parotid, parapharyngeal, and submandibular abscesses have
- facial + neck swelling, erythema, purulent oral discharge
- pooling of saliva in mouth and asymmetry of oropharynx to help determine where problem is\
- adenopathy
- flucuation
79
adenopathy
enlargement of lymph nodes anywhere in body
80
characteristic signs of deep pus
pitting or a doughy feeling on firm deep palpation
81
Is ludwig's angina an abscess?
no, but can be consued with on
82
ludwig's angina
rapidly spreading cellulitis, not an abscess
83
what anatomical feature does ludwig's angina include
floor of the mouth and loose areolar tissue above the myelohyoid diaphragm
84
what are the dominant flora in ludwig's angina
oral flora = strep and anaerobes
85
what precedes ludwig's angina in a most cases
recent lower molar extraction
86
what is critical to control during ludwig's angina
airway control, asphyxiation is a route of death, as is sepsis
87
why does ludwig's angina look like an abcess?
fluids and gases collect and can mimic collection of pus
88
what is commonly seen with ludwig's angina
people with bad oral hygiene and trismus
89
tx ludwig's angina
antibiotic therapy
90
how does death occur during ludwig's angina
suffocation (edema mouth, togue, glottis) mediastinitis, septicemia, pneumonia
91
ludwig's angina II
brawny or indurated edema of the neck, hard, does not give, no pus formation
92
indurated
hardened
93
who does acute bacterial parotitis usually affect
elderly, dehydrated, intubated, postoperative individual
94
acute bacterial parotitis
salivary stasis permis retrograde seeding of stensen's duct with virulen oral flora
95
risk factors for acute bacterial parotitis
recent vigorous teeth cleaning, use of antcholinergic drugs and salivary calculi
96
most common pathogen in acute bacterial parotitis
staphyloccoccus aureus but anaerobes, enteric gram neg bacterial and other organisms also seen
97
acute bacterial parotitis patients present with
pain, swelling of parotid gland and dysphagia
98
acute bacterial parotitis and stensen's duct
pus can be expressed, it should be cultured and gram stained
| -gland can suppurate and abscess may be present
99
treatment for acute bacterial parotitis
hydration, antibiotics directly against staphlococci + mouth flora
100
stone forms in stensen duct of acute bacterial parotitis
person is dehydrated, difficulty forign saliva, taking meds
101
give lemon drops to patients with acute bacterial parotitis
to stimulate salivary production
102
acute bacterial parotitis usually caused by
staph!
103
true submental + submandibular abscesses
usually after an infected submandibular lymph node or salivary gland suppurates
104
true submental + submandibular abscesses fluctuation is easy becasue
no overylying musculature and fascia is not dense
105
submental abcesses usually ressult from
spread of an apical abscess of the lower incisors through the thin buccolabial acrolar plate and below the myelohyoid diaphragm or from suppuration of a submental lymph node
106
true submental + submandibular abscesses
elevation of floor of mouth may be seen but swelling of ludwig's angina is NOT PRESENT
107
true submental + submandibular abscesses infection can be so bad that it destroys the
lymph node or salivary gland leading to an abscess
108
parapharyngeal
lateral pharyngeal= pharygomaxillary space
109
parapharyngeal space
upper neck, above the hyoid; inverted cone with base bounded by the skull and apex toward the hyoid bone
110
parapharyngeal space close to the
carotid sheath
111
6 lymph nodes
form a collar around the junction of head and neck; rest are chains
112
6 lymph node groups
```
occipital
mastoid
parotid
facial
submandibular
submental
```
113
node chains
lateral and anterior cervical nodes
114
common root for drainage of nodes
lateral cervical chain
115
final conduit form from all lymphatics in the head and neck
large deep carotid sheath chain
116
before antibiotics, half of all head and neck infections were from
infection in tonsils or pharynx
117
what usually arises as a complication of peritonsillar abscess but infections of the parotid gland, dental roots, petrous pyramid, or after dental or pharyngeal surgery may extend into this space
parapharyngeal abscess
118
triad of pharyngeal abscess
tonsillar prolapse with swelling of lateral pharyngeal wall, trismus, and parotid swelling
119
abscess in parapharyngeal space
extension of abscess into the carotid sheath is frequent
120
**erosion of the internal carotid artery leads to s
strokes, fatal hemorrhage, thrombophlebitis of the internal jugular vein with intracranial extension
121
inferior extension to the pyriform sinus during parapharyngeal space abscess leads
obstruction of upper airway
122
extension from the retropharyngeal space or carotid sheath during parapharyngeal space abscess leads to
mediastinitis
123
septic thrombosis
blood flow through carotid only on one side so one side of the brain has no blood flow
124
pterygopalatine fossa
maxillary nerve + branches, sphenopalatine ganglion, internal maxillary artery and branches
125
infections of maxillary and spenoid sinuses can involve
abducens nerve, inferior branch of the oculomotor nerve, and maxillary nerves
126
where do infections after a extraction of a maxillary molar tooth or after local anesthesia of the superior alveolar nerve cause infections?
pterygopalatine, infratemporal, and temporal fossa infections
127
fulminant cellulitis
involves upper molar gingiva, pterygopalatine, infratemporal, and temporal fossa, and then abscess formation in these spaces ensues
128
proptosis of the ye bc pus in inferior orbit requires (pterygopalatine abscess)
surgical drainage
129
what is the most important communication between the neck and the chest
retropharyngeal space
130
retropharyngeal space
runs longitudinally from the base of the skull to the posterior mediastinum-between the prevertebral fascia posteriorly and the posterior aspect of the pretracheal fascia anteriorly
131
what does the retropharyngeal space communicate with?
parapharyngeal space laterally, where it is bounded by carotid sheaths
132
retropharyngeal abscess
results from lymphatic spread of infection in the pharynx or sinuses to the retropharyngeal lymph nodes . The nodes suppurate, leading to abscess
133
retropharyngeal lymph node abcesses are common in
children age 3 or 4 bc that's when these lymph nodes involute
134
in older children or adults, abscess can occur after
accidental perforatoin such as with a fish bone or lollipop stick
135
retropharyngeal abscesses are polymicrobial
with anaerobes, streptococci, and staphylococcci predominating
136
retropharyngeal abscess symptoms
- chillls and fever after pharyngitis
- dysphagia
- neck pain
- dypnea
- regurgitation
137
children with retropharyngeal abscess may have
insidious onset with irritablility + refusal to eat
138
neck during retropharyngeal abscess
hyperextended with local tenderness
139
retropharyngeal symptoms
muffled voice (Dysphonia) + drooling followed by tachypnea + stridor
140
what is the most important tool for diagnosis of retropharyngeal abscess
lateral neck radiograph
141
what are treatments of retropharyngeal abscess
drainage and high dose penicillin or clindamycin
142
thickened pre-vertebral fascial space
extra space between arrow and vertebral column- entire airway is pushed forward
143
rupture of the abscess can lead to
aspiration of the pus into the lungs, and pneumonia and empyemia
144
an abscess in the danger space between the alar and the prevertebral fascias may drain into the mediastinum , resulting in
mediastinitis
145
hemorrhage suggest
involvement of the major blood vessels, and phlebitis or thrombosis of the internal jugular vein
146
lung abscesses
aspiration of oral contents, anaerobic flora predominates, alcoholics, people who have been in the hospital, little gastric acid may have different flora
147
lung abscesses
staphlococcus aureus, gram negative enterics often colonize the mouth and upper intestinal tract in those who belong to the latter group. thus, anaerobes, and at times S. aureus and gram negatives, are found in lung, again polymicrobial
148
lung abscesses description
- inoculum size must be big enough
- acid may induce a chemical pneumonitis
- occlusion of the airway by food or foreign objects renders the area anaerobic
- synergism of diff bacteria
- nutritional state and integrity of the host defenses are important
- aspiration pneumonia now very common
149
initially, lung abscesses begin with
a necrotizing pneumonia, often after aspiration
150
lung abscesses- microabscesses
form and coalesce
151
2 weeks after aspiration
lung abscess is seen
152
location of lung abscesses depends on the dependent region
lower lobes more comon than upper
=people who have gotten drunk and passed out upside down before aspiration or inhalation of vomitus may be in upper lobes
153
lung abscess drains into
bronchiole, causing foul sputum and foul oral odors
154
if air gets into lung abscess cavity
then an air-fluid lvel may be seen on chest radiograph
155
if a lung abscess drains into the pleura,
an empyema may form
156
lung abscess tx
drain, long course of antibiotics-can be oral after iv
157
bubbles in radiographs are probably
abscesses
158
therapy of abscesses
- activity against anaerobes or aerobes
- bacteroides make beta lactamase limiting penicillin, therefore broad spectrium penicillins (beta lactam) + beta lactamase inhibitor are useful like ampicillin/sulbactam
159
what is also used as therapy for abscesses
metronidazole, clindamycin btu bacteroides are becoming resistant to clinda
160
clindamycin fights
strep, staph, anaerobes
161
1st main cause of sore throat
strep
162
2nd main cause of sore throat
gonorrhea
