Abscess

Question 1

A young patient has pain, tenderness, redness and all features of a thigh abscess.

Q1. Define abscess.

Answer 1

An abscess is a localised tissue collection of pus. If pus forms in the pleural space or peritoneum it may be loculated and so considered to be an abscess (such as an appendix abscess or subdiaphragmatic abscess) or lie free and be an empyema or purulent generalised peritonitis.

Question 2

Q. Define Pus

Answer 2

Pus is the product of acute inflammation composed of cellular and fluid, exudative phases. When the cause of pus formation is infective, the solid phase consists of:
· Live and dead polymorphs
· Live and dead macrophages
· Live and dead bacteria or other causative agent
· Dead human epithelial and connective tissue cells from the tissues involved in the acute inflammation
· A fibrin meshwork on which macrophages function much better

Question 3

Q2. How does it differ from cellulitis?

Answer 3

Cellulitits; Diffuse and not well demarcated, no presence of pus
By strept which produce fibrinolysin
..
Abcess; localized, there’s pus
cuased by staph which produce ciagulase with central necrosis

Question 4

Q3. What are the constituents of pus?

Answer 4

Solid; live and dead bacteria and neutrophils and fibrin mesh
Liquid; cytokines, chemotacticans, exudatives

Question 5

Q4. How do you know which organism is the cause without any test?

Answer 5

From the color
green; pseudomonus
Silver; actinomycosis

Question 6

Q5: What are the causes of abscess?

Answer 6

Infection by bacteria / virus / fungi

Question 7

Q6. What are the causes of non-bacterial abscess?

Answer 7

Virus/ Fungi / Parasitic

Question 8

Q7. How do you treat abscess?

Answer 8

I&D
Abx coverage

Question 9

Q8. What’s the rationale of giving antibiotic in abscess?

Answer 9

Several recent trials have indicated benefits of abx therapy in abcess
Abx
–decrease the liklyhood of ttt failure and
–improve the outcome

–decrease recurrence and
–mild adverse events
Timing; After obtaining culture.

Question 10

Q9. Which stain is used to identify the causative organism?

Answer 10

Gram stain

Question 11

Q10. How does abscess cause fever?

Answer 11

Inflammatory reaction
TNF and IL-1 / IL-6 which are pyrectics

Question 12

Q. when to give Abx in abcess?

Answer 12

1- syst. Signs of toxicity like fever
2- Rapid progression of erythema or abcess
3- Extensive abcess
4- immunocompromised and old age