Abscess

Question 1

What is the usual result of acute inflammation?

Answer 1

It usually resolves entirely

Question 2

What happens if there is excess exudate in acute inflammation?

Answer 2

this leads to suppuration

this is the process of pus formation, leading to abscess formation

Question 3

What is the definition of an abscess?

Answer 3

a collection of pus that is a complication of acute inflammation

Question 4

Why does acute inflammation happen?

What usually causes it?

Answer 4

it is the initial tissue reaction to injury

it is caused by physical, chemical, infectious methods

it can also be immune mediated

Question 5

What are the 5 signs of acute inflammation?

Answer 5

1. redness (rubor)
2. heat (calor)
3. swelling (tumor)
4. pain (dolor)
5. loss of function

Question 6

What are the 3 stages associated with acute inflammation?

Answer 6

1. vascular changes
2. extravasation of white blood cells
3. phagocytosis

Question 7

What is involved in the vascular changes of acute inflammation?

Answer 7

There is initial vasoconstriction

This is followed by dilation and increased vascular permeability

Question 8

What is involved in extravasation of white blood cells?

Answer 8

It is an organised sequential process of:

1. margination
2. adhesion
3. transmigration
4. chemotaxis

Question 9

What is involved in phagocytosis?

Answer 9

Removing the substance that is causing damage in the first place, as well as damaged tissue

Question 10

What happens after the vessels have undergone vasodilation?

Answer 10

Serum, proteins and cells pass from inside to outside the vessel

The fluid that leaves the blood vessel is an exudate

Question 11

What is margination?

Answer 11

the adhesion of white blood cells to the walls of damaged blood vessels

Question 12

What is transmigration?

Answer 12

the passage of blood cells through blood vessel walls

Question 13

What is chemotaxis?

Answer 13

movement of a cell in response to a gradient of increasing or decreasing concentration of a particular substance

Question 14

What are the three stages in phagocytosis?

Answer 14

1. opsonisation of particles by IgG or C3
2. engulfment by macrophages
3. killing

Question 15

How do phagocytes kill invading pathogens?

Answer 15

1. reactive oxygen species

2. myeloperoxidase (makes HOCl)

Question 16

What causes redness (rubor)?

Answer 16

vasodilation

this increases blood flow to the area

Question 17

What causes heat (calor)?

Answer 17

hyperaemia - increased blood flow going through the tissue

cytokines also increase the temperature

Question 18

What causes swelling (tumor)?

Answer 18

Localised oedema

The exudate also has a mechanical effect to swell

Question 19

What causes pain (dolor)?

Answer 19

Local cytokines (bradykinin, serotonin, prostaglandins)

Physical pressure of the exudate pushing against nerves

Question 20

What causes loss of function?

Answer 20

Pain and swelling

The pain then stops the patient from wanting to do things

Question 21

What is suppuration?

Answer 21

the formation of pus

Question 22

What is contained within pus?

Answer 22

1. living and dead neutrophils
2. cell & tissue debris
3. bacteria

Question 23

What type of bacteria usually cause suppuration?

What colour is pus?

Answer 23

Pyogenic bacteria

It is yellow-green in colour

Question 24

What does suppuration form?

Answer 24

An abscess

This is a collection of pus in the body

Question 25

Where may an abscess form?

Answer 25

in an organ, soft tissue (such as fat) and skin

Question 26

What antibiotics can be used to treat abscesses?

Answer 26

Abscesses are not accessible to antibiotics

Question 27

What happens if an abscess is untreated?

Answer 27

it can cause an uncontrolled infection around the body this is septicaemia

Question 28

If there is pain in the right iliac fossa, what does this indicate?

Answer 28

there is inflammation/swelling in the appendix

Question 29

What is empyema?

Answer 29

a condition where pockets of pus collect inside a body cavity most commonly in the pleural space

Question 30

What usually causes empyema?

Answer 30

1. complication of surgery 2. spontaneous 3. can result from pneumonia, where fluid moves between the lung and chest wall

Question 31

What would empyema look like on an X-ray?

Answer 31

Lung is expanded on the normal side Lung is collapsed and pushed forwards on the infected side

Question 32

What is the technique used to treat an abscess?

Answer 32

incision and drainage

Question 33

Why is general anaesthetic used when treating an abscess?

Answer 33

local anaesthetic doesn't work as well around the abscess

Question 34

What is necrotising fasciitis?

Answer 34

an infection that results in death of parts of the body's soft tissue

Question 35

What is the danger of necrotising fasciitis?

Answer 35

it is a very serious infection that needs to be treated immediately

Question 36

What are the aims of treating an abscess?

Answer 36

1. to remove all the infected material | 2. to encourage healing

Question 37

Why can an abscess not be treated with medical therapy?

Answer 37

the pus needs to be drained out of the abscess

Question 38

What is involved in microbiological investigation of abscess?

Answer 38

1. send a sample to the microbiology lab - this can be a swab, pus or tissue 2. send in a sterile jar 3. put tissue in saline to stop it drying out

Question 39

What should abscess tissue not be put in?

Answer 39

Formalin This kills the organisms

Question 40

What is done to the sample once it reaches the microbiology lab?

Answer 40

1. spread the material on agar | 2. incubate at 37 degrees to culture the bacteria

Question 41

How can the microorganism be identified?

Answer 41

From the growth pattern on the agar gel

Question 42

What is the culture and sensitivity test?

Answer 42

From the suppression of growth around an antibiotic disc, you can work out what antibiotics the organism is sensitive and resistant to

Question 43

What is granulation tissue?

Answer 43

new connective tissue and microscopic blood vessels that form on the surface of wound during the healing process

Question 44

What is contained within granulation tissue?

Answer 44

Capillaries, oedema, white cells and fibroblasts

Question 45

What are the benefits of scar formation?

Answer 45

it prevents infection it protects against mechanical trauma

Question 46

What is the drawback of scar formation?

Answer 46

it stops regeneration, which can lead to a permanent scar