Abscess

Question 1

Define abscess.

Answer 1

Collection of pus that has built up within a tissue, organ or confined space walled off by fibrosis

Question 2

What is the aetiology of an abscess?

Answer 2

Usually caused by bacterial infection - staphylococcus aureus

Rarely parasites, foreign substances

Question 3

Where can abscesses be located?

Answer 3

External:

• skin surface - cutaneous or subcutaneous
  
  • Usually caused by staph aureus

Internal:

• Lungs
• brain
• teeth
• kidneys
• tonsils
• perianal abscess - common in IBD and diabetes
• incisional abscess

Question 4

What are the signs and symptoms of an external abscess?

Answer 4

• erythema
• hot
• oedema
• pain
• loss of function

Question 5

What are the signs and symptoms of an internal abscess?

Answer 5

• systemically unwell
• pain
• fever

Question 6

What investigations would you do for an abscess?

Answer 6

Usually clinically diagnosed

• History, examination, observations
• Ultrasound can aid diagnosis

Question 7

How do you manage an abscess?

Answer 7

Uncomplicated skin or soft tissue abscesses do not require antiboitics

• Aspiration
• Incision and drainage

Severe abscess, multiple sites of infection, rapid disease progression, cellulitis, sepsis:

• antibiotics - ampicillin(anaerobic) and ciprofloxacin(gram -ve coverage)
• incision and drainage
• excision in severe cases

Question 8

What are the complications of an abscess?

Answer 8

• rupture
• multiple sites of infection
• rapid disease progression
• cellulitis
• sepsis (internal)

Question 9

What organisms usually cause subphrenic abscesses? What symptoms can occur?

Answer 9

Anaerobes or gram -ve bacteria

Pain can be referred to the (right) shoulder