An abscess is a localized collection of pus caused by various factors, including infections, trauma, and iatrogenic causes. Symptoms include fever, pain, and signs of inflammation, while complications can lead to severe health issues like organ dysfunction and bacteremia. Diagnosis involves laboratory tests and imaging studies, with treatment options ranging from drainage and antibiotics to conservative management.

1. ABSCESS
Dr. Murshida Jabin
Surgery Intern

2. INTRODUCTION
● Abscess is a localised collection of pus.
● Pus composed of
➢ Tissue debris
➢ Dead and alive leukocytes
➢ Dead and alive bacteria.

3. ETIOLOGY
1. Idiopathic
2. Congenital/Genetic
3. Traumatic
4. Infections/Infestation
5. Autoimmune
6. Neoplastic (Benign/Malignant)
7. Degenerative
8. Iatrogenic

4. ETIOLOGY: PREDISPOSING FACTORS
• Impaired host defense mechanisms eg: HIV
• The presence of foreign bodies
• Obstruction to normal drainage (urinary, biliary, or resp tract)
• Tissue ischemia or necrosis
• Hematoma or excessive fluid accumulation in tissue
• Trauma
• Numerous organisms can cause abscesses,(MC: Staph aureus)

5. PATHOPHYSIOLOGY
• Abscesses may begin in an area of cellulitis or in
compromised tissue where leukocytes accumulate.
• Progressive dissection by pus or necrosis of surrounding
cells expands the abscess.
• Highly vascularized connective tissue may then surround
the necrotic tissue, leukocytes, and debris to wall off the
abscess and limit further spread.

6. • Organisms may enter the tissue by-
– Direct implantation eg:IM injection.
– Spread from an established, contiguous infection
– Dissemination via lymphatic or hematogenous routes
from a distant site
– Migration from a location where there are resident flora
into an adjacent, normally sterile area because natural
barriers are disrupted (eg, by perforation of an abdominal
viscus causing an intra-abdominal abscess)

7. CLINICAL FEATURES
Symptoms
• Fever with spikes and chills.
• Local pain and tenderness
• Anorexia
• Weight loss
• Fatigue

8. Signs
• Signs of cutaneous and subcutaneous abscesses are pain,
heat, swelling, tenderness, and redness.
• If superficial abscesses are ready to spontaneously
rupture, the skin over the center of the abscess may thin,
sometimes appearing white or yellow because of the
underlying pus (termed pointing).
• The predominant manifestation of some abscesses is
abnormal organ function (eg, hemiplegia due to a brain
abscess).

10. COMPLICATIONS
• Bacteremic spread
• Rupture into adjacent tissue
• Bleeding from vessels eroded by inflammation
• Impaired function of a vital organ
• Inanition due to anorexia and increased metabolic needs
• Antibioma
• Sterile abscess
• Chronic draining sinuses

11. INVESTIGATIONS
• Laboratory Studies
– Routine- leukocytosis, raised CRP
– Special – Blood culture
• Imaging Studies
• Tissue diagnosis
– Cytology
• FNAC
– Histology

12. IMAGING STUDIES
• X-Ray
• USG
• CT
• Angiography
• MRI
• Endoscopy
• Nuclear scan- radiolabeled leukocytes.

13. OPERATIVE THERAPY
• Drainage- Deroofing.
• Antibiotics when abscesses are large, deep, or
surrounded by significant cellulitis.
• Aspiration.
• Conservative – Amoebic Liver abscess.

14. INCISION AND DRAINAGE

15. ASPIRATION

16. SOME COMMON ABSCESS
• Brain Abscess
• Gluteal Injection abscess.
• Breast Abscess
• Lung abscess
• Liver Abscess
• Subphrenic Abscess
• Pelvic abscess.
• Psoas abscess.

17. THANK YOU