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Pyogenic abscess by Dr.K.AmrithaAnilkumar
This document discusses pyogenic abscesses, which are localized collections of pus caused by bacterial infection. It defines pyogenic abscesses and describes their causes, signs and symptoms, common sites, investigations, complications, differential diagnosis, and treatment, which involves incision and drainage after antibiotics. Common causative organisms are Staphylococcus aureus and Streptococcus pyogenes. Investigations may include blood tests and imaging like ultrasound or chest X-ray. Complications can include sepsis if not treated properly. Treatment is incision and drainage of the abscess after it has formed, along with antibiotics.
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Pyogenic abscess by Dr.K.AmrithaAnilkumar
- 1. en love daHomoeopathy PYOGENIC ABSCESS
- 2.
- 3. ABSCESS DEFINITION • An Abscessisa circumscribedarea of inflammationor an abnormal cavity that cntains pus if matured TYPES • Pyogenicabscess • Pyaemic Abscess • Metastatic abscess • Cold abscessdue to chronic infectionlike tuberculosis PYOGENICABSCESS DEFINITION • It is localized collection of pus in a cavity lined by granulationtissue, covered by pyogenic membrane • It contains pus in loculi
- 4. CAUSES Modeof infection • Direct •Haematogenous • Lymphatics • Extension fromadjacent tissues CAUSATIVEORGANISM • Staphylococcus aureus • Strepococcus pyogens • Gramnegative Bacteria • E.Coli, • Pseudomonas, • Klebsiella • Anaerobes
- 5. PATHOLOGY Pus ↓ contains dead WBC’s multiplyingbacteria, toxins & necrotic material ↓ Proteinexudationoccurs ↓ It causes fibrindeposition ↓ &formation of pyogenic membrane ↓ Macrophages &Polymorphs release lysosomal enzymes ↓ whichcauseliquefaction of tissues ↓ leads to pus formation ↓ Toxins & enzymes released causes tissue destruction & pus formation
- 6. PRECIPITATINGFACTORS • General conditionof the patient • Nutrition • Anaemia • Age of the patient • Associateddiseases • Diabetes • HIV • Immunosup pression • Types & Virulence of the organisms • Trauma • Hematoma • Road TrafficAccidents CLINICALFACTORS • Fever oftenchills & Rigors • Localized Swelling whichis smooth, soft, & fluctuant • Viable (pointing) pus • Throbbing pain • pointing Tenderness • Brawny induration around
- 7. • Redness &warmthwith restrictedmovement arounda joint • Rubor (redness) • dolar ( pain) • calor(warmness) • Tumor (swelling) and functionlesa(lossof localized&adjacent tissue/ jointFunction) are quiet obvious • Commonly cellulitis occurs first which eventually gets localized to forman abscess
- 8. COMMONSITES Site of abscess Externalsites • Fingers & hand • Thigh– here it is deeply situatedwithbrawny induration • Ischiorectal & perianal region • Abdominal wall • Dental abscess • Tonsillar abscess • Other abscessin the oral cavity Dental abscess Bilateral tonsillar abscess
- 9. Internal sites • Internalabscess • Abdominal • Sub-phrenic • Pelvic • Paracolic • AmoebicLiver Abscess • Pyogenicabscess of liver • Splenic abscess • PancreaticAbscess • PerinephricAbscess • Retroperitoneal Abscess • Lung Abscess • BrainAbscess • Retropharyngeal Abscess LUNG ABSCESS
- 10. INVESTIGATIONS • Total countisincreased • Urine • Sugar • Blood sugar is done to rule out diabetes • USGof the part or abdomen/other regionis donewhen Required • Chest X-ray in case of lung abscess • Galliumisotope scanis very useful LUNG ABSCESS
- 11. COMPLICATION • Bacteriaemia • Septicaemia •Pyaemia • Multiple abscess formation • Metastatic Abscess • Destruction of tissues • Once abscessforms ,Thickfibrous tissue develops aroundabscess cavity because of antibiotics • Cavitycontains sterile pus as Thick Plaques • It is non – tender, localizedsmooth, hard swelling which may mimiccarcinoma
- 12. • Large abscessmay erode into adjacent vessels & cause life –threatening torrential haemorrhage • Eg., as in pancreatic abscess • Brainabscess – intracranial hypertension, epilepsy, neurological deficit • Liver Abscess- cause hepaticfailure, rupture jaundice • Lung Abscess – Bronchopleural fistula or septicemia, or respiratory failureor AIDS
- 13. DIFFERENTIAL DIAGNOSIS • Aneurysm •especiallyin poplitelal • Femoral • & axillaryregions • Thrombosedaneurysm may be warm, soft & tender • Soft issues tumors : sarcomasmay be smooth,soft, & warme • Haematoma • Cold Abscess
- 14. TREATMENT • Abscessshould beformed before draining , • except ParotidAbscess • Breast Abscess • Axillary Abscess • ThighAbscess • Ischiorectal Abscess • Initially broad spectrum antibiotics are started (depending uponseverity, extent & site of the abscess) Hilton’s method of draining an abscess Under general anaesthesia or regional blockanaesthesia ↓ after cleaning & draping ↓ Abscessis aspiratedand presence of pus is confirmed ↓ Skin is incisedadequately, in the line parallel to neurovascular bundle in the most dependent position
- 15. ↓ Next pyogenicmembrane is openedusingsinus Forceps & all loculi are broken up ↓ Abscesscavity is cleared of pus & washed withsaline ↓ A drain( either gauze drain or corrugatedrubber drain) is placed ↓ Wound is not closed. woundis allowed to granulate & heal ↓ Pus is sent for culture & sensitivity ↓ Biopsy should be donein case of suspectedmalignancy ↓ Sometimes secondary suturing or skingrafting is required ↓ Treating the cause is important
- 16. INCISION & DRAINAGE OF PUSFROM ABSCESS
- 17. REFERENCE 1. SRB's Manualof Surgery by SriramBhat M 2. A Manual on Clinical Surgeryby Das 3. A Concise textbookof Surgeryby Das
- 18. A Special Thanks To AVery Special Doctor