SURGICAL DISEASES, TRAUMATOLOGY, ORTHOPEDICS, UROLOGY : ABSCESS, ABSCESS (АВSCESSUS) - etiology, pathogenesis, symptoms and course of, recognition, prediction and prevention
Etiology. An abscess formed in the tissues under the influence penetrated into them pyogenic bacteria, mainly Staphylococcus, Streptococcus, less E. coli and other microbes, as well as after the introduction into the tissues of some chemical substances (gasoline, turpentine).
The pathogenesis. The infection penetrates into the tissues through a small damage and cracks in the skin or mucous membrane, when the transfer of bacteria from the flow of lymph and blood, or when the transfer of infection from neighboring tissues. Local disorders of blood circulation, bruises, mechanical damage, breach of tissue trophism, favor the development of the inflammatory process. Degenerative changes in the nidus accompanied by purulent fusion of tissues, due to proteolysis of tissue under the influence of the selection of enzymes from disintegrating cells.
Symptoms. The formation of abscess accompanied obligationii phenomena. The intensity of their different depending on the nature of infection, size of ulcer, the individual reaction of an organism to infection. Characterized by large fluctuations in temperature, especially in 5 - 7 days after the start of the process. Usually the abscess is accompanied by headaches, General fatigue, lack of appetite. Leukocytosis up to 15 000 - 20 000, left shift: acceleration ROHE. When superficial ulcers, in addition to the General febrile phenomena, say more swelling, pain in a limited area, the local temperature rise, intense redness of the skin, without sharp borders turning into normal skin color, the feeling infiltrate palpation. The most characteristic symptom of the superficial location of the abscess is fluctuation. Determining fluctuations in the deep location of the abscess complicated (deep fluctuation), and sometimes impossible. The skin over the abscess infiltered, thin, acquires barbesino color.
For. With the development of pyogenic membrane decreases the absorption and subside the symptoms of intoxication (temperature decreases, slows heart rate, there is an appetite and reduce pain. At the break of the abscess through the skin draining pus is often insufficient, remains a long-term healing of the fistula. Deep ulcers spread through the interstitial spaces in the tissue and can be opened in the cavity (peritoneum, pleura, joints) or organs (bladder, colon, bronchus). After emptying the abscess temperature decreases, the inflammatory symptoms subside.
Complications. The infection from the abscess can spread through the lymphatic (lymphangitis, lymphadenitis) or blood tracks (phlebitis) and go into a General purulent infection (sepsis).
You must differentsirovat from notecnica tuberculosis of bones and joints, and lymph glands (cold abscess), pulsating hematoma or false aneurysm, tumor breakdown. It should be remembered that in malnourished, debilitated patients the formation of the abscess may not be accompanied by significant temperature rise and local pain. In case of uncertain diagnosis sometimes helps to recognize the trial biopsy: needle in the puncture should not pass through the free serous cavity (peritoneum, pleura).
The prediction is usually good.
Peace and moist heat in the form of hot compresses, poultices or use dry heat (heating pad, lamp, Solux). When the collection of pus or violent and acute process, compression and dysfunction of adjacent organs at risk breakthrough in the cavity and organs, with severe intoxication (chills, sweats, jaundice, anemicare, protein in the urine, a significant change painting the white blood cells) requires urgent surgical treatment. With the threat of General purulent infection at the same time penicillinate, sulfanilamide, the introduction of large amounts of fluids (drip infusion), transfusion of blood. After opening the abscess is treated according to the General principles of treatment of purulent processes: ensuring outflow, the rest of the patient body, dressing with antiseptic or hypertonic solution, and further ointment dressings as weak stimuli, improves trophic tissues. When the delimitation of abscess pyogenic membrane and availability of abscess can be applied and repeated puncture with aspiration of pus and subsequent introduction into the cavity of penicillin.