Abscess

Abscess (syn.: abscess, abscess) - accumulation of pus in various organs, tissues. Abscesses usually can be localized in different parts of the body: the liver, kidneys, lungs, skin, brain, etc.

Should clearly distinguish between an abscess, empyema (pus collects in the hollow organs or body cavities) and phlegmon (purulent inflammation of the tissues). Pyogenic abscess is characterized by the presence of the membrane, producing exudate and delimited necrotic process. Typically, the agent of purulent process is staphylococcus. Quite often, it acts in association with other microbes (Escherichia coli, Proteus, Streptococcus, etc.). 

Typically, pathogen infection penetrates from the outside (exogenous) infection, although possible and endogenous infection due to introduction of pathogens from adjacent or distant organs (odontogenic and peritonsillar abscess). In some cases there is the development of so-called aseptic abscesses, if the zone of necrosis did not take root infections. The emergence of an abscess can contribute an introduction to the fabric of concentrated solutions of drugs - magnesium sulfate, kordiamin etc.

Distinguish between acute and chronic abscesses. When superficial acute abscesses local manifestations are characterized by classic signs of inflammation: redness, swelling, pain, local increases in temperature, dysfunction, palpation can reveal an abscess fluctuation (fluctuation). Common manifestations of an abscess do not have specific signs and typical chronic inflammatory processes of any location. They boil down to an increase in body temperature from subfebrile digits to 41 ° C in severe cases, general malaise, weakness, loss of appetite, headache. In the blood, marked leukocytosis up to 20,000 or more leukocyte counts with a shift to the left, increasing the ESR. In chronic abscesses general and local symptoms are a little pronounced.

In recognition of the abscess is very important diagnostic puncture. Getting pus at puncture site, in addition to the diagnosis in doubtful cases, allows for bacteriological examination (abjection and determination of its sensitivity to antibiotics).

Surgical treatment - autopsy an abscess, evacuation and drainage of its cavity. Autopsy superficial abscess is performed under local infiltration anesthesia, 0.25 or 0.5% solution of novocaine or under short intravenous anesthesia (sombrevinom, epontolom, sodium thiopental). Aether chloratus anesthesia, as a rule do not apply. To reduce the infection the operative field carefully isolated with gauze wipes skin area where you want to open the abscess. First, puncture the abscess, followed by a needle cut through the tissue. Make a small hole in the wall of an abscess, the pus is removed, and then extend the incision, the remainder of pus and necrotic tissue are removed. Abscess cavity was washed with antiseptic solution and drained through a polyethylene tube or rubber graduate. With insufficient emptying abscess cavity through the main incision is made counteropening.

Treatment after opening the abscess is conducted on the principle of treatment of purulent wounds. Once the wound was cleansed from pus, necrotic tissue and granulation will be transferred to the application of rare exchangeable ointment dressings.

Local application of antibiotics in the postoperative treatment of an abscess is impractical because the presence of necrotic tissue and pus in the wound significantly reduces their effectiveness. Good results after the opening of the abscess allows the local use of proteolytic enzymes, which creates favorable conditions for the imposition of early secondary sutures in granulating wounds.

In the treatment of an abscess in the surgical hospital of his excised within healthy tissue and put the primary suture; content wounds actively aspirates, to achieve healing by primary intention.

General treatment of patients with large abscesses, especially of internal organs, including restorative therapy, transfusion of blood, plasma, etc., the use of antibiotics in the light sensitivity to them of the microbial flora, the use of stimulating the immune system.

Prevention is in compliance with the rules of asepsis, antisepsis and technique of therapeutic and diagnostic procedures, as well as timely and rational surgical treatment of abrasions, scratches, wounds, etc.