An abscess is a localized collection of pus within tissues, organs, or confined spaces in the body, caused by infection and subsequent tissue destruction.
Pathophysiology:
Bacteria invade → tissue necrosis → neutrophil accumulation → liquefaction necrosis → pus formation.
Surrounded by a pyogenic membrane that walls off the infection.
Common Sites:
Skin & subcutaneous tissue, breast, perianal region, liver, lung, brain, kidney.
🔎 Clinical Features
Local signs (classic features of inflammation):
Redness, warmth, swelling, tenderness, fluctuation (pus inside).
Pointing abscess → thinned, shiny skin, may rupture.Systemic signs:
Fever, malaise, leukocytosis.
Toxic features if deep-seated or spreading infection.
⚕️ Diagnosis
Clinical examination (fluctuation test, pointing).
Ultrasound → helpful for deep or doubtful abscesses.
CT/MRI → for internal organ abscesses.
💊 Management
1. General Principles:
“Ubi pus, ibi evacua” → Where there is pus, evacuate it.
Incision & drainage (I&D) is the gold standard.
2. Treatment steps:
Local anesthesia or general anesthesia depending on size/location.
Adequate incision over the most fluctuant/pointing area.
Break loculi with finger/forceps.
Drain pus completely, send sample for culture & sensitivity.
Irrigation with saline, sometimes antiseptic solution.
Insert corrugated/rubber drain or pack cavity if large.
3. Antibiotics:
Adjunct only, not definitive.
Indicated for cellulitis, systemic toxicity, immunocompromised patients, or deep organ abscesses.
4. Supportive care:
Analgesics, antipyretics, hydration, glycemic control in diabetics.
⚠️ Complications
Local spread → cellulitis, necrotizing fasciitis.
Septicemia.
Chronic abscess/sinus formation.
Scarring after healing.
