Abscess

Baghdad University Surg Depart

Surgery
Hameed Ali Al-Timmemi MSc, PhD
Abscess

Baghdad University Surg Depart

Surgery
Dr H, Al-Timmemmi
Synonyms: abscess, abscesses, boils, carbuncles, furuncles, hidradenitis suppurativa, pilonidal abscess, pustules, whiteheads An abscess (Latin: abscessus) is a collection of pus accumulated within a tissue because of an inflammatory process in response to Infectious process foreign materials . It is a defensive reaction of the tissue to prevent the spread of infectious materials to other parts of the body.

Baghdad University Surg Depart

Surgery
Dr H, Al-Timmemmi

Baghdad University Surg Depart

Surgery
Dr H, Al-Timmemmi
Signs and symptoms: Redness Heat Swelling Pain Loss of function


Baghdad University Surg Depart
Surgery
Dr H, Al-Timmemmi
Abscesses are caused by Obstruction of oil (sebaceous) glands or sweat glands, Inflammation of hair follicles, or Minor breaks and punctures of the skin. Germs get under the skin or into these glands, which causes an inflammatory response Systemic diseases

Baghdad University Surg Depart

Surgery
Dr H, Al-Timmemmi
Classification of abscess According to location: Superfacial (skin abscess) Deep or internal abscess (liver, kidney, spleen) According to the causes Primary abscess: direct infection with causative agent Secondary abscess: inflammation with certain systemic disease Ex. TB, Strangles, glanders

Baghdad University Surg Depart

Surgery
Dr H, Al-Timmemmi
According to the time or duration Acute or hot (painful, redness, swelling, hotness,loss of function). All the signs of acute inflammation subside or may Mature Abscess (soft) , immature abscess still firm

Baghdad University Surg Depart

Surgery
Dr H, Al-Timmemmi
Diagnosis: Clinical signs When the abscess is deeply situated or in an unusall location it is a good procedure to insert a hollow instrument into the swelling Palpation if mature appeared fluctuation of pus. For final diagnosis we can do exploratory puncture (Should be under aseptic technique open the abscess), or aspiration.


Baghdad University Surg Depart
Surgery
Dr H, Al-Timmemmi
If there is pus inside it that mean abscess If it is blood it mean hematoma If it is serum with blood it mean old affect If the aspirate is clear fluid it mean cyst(collection of serum inside membrane) If there is digestive contant it mean hernia

Baghdad University Surg Depart

Surgery
Dr H, Al-Timmemmi
Treatment Incision and drainage Primary closure Antibiotics

Baghdad University Surg Depart

Surgery
Dr H, Al-Timmemmi
The abscess before we opened into it.

Baghdad University Surg Depart

Surgery
Dr H, Al-Timmemmi

Baghdad University Surg Depart

Surgery
Dr H, Al-Timmemmi
Sinus

Baghdad University Surg Depart

Surgery
Dr H, Al-Timmemmi
It is a tract leading from a suppurating cavity to the surface and usually the source of a chronic purulent discharge and the tract line with epithelial cells which produce a continuous secretion. Causes Presence of a foreign body in the tissue Necrosis of bone or soft tissue Localized not destroyed chronic infection (Actinobacillosis).

Baghdad University Surg Depart

Surgery
Dr H, Al-Timmemmi
Treatment Determining the cause of the discharge if due to the presence of a FB must be removed and complete drainage established If it is due to a mass of chronic infected tissue , it should be removed When a tract is lined with epithelial cells they may be removed by dissection or counter irritant.

Baghdad University Surg Depart

Surgery
Fistula

Baghdad University Surg Depart

Surgery
Dr H, Al-Timmemmi
Is an abnormal connection or passageway between two epithelium-lined organs or vessels. It is generally a disease condition, but a fistula may be surgically created for therapeutic reasons Cause Trauma (ruminal fistula) Congenital fistula (teat fistula)

Baghdad University Surg Depart

Surgery
Dr H, Al-Timmemmi
Treatment Treatment for fistula varies depending on the cause and extent of the fistula, but often involves surgical intervention combined with antibiotic therapy. Typically the first step in treating a fistula is an examination to determine the extent and "path" that the fistula takes through the tissue.

Baghdad University Surg Depart

Surgery
Dr H, Al-Timmemmi
Various surgical procedures are commonly used, Most commonly fistulotomy, placement of a seton (a cord that is passed through the path of the fistula to keep it open for draining), or An endorectal flap procedure (where healthy tissue is pulled over the internal side of the fistula to keep feces or other material from reinfecting the channel). Treatment involves filling the fistula with fibrin glue; also plugging it with plugs made of porcine small intestine submucosa have also been explored in recent years, with variable success.