ABSCESS

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

It is necessary to clearly distinguish between an abscess, empyema (pus collects in the hollow organs or body cavities) and phlegmon (purulent inflammation of tissue). An abscess is characterized by the presence of pyogenic membrane, producing delimiting exudate and necrotic process. As a rule, the causative agent of purulent process is staphylococcus. Quite often it operates in association with other microbes (Escherichia coli, Proteus, Streptococcus, and others.). Typically, an infectious agent penetrates from the outside (exogenous infection), although possible and endogenous infection by pathogens importation from neighboring or distant organs (odontogenic and peritonsillar abscesses). In some cases, seen the development of so-called aseptic abscesses, if in the zone of necrosis is not introduced infectious agents. Occurrence abscess may facilitate the introduction into the tissues of concentrated solutions of drugs - magnesium sulfate kordiamina et al.

There are acute and chronic abscesses. When superficial acute abscess local manifestations characterized by the classic signs of inflammation: redness, swelling, pain, local temperature rise dysfunction; palpation of the abscess can be detected fluctuation (fluctuation). Common symptoms of an abscess are not specific signs and typical of inflammatory processes of any localization. They boil down to an increase in body temperature of subfebrile to 41 ° C, in severe cases, general malaise, weakness, loss of appetite, headache. In the blood marked leukocytosis of up to 20 000 and more with a shift leukocyte formula to the left, increasing the ESR. In chronic abscesses general and local symptoms expressed little.

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

Treatment operative - opening an abscess, draining and drainage 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). Anesthesia chloroethyl, as a rule, do not apply. To reduce the infection of the surgical field carefully isolate the gauze patch of skin, where it is supposed to reveal the abscess. First punctured abscess, then the needle dissect tissue. Make a small hole in the wall of the abscess, the pus is removed, and then expand the incision, the remaining pus and necrotic tissue is removed. Abscess cavity is washed with an antiseptic solution and drained via plastic or rubber tube graduate. At insufficiency of emptying the 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 is cleansed of pus, necrotic tissue granulation and will be transferred to the use of rare exchangeable ointment dressings.

Topical application of antibiotics in the treatment of postoperative abscess impractical, since the presence of necrotic tissue and pus in the wound significantly reduces their effectiveness. Good results after opening the abscess enables topical application of proteolytic enzymes, which creates favorable conditions for the imposition of early secondary sutures on the wound granulation.

In the treatment of an abscess in a surgical hospital he dissected within healthy tissue and put the primary seal; the contents of the wound actively aspirated, which allows for healing by first intention.

General treatment of patients with major abscesses, especially visceral includes strengthening therapy, transfusions of blood products, plasma, etc., The use of antibiotics in view of the sensitivity of the microbial flora thereto, the use of stimulating the immune system.

Prevention is in compliance with the rules of asepsis, antisepsis and technology performance of therapeutic and diagnostic procedures, as well as in a timely and efficient surgical treatment of abrasions, scratches, wounds, and so on. D.