Abscess in Latin means "abscess". In medicine, this term is understood as a limited accumulation of purulent exudate in tissues and organs. Purulent inflammation can occur anywhere. Soft tissue abscess is a space filled with purulent exudate and located under the skin in fatty tissue or muscles. The disease is characterized by swelling, redness and soreness of the skin.
The concept of an abscess
Abscess, or an abscess is a purulent-inflammatory disease characterized by biological tissue destruction and the formation of a purulent cavity in it. A purulent-inflammatory disease can occur as an independent disease or be a complication of any pathologies.
Abscess can occur in muscles, subcutaneous tissue, bones, organs or between them. Depending on the localization, paratonsillar, pharyngeal, appendicular, soft tissue abscesses, etc. are distinguished. More oftenthe infection is exogenous (the pathogen penetrates from the outside), but there are cases of endogenous infection. The pathogen can get both from nearby and distant organs.
Soft tissue abscess
The disease is quite common. According to some reports, about 14 million patients seek medical help every year with a similar problem.
The main difference between soft tissue abscess (photo below) is the presence of a capsule (pyogenic membrane). Such capsules are inherent in abscesses of any localization, even for those that appear in the internal organs. The pyogenic membrane of soft tissue abscesses plays a very important role - it prevents the spread of the purulent-inflammatory process to nearby anatomical structures. However, an excess amount of exudate can lead to thinning of the capsule, followed by its rupture and the release of purulent contents into the surrounding spaces.
Another advantage of soft tissue abscesses is their localization. Abscesses are on the surface, which contributes to the most accurate diagnosis with the appointment of adequate therapy.
According to ICD-10, a soft tissue abscess has the code L02. Furuncles and furuncles are also included. International standards classify the disease as soft tissue and skin infections.
Abscess and infiltrate - what's the difference?
When the skin is injured due to surgical operations or inflammatory pathologies, complications arise. An infection enters the body and an abscess and infiltrate is formed. Last -this is an accumulation in the tissue of cellular elements with an admixture of blood and lymph.
Despite the common etiology and pathological anatomy, these are two different pathological processes. Soft tissue abscess differs from infiltrate as follows:
- The presence of liquid in a closed cavity. With an abscess, the liquid is purulent exudate, with an infiltrate there is no cavity at all, the tissue is saturated with decay products of the inflammatory process.
- Infiltrate can arise from tumor cells, and abscess is caused only by pathogens.
- Infiltration can lead to abscess formation, but the other way around doesn't happen.
Classification of abscesses
Soft tissue ulcers are classified in different ways. The etiotropic systematization is considered the main one:
- Simple - monomicrobial with localized clinical data. The main pathogens are staphylococcus aureus (usually golden) and beta-hemolytic streptococcus. Most often they are small in size, located on the surface and easily treatable
- Complex - can be mono- or polymicrobial. The causative agent is Staphylococcus aureus in association with Escherichia coli, Proteus and other microorganisms, mostly anaerobic. Complex ones penetrate deep into the tissues, follicles. According to ICD-10, soft tissue abscess and boils are combined into one category and have a common code.
Classification by the nature of the flow:
- Acute, characterized by a small focus of inflammation and a single-layer capsule. In the early stages of inflammation, the walls of the capsule are covered with purulentfibrous deposits and particles of molten tissue.
- Chronic abscess is characterized by a severe course with extensive general toxic symptoms. A bilayer pyogenic membrane is formed. The inner layer consists of granulations and faces the cavity, the outer layer consists of mature connective tissue.
The following abscesses are separated into separate groups:
- Cold - accumulation of pus in a small limited cavity, without any manifestations of the inflammatory process (redness, soreness, fever). Such an infection is endogenous and is observed in tuberculosis or actinomycosis.
- A swollen abscess is almost asymptomatic. It can develop within several months without signs characteristic of the inflammatory process. The danger lies in the fact that people do not attach importance to such an abscess and do not engage in therapy. In the meantime, it becomes chronic.
Causes of subcutaneous abscess
The main reason for the formation of an abscess is the ingress of pathogenic microflora into the body. The most common causative agent of infection is staphylococcus aureus, but cultures determine the presence of other microorganisms:
- Epidermal, hemolytic, Staphylococcus aureus.
- Staphylococci, most often beta-hemolytic, pneumococcal are also found. The latter are characteristic of complicated endogenous abscesses.
- Gram-negative bacteria: E. coli.
- Proteus. The habitat of this speciesenterobacteria - soil and water. The pathogen enters the body, as a rule, through a dirty reservoir.
- Pseudomonas aeruginosa is highly antibiotic resistant. It is the causative agent of nosocomial (nosocomial) infections.
- Klebsiella are found on the skin, mucous membranes. Their biological activity is boosted by a weakened immune system.
- Shigels. The carrier of bacteria and the source of infection is a sick person.
- Koch's wand.
You can determine the causative agent of soft tissue abscess by purulent contents, more precisely by its nature (smell, color). Experienced doctors make a preliminary diagnosis based on these characteristics.
- The putrefactive microflora (E. coli) is characterized by a gray color and a fetid odor.
- If the causative agent is staphylococcus aureus - yellow-green purulent exudate.
- The sweet smell and blue-green color of the exudate is characteristic of Pseudomonas aeruginosa.
Pyogenic microbes most often enter the body when the integrity of the skin is violated (wounds, scratches). A purulent process can occur when bacteria spread by lymphogenous or hematogenous routes from existing foci of inflammation.
Often a purulent-inflammatory disease is formed against the background of other protracted infections. Contributes to the development of soft tissue abscess chronic tonsillitis, sinusitis. Diabetes mellitus plays a special role in the development of ulcers.
Pathogenesis of purulent-inflammatory disease
Abscess occurs either in dead tissues, where autolysis processes occur (self-dissolution of cells under the influence ofenzymes), or in living tissues exposed to the aggressive action of pathogenic microorganisms.
When an infection enters the body, immunity is activated. The main "defenders" are leukocytes (neurophilic, basophilic). 6-8 hours after the introduction of an infectious agent, neurophiles from the vascular bed pass into the mucous membranes. With the help of chemoattractants, neurophilic leukocytes penetrate the inflamed focus.
In the initial stage of the purulent process, the affected area is infiltrated (impregnated) with inflammatory fluid and leukocytes. Over time, under the influence of neutrophil enzymes, the tissue undergoes melting, an internal space filled with exudate is formed. The pus in the cavity is the lysosomal enzymes of neurophilic residues. The walls of the soft tissue abscess eventually form a two-layer pyogenic membrane. It prevents exudate from spreading to adjacent anatomical structures.
Clinical manifestations of an abscess
The general symptoms of abscesses are the same as with any inflammatory processes accompanied by the formation of pus. The severity of clinical manifestations is determined by several factors:
- The human condition. People have heterogeneous susceptibility to various pathogenic agents, the reaction can manifest itself in different ways.
- Toxicity of an infectious agent. Some types of bacteria, even in very small quantities, can cause severe inflammation.
- Extensity of inflammation.
- Prevalence of necroticchanges.
Abscesses have both local and general somatic symptoms.
- Hyperemia at the site of inflammation.
- Slight swelling.
- Increased temperature in the area of the abscess.
- Pain.
- With deep necrotic changes, there is a general malaise, an increase in body temperature up to 40 ° C with chills.
With tuberculous etiology, the purulent-inflammatory process spreads far from the place of origin. For example, a swollen abscess of the soft tissues of the thigh (mainly on the medial surface) may occur.
Large abscesses that have arisen on the surface of the skin of the limbs affect their functionality. Pain occurs when walking or moving the arms, which severely limits motor activity.
Buttock soft tissue abscess resulting from intramuscular injection of drugs is usually accompanied by severe pain. The inflamed area may take on a burgundy or even blue tint. The formation of a hematoma prevents the capsule from breaking out and creates a risk of sepsis.
What are the chances of complications?
In a severe purulent-inflammatory process with predominant intoxication, problems arise in finding out the causes of the patient's serious condition. There may be several reasons for this condition:
- Purulent-resorptive fever - absorption of toxic decay products into the blood from the focus of inflammation. With a significant accumulation of pus, it penetrates the membrane. Absorption occurslymphogenous and hematogenous routes.
- Generalization of infection or sepsis is a common purulent infection caused by pathogens and their toxins entering the circulating blood. The infection is characterized by intoxication, thrombohemorrhagic syndromes, metastatic tissue damage.
- Another complication of soft tissue abscess is phlegmon. The purulent process tends to spread. Phlegmon is characterized by general malaise, high fever, soreness of the affected area during movement or palpation.
- Neuritis may occur as a result of purulent fusion of the wall of a large vessel and the nerve trunk located in it.
- Osteomyelitis. When the purulent process spreads to the bones, inflammation of the bone marrow may develop.
Diagnosis
A purulent surgeon is engaged in a physical examination, anamnesis, and the appointment of diagnostic measures. When conducting a survey, the doctor pays attention to the presence of past infections, the appearance of inflammation after injuries, surgeries, injections.
During the physical examination, the doctor determines the following:
- During the examination, there is swelling of the tissues and redness of the skin in the area of the abscess. The temperature at the site of inflammation is much higher. The skin on the surface of the purulent formation is very thin, exudate is visible through it.
- On palpation, there is an elevation at the site of inflammation, the patient experiences pain during palpation. When you press on the purulent focus, characteristic waves are noted -fluctuation.
Diagnostic activities include laboratory tests:
- The microscopic research method allows you to study the morphological and tinctorial properties of microbes.
- Bacterial culture. With its help, the pathogen and its resistance to antibacterial drugs are determined.
- Clinical blood test.
- If tuberculosis is suspected, a Mantoux test is done.
Instrumental diagnostic methods:
- Ultrasound of a soft tissue abscess allows you to study deep and necrotic ulcers.
- Diagnostic puncture is performed for the same purpose as sonography.
- An X-ray examination is ordered if TB is suspected.
Differential diagnosis of subcutaneous abscess
The clinical manifestations of abscesses have much in common with some pathological conditions. Differential diagnosis allows not only to confirm the diagnosis, but also to determine the nature of inflammation, the depth of the pyogenic membrane, and to identify the presence of necrotic tissues. Diagnosis includes sonography, laboratory tests and other methods of examination of the abscess must be differentiated from:
- Infiltration.
- A decaying tumor. Under the influence of decay products, severe intoxication occurs with characteristic symptoms that are also characteristic of an abscess.
- Foreign body. Soft tissue abscess on ultrasound looks like a dark accumulation of fluid with gray contents inside, while a foreign body has a characteristic appearance, small pieces of glass may not appear at all.viewed.
Treatment of soft tissue abscess
Therapy is determined depending on the course of the purulent process, the patient's well-being. In the initial stages, conservative therapy is prescribed. Its main task is to cause a spontaneous external breakthrough of the capsule. Heat compresses are applied, a heating pad is applied. They prescribe anti-inflammatory drugs ("Demiksid", "Biopin" ointment) and UHF therapy.
In most cases, patients come to the later stages of purulent-inflammatory disease, when conservative treatment of soft tissue abscess is ineffective. Such abscesses are subject to surgical treatment. Opening and drainage of the focus of inflammation is usually performed by a surgeon with a nurse in an outpatient operating room. Manipulation is performed using local anesthesia by impregnating tissues with novocaine 0.5% or intravenous anesthesia (Epontol, Sodium Thiopental). The dissection is carried out along the entire length of the abscess, so that free outflow of exudate is ensured. The opened cavity is washed with an antiseptic solution until it is completely cleansed and the anesthetized tissue is eliminated. For postoperative incision, a PVC tube, turundas with saline solution are inserted into the abscess cavity.
In case of deep abscesses through a small incision, the inner wall is cleaned with suction of the contents, the cavity is drained with lavage and active aspiration.
The use of antibiotics for soft tissue abscesses is prescribed if, after surgical treatment, intoxicationsymptoms do not subside. The use of antibacterial drugs is advisable if generalization of infection or purulent-resorptive fever is suspected.
Preventive measures
Abscesses are quite a dangerous disease. A breakthrough of the pyogenic membrane with the release of purulent exudate into the internal spaces threatens with severe intoxication. The etiology of the disease is well understood, which allows taking measures for its prevention. Preventive measures are not specific and differ little from antiseptic rules.
- Timely and complete treatment of wounds.
- For burns, frostbite, therapy should be carried out by a doctor and control the process until complete recovery.
- Compliance with antiseptic rules for injections and other medical procedures.
- Adequate therapy for any diseases of infectious genesis.
- See a doctor immediately for suspicious sores.
Abscess monitoring
With timely treatment and the appointment of adequate therapy, the prognosis for recovery is favorable. As they recover, unpleasant symptoms are eliminated, patients return to their normal lives. The use of antibiotics for soft tissue abscesses can cause disturbances in the intestinal microflora. For recovery, you should take a course of probiotics. Otherwise, pathogens may re-infect.
