Abscess

Definition

An abscess is an enclosed collection of liquefied tissue, known as pus, somewhere in the body. It is the result of the body's defensive reaction to foreign material.

Description

There are two types of abscesses, septic and sterile. Most abscesses are septic, which means that they are the result of an infection. Septic abscesses can occur anywhere in the body. Only a germ and the body's immune response are required. In response to the invading germ, white blood cells gather at the infected site and begin producing chemicals called enzymes that attack the germ by digesting it. These enzymes act like acid, killing the germs and breaking them down into small pieces that can be picked up by the circulation and eliminated from the body. Unfortunately, these chemicals also digest body tissues. In most cases, the germ produces similar chemicals. The result is a thick, yellow liquid—pus—containing digested germs, digested tissue, white blood cells, and enzymes.

An abscess is the last stage of a tissue infection that begins with a process called inflammation. Initially, as the invading germ activates the body's immune system, several events occur:

• Blood flow to the area increases.
• The temperature of the area increases due to the increased blood supply.
• The area swells due to the accumulation of water, blood, and other liquids.
• It turns red.
• It hurts, because of the irritation from the swelling and the chemical activity.

These four signs—heat, swelling, redness, and pain—characterize inflammation.

As the process progresses, the tissue begins to turn to liquid, and an abscess forms. It is the nature of an abscess to spread as the chemical digestion liquefies more and more tissue. Furthermore, the spreading follows the path of least resistance—the tissues most easily digested. A good example is an abscess just beneath the skin. It most easily continues along beneath the skin rather than working its way through the skin where it could drain its toxic contents. The contents of the abscess also leak into the general circulation and produce symptoms just like any other infection. These include chills, fever, aching, and general discomfort.

Sterile abscesses are sometimes a milder form of the same process caused not by germs but by nonliving irritants such as drugs. If an injected drug like penicillin is not absorbed, it stays where it was injected and may cause enough irritation to generate a sterile abscess—sterile because there is no infection involved. Sterile abscesses are quite likely to turn into hard, solid lumps as they scar, rather than remaining pockets of pus.

Causes and symptoms

Many different agents cause abscesses. The most common are the pus-forming (pyogenic) bacteria like Staphylococcus aureus, which is nearly always the cause of abscesses under the skin. Abscesses near the large bowel, particularly around the anus, may be caused by any of the numerous bacteria found within the large bowel. Brain abscesses and liver abscesses can be caused by any organism that can travel there through the circulation. Bacteria, amoeba, and certain fungi can travel in this fashion. Abscesses in other parts of the body are caused by organisms that normally inhabit nearby structures or that infect them. Some common causes of specific abscesses are:

• skin abscesses by normal skin flora
• dental and throat abscesses by mouth flora
• lung abscesses by normal airway flora, pneumonia germs, or tuberculosis
• abdominal and anal abscesses by normal bowel flora

Specific types of abscesses

Listed below are some of the more common and important abscesses.

• Carbuncles and other boils. Skin oil glands (sebaceous glands) on the back or the back of the neck are the ones usually infected. The most common germ involved is Staphylococcus aureus. Acne is a similar condition of sebaceous glands on the face and back.
• Pilonidal abscess. Many people have as a birth defect a tiny opening in the skin just above the anus. Fecal bacteria can enter this opening, causing an infection and subsequent abscess.
• Retropharyngeal, parapharyngeal, peritonsillar abscess. As a result of throat infections like strep throat and tonsillitis, bacteria can invade the deeper tissues of the throat and cause an abscess. These abscesses can compromise swallowing and even breathing.
• Lung abscess. During or after pneumonia, whether it's due to bacteria [common pneumonia], tuberculosis, fungi, parasites, or other germs, abscesses can develop as a complication.
• Liver abscess. Bacteria or amoeba from the intestines can spread through the blood to the liver and cause abscesses.
• Psoas abscess. Deep in the back of the abdomen on either side of the lumbar spine lie the psoas muscles. They flex the hips. An abscess can develop in one of these muscles, usually when it spreads from the appendix, the large bowel, or the fallopian tubes.

KEY TERMS

Cellulitis— Inflammation of tissue due to infection.

Enzyme— Any of a number of protein chemicals that can change other chemicals.

Fallopian tubes— Part of the internal female anatomy that carries eggs from the ovaries to the uterus.

Flora— Living inhabitants of a region or area.

Pyogenic— Capable of generating pus. Streptococcus, Staphocococcus, and bowel bacteria are the primary pyogenic organisms.

Sebaceous glands —Tiny structures in the skin that produce oil (sebum). If they become plugged, sebum collects inside and forms a nurturing place for germs to grow.

Septicemia— The spread of an infectious agent throughout the body by means of the blood stream.

Sinus— A tubular channel connecting one body part with another or with the outside.

Diagnosis

The common findings of inflammation—heat, redness, swelling, and pain—easily identify superficial abscesses. Abscesses in other places may produce only generalized symptoms such as fever and discomfort. If the patient's symptoms and physical examination do not help, a physician may have to resort to a battery of tests to locate the site of an abscess, but usually something in the initial evaluation directs the search. Recent or chronic disease in an organ suggests it may be the site of an abscess. Dysfunction of an organ or system—for instance, seizures or altered bowel function—may provide the clue. Pain and tenderness on physical examination are common findings. Sometimes a deep abscess will eat a small channel (sinus) to the surface and begin leaking pus. A sterile abscess may cause only a painful lump deep in the buttock where a shot was given.

Treatment

Since skin is very resistant to the spread of infection, it acts as a barrier, often keeping the toxic chemicals of an abscess from escaping the body on their own. Thus, the pus must be drained from the abscess by a physician. The surgeon determines when the abscess is ready for drainage and opens a path to the outside, allowing the pus to escape. Ordinarily, the body handles the remaining infection, sometimes with the help of antibiotics or other drugs. The surgeon may leave a drain (a piece of cloth or rubber) in the abscess cavity to prevent it from closing before all the pus has drained out.

Alternative treatment

If an abscess is directly beneath the skin, it will be slowly working its way through the skin as it is more rapidly working its way elsewhere. Since chemicals work faster at higher temperatures, applications of hot compresses to the skin over the abscess will hasten the digestion of the skin and eventually result in its breaking down, releasing the pus spontaneously. This treatment is best reserved for smaller abscesses in relatively less dangerous areas of the body—limbs, trunk, back of the neck. It is also useful for all superficial abscesses in their very early stages. It will "ripen" them.

Contrast hydrotherapy, alternating hot and cold compresses, can also help assist the body in resorption of the abscess. There are two homeopathic remedies that work to rebalance the body in relation to abscess formation, Silica and Hepar sulphuris. In cases of septic abscesses, bentonite clay packs (bentonite clay and a small amount of Hydrastis powder) can be used to draw the infection from the area.

Prognosis

Once the abscess is properly drained, the prognosis is excellent for the condition itself. The reason for the abscess (other diseases the patient has) will determine the overall outcome. If, on the other hand, the abscess ruptures into neighboring areas or permits the infectious agent to spill into the bloodstream, serious or fatal consequences are likely. Abscesses in and around the nasal sinuses, face, ears, and scalp may work their way into the brain. Abscesses within an abdominal organ such as the liver may rupture into the abdominal cavity. In either case, the result is life threatening. Blood poisoning is a term commonly used to describe an infection that has spilled into the blood stream and spread throughout the body from a localized origin. Blood poisoning, known to physicians as septicemia, is also life threatening.

Of special note, abscesses in the hand are more serious than they might appear. Due to the intricate structure and the overriding importance of the hand, any hand infection must be treated promptly and competently.

Prevention

Infections that are treated early with heat (if superficial) or antibiotics will often resolve without the formation of an abscess. It is even better to avoid infections altogether by taking prompt care of open injuries, particularly puncture wounds. Bites are the most dangerous of all, even more so because they often occur on the hand.

Resources

BOOKS

Fauci, Anthony S., et al., editors. Harrison's Principles of Internal Medicine. New York: McGraw-Hill, 1997.

Abscess

Definition

An abscess is a place of accumulation of the creamy white, yellow, or greenish fluid, known as pus, surrounded by reddened tissue. It is the result of the body's inflammatory response to a foreign body or a bacterial, viral, parasitic, or fungal infection. An abscess usually dries out and resolves when it is drained of pus. The most common parts of the body affected by abscesses are the face, armpits, arms and legs, rectum, sebaceous glands (oil glands), and the breast during lactation.

Description

Most abscesses are septic, which means they are the result of an infection. Abscesses occur when white blood cells (WBCs) gather in response to an infection. They produce oxidants (for example, superoxide radical) and enzymes to digest the invading bacteria, viruses, parasites, or fungi. The infective agents are then broken down by the WBCs into small pieces that can be transported through the bloodstream and eliminated from the body. Unfortunately, the enzymes may also digest part of the body's tissues along with the infective agents. The resulting liquid of this digestion is pus, which contains the remains of the infective agents, tissue, white blood cells, and enzymes.

A sterile abscess is one that is not produced by an infection. It is caused by irritants, such as foreign bodies or injected drugs, and medications that have not been totally absorbed. Sterile abscesses quite often heal into hardened scar tissue.

Common types of abscesses:

• Boils and carbuncles. Sebaceous glands and superficial skin are the places usually infected.
• Dental abscess. An abscess that develops along the root of a tooth.
• Pilonidal abscess. People who have a birth defect involving a tiny opening in the skin just above the anus may have fecal bacteria enter this opening, causing an infection and a subsequent abscess.
• Retropharyngeal, parapharyngeal, peritonsillar abscess. As a result of throat infections like strep throat and tonsillitis , bacteria invade the deeper tissues of the throat and cause a parapharyngeal or peritonsillar abscess. A retropharyngeal abscess is a result of something usually blood-borne, and not from a direct spread of tonsillitis. These abscesses can compromise swallowing and even breathing.
• Lung abscess. During or after pneumonia , an abscess can develop as a complication.
• Liver abscess. Bacteria, parasites, or amoeba from the intestines can spread through the blood to the liver and cause abscesses.
• Psoas abscess. An abscess can develop in the psoas muscles, when an infection spreads from the appendix, the large intestine, or the fallopian tubes.
• Butin abscess. Any blood-borne feeding off bacteria that stimulate pus production (pyogenic organisms). Can cause abscesses in possibly many sites.

Causes & symptoms

Many different agents cause abscesses. The most common are the pyogenic, or pus-forming bacteria, such as Staphylococcus aureus, which is nearly always the cause of abscesses directly under the skin. Abscesses are usually caused by organisms that normally inhabit nearby structures or that infect them. For example, abscesses around the anus may be caused by any of the numerous bacteria found within the large intestine. Brain abscesses and liver abscesses are caused by the bacteria, amoeba, and fungi that are able to travel there through circulation.

Symptoms of an abscess are the general signs of inflammation. Symptoms that identify superficial abscesses include heat, redness, swelling, and pain over the affected area. Abscesses in other places may produce only generalized symptoms, such as fever and discomfort. A sterile abscess may present as painful lump deep under the site of an injection. A severe infection may bring on fever, fatigue , weight loss, and chills . Recurrent abscesses may indicate undiscovered allergies or decreased immune functioning.

Diagnosis

A general physical examination and a detailed patient history are used to diagnose an abscess. Recent or chronic disease or dysfunction in an organ suggests it may be the site of an abscess. Pain and tenderness on physical examination are common findings. There may also be a leakage of pus from a sinus tract connected to an abscess deep in the body tissue.

Treatment

Bentonite clay packs with a small amount of goldenseal powder (Hydrastis canandensis ) can be placed on the site of a superficial abscess and used to draw out the infection. Tea tree oil (Melaleuca spp.) and garlic (Allium sativa ) directly applied to abscesses may also help to clear them.

Applications of a hot compress to the skin over the abscess will hasten the draining or the reabsorption of the abscess. Contrast hydrotherapy , using alternating hot and cold compresses, can also be used. Additionally, localized warm/hot soaks three to five times daily frequently brings an abscess to heal.

Homeopathic remedies that can be taken to help diminish abscess formation include belladonna, silica, Hepar sulphuris, and calendula. Also, acupuncture may be recommended to help treat pain caused by an abscess. In addition, vitamins A and C, beta-carotene, zinc , liquid chlorophyll, and garlic are useful as supportive daily nutrients to help clear up abscesses.

Allopathic treatment

Often, the pus of an abscess must be drained by a physician. Ordinarily, the body will handle the remaining infection. Sometimes antibiotics are prescribed. The doctor may often put a piece of cloth or rubber, called a drain, in the cavity of the abscess to prevent it from closing until all the pus has drained.

Expected results

Once the abscess is properly drained, it should clear up in a few days. Any underlying diseases will determine the overall outcome of the condition. Recurrent abscesses, especially those on the skin, return due to either defective/altered immunity, or staph overgrowth, where there is high bacterial colonization on the skin. The patient should consult a physician for treatment with which to wash the skin areas, and treatment to eradicate colonization.

If the abscess ruptures into neighboring areas or if the infectious agent spills into the bloodstream, serious consequences are likely. Abscesses in and around the nasal sinuses, face, ears, and scalp may spread the infection into the brain. Abscesses in the abdominal cavity, such as in the liver, may rupture into that cavity. Blood poisoning , or septicemia, is an infection that has spilled into the bloodstream and then spreads throughout the body. These are emergency situations where the patient needs to be seen by a physician as soon as possible.

It is important to take note that abscesses in the hand may be more serious than they might appear. Due to the intricate structure and the overriding importance of the hand, any hand infection must be treated promptly and competently.

Prevention

Infections that are treated early with heat, if superficial, or antibiotics, if deeper, will often resolve without the formation of an abscess. It is even better to avoid infections altogether by promptly cleaning and irrigating open injuries, particularly bites and puncture wounds .

Resources

BOOKS

Bennett, J. Claude and Fred Plum, ed. Cecil Textbook of Medicine. Philadelphia: W. B. Saunders Co., 1996.

Duke, James A., et al. The Green Pharmacy. Pennsylvania: Rodale, 1997.

Isselbacher, Kurt, et al, ed. Harrison's Principles of Internal Medicine. New York: McGraw–Hill, 1997.

Tierney, Jr., Lawrence M., et al, ed. Current Medical Diagnosis and Treatment. Connecticut: Appleton & Lange, 1996.

OTHER

AlternativeMedicine.com. <http://www.alternativemedicine.com/> (December 28, 2000).

Patience Paradox

abscess (ab-sis) n. a collection of pus and necrotic tissue enclosed by damaged and inflamed tissues. acute a. an abscess associated with pain, inflammation, and some fever. apical a. an abscess in the bone around the tip of the root of a tooth. Brodie's a. a chronic abscess of bone that develops from acute bacterial osteomyelitis. cerebral a. an abscess resulting from infection of the brain or its meninges. cold or chronic a. an abscess, usually due to tuberculosis bacilli, in which there is little pain or inflammation. psoas a. a cold abscess in the psoas muscle (in the groin), which has spread from diseased vertebrae in the lower part of the spine. subphrenic a. an abscess in the space below the diaphragm, usually resulting from a spread of infection from the abdomen. tropical (or amoebic) a. an abscess of the liver caused by infection with Entamoeba histolytica. See also ischiorectal abscess.

abscess localized inflamation associated with tissue necrosis. Abscesses are characterized by inflamation, which is due to the accumulation of pus in the local tissues, and often painful swelling. They occur in the skin, at the root of a tooth, in the middle ear, on the eyelid (see sty ), in the mammary glands, in the recto-anal area, and elsewhere in the body. Abscesses may develop in lung tissue, in the lymph nodes, and in bone. A sinus abscess may result in a fistula , and abscess of the appendix in appendicitis. Unless an abscess discharges spontaneously, surgical incision and drainage is required. See boil ; carbuncle .

abscess XVI. — F. abcès — L. abscessus (Celsus, rendering Gr. apóstēma IMPOST(H)UME), f. abscess-, pp. stem of abscēdere depart, f. ABS- + cēdere go.

ab·scess / ˈabˌses/ • n. a swollen area within body tissue, containing an accumulation of pus.

abscess Collection of pus anywhere in the body, contained in a cavity of inflamed tissue. It is caused by bacterial infection.

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