Abscesses

An abscess is a collection of pus collected in a cavity formed by the tissue on the basis of an infectious process (usually caused by bacteria or parasites) or other foreign materials (e.g. splinters or bullet wounds). It is a defensive reaction of the tissue to prevent the spread of infectious materials to other parts of the body.

The organisms or foreign materials that gain access to a part of tissue kill the local cells, release toxins and trigger an inflammatory response by drawing huge amounts of white blood cells to the area and increasing the regional blood flow. So, pus is a collection of local dead tissue cells, white blood cells, infecting organisms or foreign material and toxins released by both organisms and blood cells. The final structure of the abscess is an abscess wall that is formed by the adjacent healthy cells in an attempt to build a barrier around the pus that limits the infected material from neighboring structures.

Manifestations
The cardinal symptoms and signs of any kind of inflammatory process are redness, heat, swelling, and pain. Abscesses may occur in any kind of solid tissue but most frequently on skin surface (where they may be superficial pustules (boils) or deep skin abscesses), in the lungs, brain, kidneys and tonsils. Major complications are spreading of the abscess material to adjacent or remote tissues and extensive regional tissue death (gangrene). Abscesses in most parts of the body rarely heal themselves, so prompt medical attention is indicated at the first suspicion of an abscess.

Treatment
The abscess should be inspected to identify if foreign objects are a cause, requiring surgical removal. Surgical drainage of the abscess (e.g. lancing) is usually indicated once the abscess has developed from a harder serous inflammation to a softer pus stage. As Staphylococcus aureus bacteria is a common cause, an anti-Staphylococcus antibiotic such as Flucloxacillin or dicloxacillin is used. It is important to note that antibiotic therapy alone without surgical drainage of the abscess is seldom effective.

In critical areas where surgery presents a high risk (such as the brain), surgery may be delayed or used as a last resort. The drainage of a lung abscess may be performed by positioning the patient in a way that enables the contents to be discharged via the respiratory tract. Warm compresses and elevation of the limb may be beneficial for skin abscess.

Perianal abscess
Perianal abscesses can be seen in patients with for example inflammatory bowel disease (such as Crohn's disease) or diabetes. Often the abscess will start as an internal wound caused by ulceration or hard stool. This wound typically becomes infected as a result of the normal presence of feces in the rectal area, and then develops into an abscess. This often presents itself as a lump of tissue near the anus which grows larger and more painful with the passage of time.

Like other abscesses, perianal abscesses may require prompt medical treatment, such as an incision and debridement or lancing.