Surgery - Abscesses

Question 1

What is an abscess?

Answer 1

• Localized area of induration or fluctuance caused by a collection of pus within the dermis or deeper skin tissues secondary to infection and inflammation.

Question 2

What causes an abscess?

Answer 2

There is usually a breakdown in the integrity of the skin allowing normal flora to invade.

• Ex: insect bites, abrasions, shaving, IVDA

Increased likelihood of abscess formation with:

• Increased temperature
• Increased humidity
• Poor hygiene
• Sitting often
• DIABETICS

Common affected areas include gluteal, superior gluteal fold and axilla but often found on back and extremities

Question 3

What organisms commonly cause abscesses?

Answer 3

• Causative organisms depend on area of abscess but most commonly caused by Staph. Aureus and Streptococcus.
• Increase in incidence of CA-MRSA (community associated methicillin-resistant Staphylococcus Aureus )

Question 4

What are common risk factors for MRSA?

Answer 4

• Resident of long term care facility
• Sharing needles, razors or other sharps
• Sharing sports equipment
• Military service
• Incarceration
• IVDA
• Men who have sex with men
• HIV infection
• Recent hospitalization

Question 5

How will an abscess present?

Answer 5

• Painful, tender, erythematous
• Indurated in early, fluctuant later

Question 6

What are some common types of abscesses?

Answer 6

• Cutaneous
• Perirectal
• Pilonidal
• Infected Sebaceous Cyst
• Hidradenitis Suppurativa
• Axilla, groin, perineal
• Blocked apocrine glands
• Chronic
• Bartholin’s gland abscess, Paronychia, Felon

Question 7

Peranal Abscesses

Answer 7

Question 8

Bartolin’s Cyst

Question 9

How do I know if an abscess is “ready” to be drained?

Answer 9

Early abscess: indurated

• Warm compresses, antibiotics
• Warn most likely need I&D
• F/U in 3-4 days

Fluctuant
If unsure, can aspirate (18 guage needle and 10 cc syringe)