57 Questions
What is cellulitis?
A type of skin infection causing redness, swelling, and pain
What can result from skin entry by pathogenic bacteria?
Furuncle, carbuncle, or abscess
How do skin infections occur?
When bacteria infect the skin and sometimes the deep tissue beneath the skin
What is the usual outcome for skin infections if treated promptly?
Heals by resolution
Which antibiotic is indicated for coverage in the text?
IV benzylpenicillin and flucloxacillin
When are systemic antimicrobial drugs indicated as adjunctive therapy according to the text?
If the size of abscess is > 2 cm
What is a complication of abscesses mentioned in the text?
Rupture into adjacent tissue
What factor does the text mention as essential for the effectiveness of antimicrobial drugs?
Drainage
What does empiric antimicrobial therapy depend on?
Location and likely infecting pathogen
Which antibiotic could be a potential alternative based on the text?
Oral clindamycin
Which bacteria are common pathogens in cellulitis?
Beta-hemolytic Streptococcus and Staphylococcus aureus including MRSA
What is a characteristic feature of cellulitis?
Expanding, painful redness with edema
When are blood cultures recommended for cellulitis patients?
Patients with malignancy on chemotherapy, neutropenia, severe cell-mediated immunodeficiency, and animal bites
How do streptococcal skin infections spread?
Widely along tissue planes, with no pus present
What is the recommended treatment for purulent infections in cellulitis?
Incision and drainage +/- antibiotics
When is hospitalization recommended for cellulitis?
Deeper or necrotizing infections, poor adherence to therapy, severely immunocompromised patients, or when outpatient treatment is failing
What is lymphangitis in the context of cellulitis?
Erythema tracking along lymphatic drainage leading to lymphangitis
What distinguishes erysipelas from other streptococcal skin infections?
It is a superficial streptococcal infection with a well-demarcated, palpable edge.
What is the defining feature of an abscess?
A collection of pus usually caused by a bacterial infection.
How is diagnosis typically made in cellulitis?
Based on clinical manifestations.
What distinguishes staphylococcal skin infections from streptococcal skin infections?
Staphylococcal infections produce localized pus and abscesses with a small area of surrounding erythema.
What is the most common cause of abscesses?
Bacterial infections
What can result from incomplete treatment of abscesses?
Chronic abscesses
What do abscesses contain?
Liquefied tissue products
How can deep abscesses be diagnosed?
Imaging
What can happen if a chronic abscess is completely eliminated without drainage?
'Sterile abscess' or 'antibioma'
What is the main form of treatment for abscesses?
Incision and drainage
What can be a risk factor for developing abscesses?
Weakened immune system
What might happen if an abscess ruptures?
Discharge into another organ
What is the role of lymphocytes in abscesses?
Producing antibodies against bacteria
What is a possible consequence of poor treatment of an abscess?
Development of resistant organisms in the abscess
How does an individual with diabetes have an increased risk of developing an abscesse?
Impaired immune response due to high blood sugar levels
What is the role of macrophages in an abscess?
Phagocytosis of bacteria
What is gangrene?
A type of tissue death caused by a lack of blood supply
Which symptoms may indicate gangrene?
Change in skin color, numbness, and pain
What are common risk factors for gangrene?
Diabetes, smoking, and alcoholism
Which body parts are most commonly affected by gangrene?
Feet and hands
How is the diagnosis of gangrene typically made?
Based on symptoms and supported by tests such as medical imaging
What might certain types of gangrene present with in addition to typical symptoms?
Fever or sepsis
What is the role of blood supply in the development of gangrene?
It is essential for maintaining tissue health and preventing tissue death
What distinguishes gangrene from a bacterial skin infection?
Tissue death due to lack of blood supply vs. bacterial invasion of the skin
Which type of gangrene is characterized by thriving bacteria and poor prognosis due to sepsis?
Wet gangrene
What type of gangrene may result in the affected part being saturated with stagnant blood?
Wet gangrene
Which bacterial infection produces gas within tissues and spreads rapidly as gases expand and infiltrate healthy tissue?
Gas gangrene
Which condition infects deep into the body along tissue planes and spreads rapidly with a high mortality rate?
Necrotizing fasciitis
What type of gangrene is the end result of chronic ischemia without infection and is not salvageable once developed?
Dry gangrene
What type of gangrene may develop rapidly due to venous or arterial blood flow blockage?
Dry gangrene
What is the mainstay of treatment for gangrene according to the text?
Surgical removal of all dead tissue
In the case of gangrene due to critical limb ischemia, what treatment can be performed to treat the underlying peripheral artery disease?
Revascularization via vascular bypass or angioplasty
What is the most common reason for amputations according to the text?
Ischemic disease of the legs
When should angioplasty be considered according to the text?
If severe blockage in lower leg vessels leads to gangrene
What treatment is used to treat gas gangrene according to the text?
Hyperbaric oxygen therapy
What is the role of surgical debridement in treating gangrene according to the text?
To remove all dead tissue
What is recommended for gas gangrene after treatment with debridement and antibiotics according to the text?
Treating the underlying cause
What distinguishes dry gangrene from other forms of gangrene according to the text?
Autoamputation of affected part making surgical removal unnecessary
What can be performed in cases where severe blockage in lower leg vessels leads to gangrene according to the text?
Angioplasty
After surgical removal of all dead tissue, what can be performed to treat underlying peripheral artery disease according to the text?
Revascularization via vascular bypass or angioplasty
Study Notes
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Abscesses can develop anywhere in the body, including skin abscesses and internal abscesses.
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Most often caused by bacteria Staphylococcus aureus, which enters the body through cuts, abrasions, punctures, or insect bites. Other risk factors include chronic skin conditions, diabetes, weakened immune systems, and poor hygiene.
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Contain polymorphonuclear neutrophils, macrophages, lymphocytes, bacteria, and liquefied tissue products.
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May rupture, discharge into another organ, or open onto another epithelial surface.
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Incomplete treatment due to resistant organisms or poor treatment may lead to chronic abscesses.
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Complete elimination of organisms in a chronic abscess without drainage can result in a 'sterile abscess' or 'antibioma'.
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Diagnosis of cutaneous and subcutaneous abscesses is by physical examination, while deep abscesses often require imaging for diagnosis.
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Treatment includes draining the pus through incision and drainage, CT-guided drainage, closed surgical drainage, and surgical drainage and debridement.
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Renaldo Womatalze specializes in diagnosing gangrene based on symptoms and supports it with tests like imaging.
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Types of gangrene:
- Dry gangrene: end result of chronic ischemia without infection, not salvageable once developed, not as emergent as gas or wet gangrene, can develop into wet gangrene if infection occurs.
- Wet gangrene: characterized by thriving bacteria, poor prognosis due to sepsis, usually develops rapidly due to venous or arterial blood flow blockage, affected part saturated with stagnant blood, rapid growth of bacteria, toxic products absorbed and cause sepsis, high mortality, emergency amputation often required.
- Gas gangrene: bacterial infection that produces gas within tissues, caused by Clostridium or non-clostridial species, infection spreads rapidly as gases expand and infiltrate healthy tissue.
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Necrotizing fasciitis (hemolytic streptococcal gangrene): infects deep into the body along tissue planes, spreads rapidly, high mortality rate.
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Noma: a gangrene of the face.
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Fournier gangrene: type of necrotizing fasciitis that usually affects the genitals and groin.
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Severe mesenteric ischemia: may result in gangrene of the small intestine due to severe ischemic colitis that may result in the large intestine gangrene.
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Dry gangrene: not accompanied by infection, not as emergent, can develop into wet gangrene, over time may become wet gangrene if infection occurs.
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Wet gangrene: characterized by thriving bacteria, poor prognosis due to sepsis, affected part saturated with stagnant blood, rapid growth of bacteria, toxic products absorbed and cause sepsis, high mortality, emergency amputation often required.
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Gas gangrene: bacterial infection that produces gas within tissues, infection spreads rapidly as gases expand and infiltrate healthy tissue.
Learn about the development and causes of abscesses, which can occur internally or under the skin. Abscesses are commonly caused by bacteria, such as Staphylococcus aureus.
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