Cellulitis & Abscess Notes PDF

Cellulitis & abscess Prof Hayder M.Abdulnabi Cellulitis Acute spreading bacterial infection of the skin, charecterized by redness, warmth, swelling, and pain Cellulitis, occur when an entry point through normal skin barriers allow bacteria to enter and releases their toxins in the subcutaneous t...

Cellulitis & abscess Prof Hayder M.Abdulnabi Cellulitis Acute spreading bacterial infection of the skin, charecterized by redness, warmth, swelling, and pain Cellulitis, occur when an entry point through normal skin barriers allow bacteria to enter and releases their toxins in the subcutaneous tissues Etiology 1. Break in the skin from an abrasion or cut or a skin ulcer 2.local trauma ( animal bite ) 3. Bacteremic spread of infection—- bacteria arrive from a distant source via the bloodstream Causative agents Staphylococcus aureus and streptococci Signs and symptoms 1. Fever 2. Chills 3. Erythema 4. Swelling 5. Local tenderness and pain 6. Regional lymph nodes ( lymphadenopathy ) Diagnosis 1. History 2. Physical examination 3. CBC 4. Culture and sensitivity Management 1. Mild cases—- oral antibiotic therapy ( Ampicillin, amoxil, cephalosporins ) ( outpatient) 2.severe cases —- intravenous antibiotics ( hospital) 3. Immobilize and elevate the part infected Complications 1. Blood infection ( septicaemia ) 2. Bone infection ( osteomyelitis ) 3. In lammation of lymph nodes ( lymphadinitis ) f f 4. In lammation of the heart ( endocarditis ) 6. Meningitis 7. Shock 8. Tissue death ( gangrene) Abscess Abscess is a localized collection of pus What is pus? Pus is composed of * Tissue debris * Dead & alive bacteria Pus is laudable Pus was cosidered good because it precedes cure, It represents near win of body’s defenses battle against bacteria Causes 1- Traumatic 2- Infection 3- Neoplastic 4- Iatrogenic Predisposing factors 1- Impaired host defense mechanism eg. HIV 2- Foreign body presence 3- Obstruction if normal drainage ( eg. Urinary, biliary, respiratory) 4- Tissue ischemia or necrosis 5- Hematoma or excessive luid accumulation in the tissue f 6- Trauma Etiology Numerous organisms can cause abscesses but the most common is Staphylococcus aureus Abscess usually begins in an area of cellulitis where leukocytes accumulate Pus increase in size by necrosis of cells and WBC collection Highly vascularized connective tissue then surround the abscess ( wall off ) preventing further spread Symptoms Fever Pain Annorexia Weight loss Farigue Signs Heat, swelling, tenderness, redness Skin may be thin, white or yellow if the abscess is ready for spontaneous rupture ( pointing ) Signs according to the site of the abscess ( hemiplegia due to brain abscess ) Complications 1- Bateremia 2- Rupture into near tissue 3- Bleeding from nearby vessel 4- Loss of function of a vital organ 5- Antibioma 6- Chronic draining sinuses Chronic discharging sinus Lung Rupture d abscess Colon Antibioma is a sterile, chronic abscess formed because of incomplete treatment of an infection by using antibiotics without incision and drainage. Investigatiin WBC increase Culture and sensitivity Cytology Fine needle aspiration cytology (FNAC) Histology FNAC X- ray US CT MRI Treatment 1- Drainage ( deroo ing) 2- Antibiitics f 3- Aspiration Some common abscesses 1- Brain abscess 2- Gluteal abscess 3- Lung abscess 4- Liver abscess 5- Subfrenic abscess 6- Pelvic abscess 7- Psoas abscess Lung abscess Liver abscess Lung abscess Brain abscess Pelvic abscess Subfrenic abscess Fluid therapy in surgery a a Prof. H yder M. Abduln bi IV luids are chemically prepared solutions that are given to the patient who cannot take orally Used to replace luid loss or help in giving IV f f medication Indication 1. Rapid restoration of luid and electrolytes in dehydration ( vomiting, diarrhoea, shock due to haemorrhge or sepsis or burn , post operative) 2. Total parenteral nutrition f f 3. For replacement of special luid loss ( blood&plasma) Disadvantages 1. Needs hospitalization, costly 2. Infection 3. Pyrogenic reaction ( fever) 4. Discomfort 5. Fluid overload Distribution of luid in the body Role of thirds 2/3 of body is water 2/3 of it is intracellular 1/3 is extracellular—— 2/3 is extravascular f 1/3 is intravascular Chemically water is considered as solvent Solvent is a substance that dissolves other materials called solutes In IV solution the solute can be molecules called electrolytes Or larger compounds such as proteins Daily water requirement The body needs about 35ml/kg of body weight and can be calculated by the rule of 4 2 1 4ml/kg/h for the 1st 10 kg 2 ml/ kg /h for next 10 kg 1 ml/kg/h after that 70kg man needs 4ml/kg/h for the irst 10kg=40 ml/h 2ml/kg/h for next 10 kg = 20 ml / h 1ml/kg/h for the remaining 50kg= 1ml x 50kg(50ml) The need will be 40+20+50 = 110 ml/ hour f 110ml/h x 24h = 2640 ml ( 2500 ml) Types of IV FLUIDS 1. colloids 2. Crystalloids 3. Blood and blood products Fluids classi ied according to their ability to cross capillary membrane that separates intravascular and interstitial compatement Fluid movement is determined by capillary f hydrostatic pressure and colloid osmotic pressure Osmosis Water movement across a semipermeable membrane from low concentration ion or solute to a high concentration region in a solution controlled by oncotic ( osmotic) pressure Filtration Body substances are pushed by pressure such as the pressure of blood low —— this pressure is called hydrostatic pressure f f For example when blood low through capillaries Colloids Fluid that contains large proteins and molecules so they stay in the blood vessels ( intravascular) increasing the oncotic pressure They shift water from iterstitial to intravascular space So useful in keeping blood volume Examples —- plasma, albumin, dextran What is dextran Is a branched polysaccharide made of many glucose molecules joined together into a different lengths Crystalloids Contain electrolytes only Classi ied to their tonicity Tonicity describe the concentration of electrolytes ( solute) Dissolved in water as compared to the tonicity of blood f plasma or cytoplasm 1. Isotonic crystalloid—- have similar tonicity of plasma The luid distribute equally between intravascular space and extra vascular space ( cytoplasm tonicity) Example—- 0.9% NaCl ( Normal saline) ( 154meq/ l Na and 154meq/l K) 5%glucose f Ringer lactate Na Cl K Ca Lactate In Water 2. Hypotonic crystalloid — have tonicity lower than that of plasma So shift luid from intravascular to extravascular space and then into tissue cells f Example— 0.45 NaCl ( 1\2 normal saline) 3. Hypertonic crystalloid— have tonicity higher than plasma Cause shift of water from extravascular Space into blood stream so increasing blood volume Examp. —5%dextrose in 0.45%NaCl, hypertonic saline, 20% dextrose and mannitol Mannitol Mannitol Increase low of water from tissues including brain ( head injury) So reduce intracranial pressure It cause increase diuresis so patient who receive f mannitol should have a catheter Fluid Infusion giving set Blood infusion giving set Micro drop infusion set Commonly used luids Ringer lactate — contain NaCl and KCl, Ca and Na lactate in water Normal saline —- contain 0.9 % NaCl in water ( 9gm in liter) f 5%glucose —— (50gm glucose in liter) Indication of normal saline 1. Keep body blood volume and pressure in emergencies 2. Water and salt loss in diarrhoea & vomiting 3. Irrigation for washing body luids f 4. Vehicle for drugs Contraindication of normal saline 1. Hypertension 2. Heart failure as large amount if normal saline will cause pulmonary edema Drip factor Is the No. of drops (ggt) that equal 1 ml of luid Usual iv transfusion set is 16 gtt = 1 ml f For microdrip drip factor is 60 gtt = 1 ml Drip factor formula Total vol. in ml x drip factor ÷ time in min = low rate ( drop/min) Example- patient need 1 liter ( 1000ml) of luid in 6 hours Calculating drops/min——— 1000 x 16 =16000 ÷ time in min (360) =44.4 rounded to f f 45 gtt / min Summary Therefore it is important to choose the uid most appropriate to patient needs It is important to carefully examin the label on the bag to ensure the tight uid is selected fl • Depending on their components uid can cause shift between intracellular and extracellular compartments fl • There are several types of IV FLUID fl • •