1. An abscess is a localized collection of pus caused by bacterial infection, while a cyst is a sac containing fluid or semi-solid material. A hematoma is a collection of blood under the skin caused by damaged blood vessels.
2. Abscesses are treated through maturation and drainage - draining pus and removing debris. Cysts are drained by puncturing and injecting iodine to destroy the membrane. Hematomas are drained by removing blood and ligating bleeders.
3. Differentiation is based on aspirated contents - pus for abscesses, fluid for cysts, blood for acute hematomas and serum for chronic hematomas. History and physical exam also help determine
1. An abscess is a localized collection of pus caused by bacterial infection, while a cyst is a sac containing fluid or semi-solid material. A hematoma is a collection of blood under the skin caused by damaged blood vessels.
2. Abscesses are treated through maturation and drainage - draining pus and removing debris. Cysts are drained by puncturing and injecting iodine to destroy the membrane. Hematomas are drained by removing blood and ligating bleeders.
3. Differentiation is based on aspirated contents - pus for abscesses, fluid for cysts, blood for acute hematomas and serum for chronic hematomas. History and physical exam also help determine
1. An abscess is a localized collection of pus caused by bacterial infection, while a cyst is a sac containing fluid or semi-solid material. A hematoma is a collection of blood under the skin caused by damaged blood vessels.
2. Abscesses are treated through maturation and drainage - draining pus and removing debris. Cysts are drained by puncturing and injecting iodine to destroy the membrane. Hematomas are drained by removing blood and ligating bleeders.
3. Differentiation is based on aspirated contents - pus for abscesses, fluid for cysts, blood for acute hematomas and serum for chronic hematomas. History and physical exam also help determine
Abscess • It is circumscribed area of inflammation which is invaded by pus forming organisms or it is localized collection of pus surrounded by inflamed or pyogenic membrane. Size of the abcess is variable from few mm to foot ball size. • Classification: basis of cardinal sign of inflammation there are 2 types of abcess • Acute and Chronic • Both may be superficial or deep. • Etiology: Pyogenic organisms; Irritant drugs, Orgnsms Like staph., srept., corynebacterium pyogenes, E coli,Helminthes; FungusProtozoa. Irritantdrugs:Oilbase;drugs,e.goxytetracycline, chloral hydrate or Mg sulfate etc these are not given I/M or S/C always give these medicine I/V.Then foreign bodies can be cause which could be endogenous and exogenous bodies. Continue… Endogenous are the substances which are produced by own body i.e bone, dead tissue Exogenous are outside body which enter through any accident e.g piece of wood Acute superficial abscess: • Appear within 3-5 days after entry of microbe. Appear as small pockets underneath the skin. Then with the passage of time these small pockets are converted into big pocket due to necrosis of inflammatory membrane. Then pus move upward and put pressure on the weak tissue making pointing of abscess. Continue… • Acute deep abscess: Abscess develops in deeper tissue e.g muscle which is not visible. The superficial area feels tense and painful. No visible signs are seen apparently unless it becomes superficial. Sometimes it burst in deeper tissue. Sometimes abscess burst in other cavities and if pus reach to the blood it may lead to pyemia or toxemia. If abscess is well diagnosed by a surgeon in time drainage may be applied surgically. • Septic emboli may be carried to other parts of the body producing abscess, pyemia and septicemia • Chronic superficial abscess: • In this type abcess is present but no cardinal signs it looks like tumor due to fibrous tissue. Chronic abcess is not watery in nature. It may be in the form of curdles, may be calcified or inspissated (To undergo thickening ). • Chronic deep abscess: • Hard fibrous mass is present in deep tissue. Here surgery is recommended. • International treatment of abscess: • Maturation .Drainage • Maturation: First of all mature the abcess by using irritant drugs or naturally. Irritants only assist the natural maturity of the abcess. • Drainage: Make incision for drainage and incision is always given towards the gravity. If football like abcess is present on neck here we do setoning for 5-6 days to maintain the patency (The quality of being open, expanded, or unblocked) of abcess. Ideal dressing material for abcess is MgSO4 because it has lymph lavage action so it will absorb water. • Case: If acute abcess is at the neck site then we will wait for some days for its maturation. We apply counter irritant on the abcess site. After maturation drainage is done by puncturing. • Diagnosis: Physical examination Puncturing (aspiration) • Physical examination: • Soft at center and harder at periphery. When it matures it starts fluctuation from periphery to centrei.e soft at all site. • Puncturing: • Use 16 Guage needle which is inserted right in the centre of abcess. Then pus will come out. • Confuse with abcess: • Hematoma • Cyst • Tumors • Bursitis • Hernia • Fibroma/granuloma • Hematoma: Blood comes out after puncturing. In this case there is accumulation of blood underneath the skin after rupturing of vessel. So in acute form blood come out and in chronic form serum come out. • Cyst:If watery fluid comes out then it is cyst. And you never see sign of inflammation in it. • Tumor:Always hard and after puncturing nothing comes out may be some granular tissue come out but very rare. • Bursitis: It is inflammation of bursa (it is space between two tendons, or between tendon and muscle or between tendon and bone). It is always close to the proximal or distal extremity of bone. In this case swelling involving all signs of inflammation but nothing comes out after puncturing but sometime serum come out. Treatment In acute mature abscess
• Hasten the maturation abscess by application
of counter irritant • Like iodine ointment 5% • In certain cases its advisable to open the abscess as soon as its diagnose Treatment • The skin over the abscess should be clipped and sheared and antiseptic application is done. • An opening is made at the most dependant part of the swelling which is fluctuating and its better in the ventral part of the swelling to provide complete drainage of the abscess cavity. • After the pus is removed the cavity should be checked for any F.B and necrotic T. should be removed • Then although flashing of the cavity should be made by suitable antiseptic like 10% povidone iodine or 1% chlorhexidene Continue… • Then the abscess cavity should be packed completely with gauze saturated with ten. Iodine 5% • This ten. Iodine gauze help in destruction of the lining membrane of abscess cavity and reduce the number of microrganisms • The gauze is removed in 24h and then the cavity again flashed with mild antiseptic solution Cyst • A sac containing liquid and semi-solid substance • It has an inner lining of secretary membrane • May contains a solid substances like tooth and hair Types • Retention cyst- due to occlusion of duct or gland e.g. salivary cyst • Exudation cysts- due to accumulation of fluid in existing cavity e.g hydrocele • Congenital cysts- present of at birth due to failure of embryonic cavity to close e.g urachal cyst • Cyst due to misplaced embryonic tissue e.g dermoid cyst and dentigerous cyst Diagnosis • Cysts are non- inflammatory and develop slowly • Fluid fluctuates in the cyst • If contents are semi- solid it fluctuate en masse • May be differentiated from abscess, swelling, haematoma Treatment • Puncturing of cyst and evacuation of contents • Tr. Iodine is injected to destroy the membrane • Cyst may be incised to get the contents evacuated • Passing of seton • Dentigerous cyst of temporal bone • Tooth is extracted and sinus tract is cauterized • Branchial cyst (honey cyst) • Complete excision of the cyst Contusion • Deep wound in which skin remains intact. It is very serious and involve: • Muscle • Blood vessels • Nerves • Bone • Types: • 1st degree contusion (ecchymosis) • 2nd degree contusion (hematoma) • 3rd degree contusion (gangrene) 1st degree contusion (ecchymosis): • It is very mild type which is characterized by pin point hemorrhages on skin and these hemorrhages are more prominent in non pigmented area of body. • Etiology: Blunt object, Compression of hard object, By constant pressure • Clinical signs: • Pin point hemorrhages, Mild inflammation, slight pain • Treatment: • Auto recovery • Apply all methods of acute inflammation • Pain killer drugs (steroids, NSAID or non steroidal) 2nd degree contusion (hematoma): • It is the accumulation of blood under beneath the skin due to damage to major vassals. So blood comes out and accumulates and looks like tumor, abscess and appear as visible bulge. The examples are swelling of on the caudal side of horse, udder of the female, neck of the horse and area where vassals are very superficial. Always fluctuate uniformly and u will see movements of fluid from one side to other. It has all the 4 signs of acute inflammation. Haematoma • Diagnosis • History (fight, automobiles, hit by blunt object) • Physical examination (signs of inflammation) • Differencial diagnosis that confuses with • 1: Abscess 2: Tumor 3: Cyst 4: Bursitis 5: Herniation • Aspiration test. Aspiration needle used to check the acute or chronic hematoma. If by puncturing blood come out it means acute hematoma. In chronic haematoma case serum comes out after aspiration by needle. 2nd degree contusion (hematoma): • Accumulation of extravasated blood (the leakage of blood from a vessel into tissues surrounding. There are two types of hematoma: Acute and Chronic hematoma • Acute and chronic hematoma: • Acute is Fresh or recent case which has all cardinal signs of inflammation. When blood is oozing out from artery. If acute form is not treated then it is converted into chronic after the passage of time. A crepitus (friction rub sound) sound is there. If chronic stage persist for a long period of time the serum is reabsorbed and clot remain there. If this stage is contaminated by micro organisms then it leads to abcess formation. Treatment of acute hematoma: • Two things are very important • If the size of the hematoma continuously increasing and history reveals that it is a recent case so it is acute heamatoma which will indicate that damaged vessel is still bleeding we will never open it and wait for 4-5 days with hydrotherapy untill bleeding stops vassel heals and it is converted into chronic . • If acute heamatoma is opened it may lead to hypovolemic shock because of decrease in blood. • If the size of the hematoma is constant and it is old case , we open the area (long elliptical incision) remove blood, and main bleeder is identified and ligated to stop the hemorrhage. In this case hematoma is not sutured because we want drainage. Treatment of chronic hematoma: • first of all long incision is given and serum and clot is removed. Sometime irrigation of hematoma is done for the proper drainage purpose. • If size of hematoma is 14 inch then never make long incision. On buttock the size of the hematoma may reach upto 12 inch. In such cases give two incisions one on proximal side and one distal side then clear the wound with water. • In big size hematoma setoning is done by giving two incisions for proper drainage. • Organs prone to chronic hematoma: • Base of neck, Shoulder region, Buttock, Abdomen cranial to udder and sheath, Caudal epigastric vein Gangrene • 3rd degree contusion (gangrene): • Gangrene is the death of tissue in part of the body. It is very severe type and blood vessels, muscles and nerves damage and no life is there. Pinch the area to check the response. It can also be checked by.. • Hammering the part • Pinch the area by hand or traumatic object. • Signs: Dark red area Black discoloration No evidence of pain Treatment: Treatment: • There are two methods • If there is little bit response i.e 5% then we go for treatment. If the area below knee is cold then we do following procedures: • Vigorous massage of area to ensure blood supply • Flexion and extension • Counter irritant drug is applied which induce: • Blister Treatment:
• Rubifaciant (A rubefacient is a substance for external
application that produces redness of the skin)These are moderate type of counter irritant. • If the part is not responding then amputation (remove the part) is done. If for example in case of buffalo the last two vertebra are damaged at tail region then we remove the last two vertebra because the infected part is source of infection and saprophytic bacteria (clostridium) are present and lead to toxicity of blood by reaching to blood. If in this case the infection reach up to spinal cord then there is no treatment. Auricular hematoma: • An aural (ear) haematoma is a collection of blood or serum, and sometimes a blood clot within the pinna or ear flap and ear flap become thickened. The swelling may involve the entire ear flap or it may involve only a small area. • Dropping of ear • Tilting of head • Pain, discomfort and depression • The first aim of treatment is to drain the haematoma to relieve the pressure and pain associated with the build up of fluid within the ear flap. This is achieved under general anesthesia where either a single incision or multiple small biopsy holes are made on the inner surface of the ear. The blood is drained and the ear flushed to remove any remaining blood clots. These holes are left open to allow continued drainage of fluid whilst waiting for the ear flap to heal. • Reattachment of the ear cartilage is encouraged with the use of multiple sutures placed through the ear flap (with or without the use of a support to maintain the normal architecture of the ear) and these sutures are left in place for 3 weeks. The specific method used will depend on the size, age and position of the haematoma. Treatment: • Any reason that causes the dog to shake its head can result in the formation of an aural haematoma sh be treated first. • Apply pressure (if hematoma is 1-2 mm) • Drainage (aspiration is done by insulin syringe) • Giving “S” shape incision • Giving “+” shape incision • Small and S-shape incision: mattress sutures are applied in small incisions and knots are always place on the outer side of ear. The inner side skin of ear is very thin and it can cause infection on that side that’s why we apply knots on outer side. • In case of S-shape incision it has edge on elliptical incision because in case of linear incision we can’t expose more area while in case of S-shape incision we can expose more area of infection. • “+” shape incision (cruciate incision): we never apply suture at this type of incision. Here we apply undermining (separation of skin from under lying tissue). Now apply gauze and bandage. Here healing is done by 2nd intension as an open wound. WHAT HAPPENS IF YOUR DOG DOES NOT HAVE SURGERY? • If a haematoma is left untreated the blood in the ear flap will separate into serum and a clot and will gradually be absorbed over a period of 10 days to 6 weeks. This is an uncomfortable time for your dog and unfortunately some scarring will take place during this process. It also causes a deformity of the ear flap resulting in a "cauliflower ear" which may cause further problems.