6 abscesses Flashcards Preview

infectious disease > 6 abscesses > Flashcards

Flashcards in 6 abscesses Deck (162):
1

abscess

a swollen, inflamed area in body tissues, in which pus gathers and would presumably drain from

2

what determines the pathogens within the abscess

flora of the region

3

what determines the site of the abscess?

-head and neck anatomy
-syndromes you must recognize
-therapeutic principles/guidelines

4

how can organisms involved in abscesses reach a normally sterile internal area?

blood borne
penetration/trauma
extension from a nearby non-sterile area, such as a mucosal surface

5

blood borne

hematogenous spread

6

penetration/trauma

knife wound

7

extension from a nearby non-sterile area such as a

mucosal surface

8

most brain abscesses are from

oral focus

9

eusobacterium

oral flora that can spread to brain tissue

10

commensal

normal flora

11

streptococcus pyogenes

group A strep

12

what adheres well to oral epithelial cells and

strep pyogenes (group A strep)

13

S salivarius and veillonella species colonize

tongue + buccal mucosa

14

S mutans + mitis and actinomyces viscosus colonize

dental surfaces

15

staphylococcus aureus is present on

skin and nares

16

pelvic abscess is an extension of an

intestinal wall infection (diverticulitis) + contains a mixture of bacteria that originated in the large intestine

17

abdominal abscesses

aeropic organisms + anaerobes

18

aerobic organisms of abdominal abscesses

e. coli which tolerate anoxic conditions

19

anaerobes of abdominal abscesses such as bacteroides

not killed by tiny doses of oxygen, and have enzymes such as superoxide dismutase to detoxify oxygen radicals and catalase to break down hydrogen peroxide

20

anaerobes

clostridia, anaerobic and facultative anaerope, strep

21

strict anaerobe

22

facultative anaerobe

2-8% oxygen

23

abscesses in gluteus muscle

cardiac infection (endocarditis) allowed bacteria to spread to the butt via the bloodstream

24

what causes cardiact valve infections?

staphylococcus + streptococcus

25

distant site abscess is a pure culture of the

single organism

26

hematogenous spread= bacteremia common with

skin infections, pneumonia, uti/kidney infections

27

secondary sites of hematogenous spread

large joints (hips, elbows), bones, lungs, liver, spleen`

28

bacteriology of the abscess may be anticipated from

the microbial flora of the originating focus

29

most abscesses originate from

teeth, dental crevices

30

most abscesses harbor

harbor four or five organisms, mainly oral anaerobes

31

infections arise from the pharynx contain oral anaerobes and

strep pyogenes + staph aureus

32

polymicrobial synergy

typical deep neck ifnections + abscesses include on average 5 or 6 bacterial species
-synergy between a # of species renders the whole pathogenic

33

upper airway harbors large numbers of what kind of bacteria?

anaerobic bacteria of limited virulence unless allowed entry into sterile areas

34

some pathogens need no assistance! no polymicrobial synergy

staph + strep fusobacterium

35

how do polymicrobibal synergistic infection species work?

add something necessary but not sufficient

36

pyrosequencing

many uncultured species

37

example of pyrosequencing

bacteroids fragilis has a capsular polysaccharide complex (CPD) with (+) and (-) charges promoting abscesses; without CPD, no abscess is formed

38

with polymicrobial synergistic infections, tx has to be aimed at

different kinds of bacteria, not just one

39

abcesses can be

polymicrobial

40

how are organisms introduced during abscess formation

trauma or via bloodstream (local)

41

what can narrow the mixture of organisms?

early presence of oxygen and then later, the lack of oxygen

42

host response to abscess

walls off organisms with fibrin deposition, eventually thick-walled fibrous collagen capsule

43

inside an abscess

live/dead cells, bacteria, debris

44

healthy tissue is well oxygenated unless you have

-interruption of blood flow (surgery + trauma)
-ischemic necrosis from tumors
-adjacent infection

45

adjacent infections produce

cytotoxic and necrotizing factors extending infection; organisms can consume oxygen rednering tissue anaerobic, which means dead tissue

46

are most oral infections anaerobic or aerobic?

anaerobic (oral abscesses, periodiontal lesions, pulp, periapical lesions0

47

oxygen tolerance varies from species to species

-requires low [02] and reduced oxidation-reduction potential

48

anaerobes outnumber aerobes by how much in the oral cavity and skin

10:1

49

anaerobes outnumber aerobes by how much in the colon

1,000 : 1

50

few anaerobes by themselves are very virulen

fusobacterium, clostridium, + bacteroides

51

what presents on gram negs, and have a strong correlation with pulp + periodontal damage and endotoxin?

endotoxin; metabolites (hydrogen sulfide, ammonia) and injurious enzymes are made

52

host neutrophils require oxygen for their

metabolic burst but is lacking

53

beta- lactamases mediate

penicillin resistance

54

bacteria have acquired antibiotic resistance like

beta lactamase + penicilin lactamase

55

anaerobic infections characteristics

-polymicrobial, usually endogenous + opportunistic
-occur in closed spaces
-smell foul (cadavers)
- accompanied by thrombophlebitis

56

thrombophlebitis

bacterial enzymes promote clot formation; gram neg endotoxins activate clotting cascade, bad since clotted vessels lead to death

57

why are abscesses often biphasic

phase 1 acute inflammation phase 2 local abscess formation

58

resurgent infection

some anaerobes (bacteroides) are resistant to antibiotics, so initial tx with antibiotics may kill off bacteria, but not the bacteroides, leading to resurgent infection

59

resurgent infection

kils of bacteria that are sensitive to antibiotics, but the ones that aren't still survive, so youthink people are fine, but they are in fact still sick

60

cervical fascia

muscles, vessels, and visceral structure of the neck are eveloped in fascia

61

interfascial spaces

potential areas where abscesses can sit

62

what are borders for infections

fascia

63

pediatric neck abscessse commonly in

submandibular and posterior triangle and submental

64

superficial fascia

subcutaneous tissues of neck which are continuous with platysma anteriorly; begins at nuchal line

65

what does the superficial fascia enclose

trapezius
SCM
strap mmms
submaxillary glands
parotid glands

66

middle or pretracheal fascia

often involved in dental infections that have extended from site of origin

67

infection in what artery with compromise blood flow to brain

carotid

68

second spaces

within submental + submandibular triangles, between mucosa of floor of mouth and superficial layer of deep fascia

69

what divides the second spaces

myelohyoid mucsle into submandibular + sublingual spaces

70

clinical syndromes

-peritonisillar, parotid, parapharyngeal and submandibular abscesses
-parapharyngeal space abscess
-pterygopalatine, infratemporal, + temporal fossa abscesses
-retropharyngeal abscesses
-lung abscesses

71

*sore throat and trismus is sean in

peritonsillar , parotid, parapahryngeal, and submandibular abscesses

72

trismus

inability to open the jaw; pressure or infection of the muscles of mastication

73

trismus involves motor branch of which nerve

trigeminal

74

dysphagia (can't eat) + odynophagia (can't swallow

inflammation of cricoarytenoid joint

75

dysphonia + hoarseness

-neck infection (10th cranial nerve)
-unilateral tongue paresis (12th cranial nerve

76

stridor + dypsnea

local pressure or spread of infection to mediastinum

77

unilateral tongue paresis

nerve problems

78

patients w/ peritonsillar, parotid, parapharyngeal, and submandibular abscesses have

-facial + neck swelling, erythema, purulent oral discharge
-pooling of saliva in mouth and asymmetry of oropharynx to help determine where problem is\
-adenopathy
-flucuation

79

adenopathy

enlargement of lymph nodes anywhere in body

80

characteristic signs of deep pus

pitting or a doughy feeling on firm deep palpation

81

Is ludwig's angina an abscess?

no, but can be consued with on

82

ludwig's angina

rapidly spreading cellulitis, not an abscess

83

what anatomical feature does ludwig's angina include

floor of the mouth and loose areolar tissue above the myelohyoid diaphragm

84

what are the dominant flora in ludwig's angina

oral flora = strep and anaerobes

85

what precedes ludwig's angina in a most cases

recent lower molar extraction

86

what is critical to control during ludwig's angina

airway control, asphyxiation is a route of death, as is sepsis

87

why does ludwig's angina look like an abcess?

fluids and gases collect and can mimic collection of pus

88

what is commonly seen with ludwig's angina

people with bad oral hygiene and trismus

89

tx ludwig's angina

antibiotic therapy

90

how does death occur during ludwig's angina

suffocation (edema mouth, togue, glottis) mediastinitis, septicemia, pneumonia

91

ludwig's angina II

brawny or indurated edema of the neck, hard, does not give, no pus formation

92

indurated

hardened

93

who does acute bacterial parotitis usually affect

elderly, dehydrated, intubated, postoperative individual

94

acute bacterial parotitis

salivary stasis permis retrograde seeding of stensen's duct with virulen oral flora

95

risk factors for acute bacterial parotitis

recent vigorous teeth cleaning, use of antcholinergic drugs and salivary calculi

96

most common pathogen in acute bacterial parotitis

staphyloccoccus aureus but anaerobes, enteric gram neg bacterial and other organisms also seen

97

acute bacterial parotitis patients present with

pain, swelling of parotid gland and dysphagia

98

acute bacterial parotitis and stensen's duct

pus can be expressed, it should be cultured and gram stained
-gland can suppurate and abscess may be present

99

treatment for acute bacterial parotitis

hydration, antibiotics directly against staphlococci + mouth flora

100

stone forms in stensen duct of acute bacterial parotitis

person is dehydrated, difficulty forign saliva, taking meds

101

give lemon drops to patients with acute bacterial parotitis

to stimulate salivary production

102

acute bacterial parotitis usually caused by

staph!

103

true submental + submandibular abscesses

usually after an infected submandibular lymph node or salivary gland suppurates

104

true submental + submandibular abscesses fluctuation is easy becasue

no overylying musculature and fascia is not dense

105

submental abcesses usually ressult from

spread of an apical abscess of the lower incisors through the thin buccolabial acrolar plate and below the myelohyoid diaphragm or from suppuration of a submental lymph node

106

true submental + submandibular abscesses

elevation of floor of mouth may be seen but swelling of ludwig's angina is NOT PRESENT

107

true submental + submandibular abscesses infection can be so bad that it destroys the

lymph node or salivary gland leading to an abscess

108

parapharyngeal

lateral pharyngeal= pharygomaxillary space

109

parapharyngeal space

upper neck, above the hyoid; inverted cone with base bounded by the skull and apex toward the hyoid bone

110

parapharyngeal space close to the

carotid sheath

111

6 lymph nodes

form a collar around the junction of head and neck; rest are chains

112

6 lymph node groups

occipital
mastoid
parotid
facial
submandibular
submental

113

node chains

lateral and anterior cervical nodes

114

common root for drainage of nodes

lateral cervical chain

115

final conduit form from all lymphatics in the head and neck

large deep carotid sheath chain

116

before antibiotics, half of all head and neck infections were from

infection in tonsils or pharynx

117

what usually arises as a complication of peritonsillar abscess but infections of the parotid gland, dental roots, petrous pyramid, or after dental or pharyngeal surgery may extend into this space

parapharyngeal abscess

118

triad of pharyngeal abscess

tonsillar prolapse with swelling of lateral pharyngeal wall, trismus, and parotid swelling

119

abscess in parapharyngeal space

extension of abscess into the carotid sheath is frequent

120

**erosion of the internal carotid artery leads to s

strokes, fatal hemorrhage, thrombophlebitis of the internal jugular vein with intracranial extension

121

inferior extension to the pyriform sinus during parapharyngeal space abscess leads

obstruction of upper airway

122

extension from the retropharyngeal space or carotid sheath during parapharyngeal space abscess leads to

mediastinitis

123

septic thrombosis

blood flow through carotid only on one side so one side of the brain has no blood flow

124

pterygopalatine fossa

maxillary nerve + branches, sphenopalatine ganglion, internal maxillary artery and branches

125

infections of maxillary and spenoid sinuses can involve

abducens nerve, inferior branch of the oculomotor nerve, and maxillary nerves

126

where do infections after a extraction of a maxillary molar tooth or after local anesthesia of the superior alveolar nerve cause infections?

pterygopalatine, infratemporal, and temporal fossa infections

127

fulminant cellulitis

involves upper molar gingiva, pterygopalatine, infratemporal, and temporal fossa, and then abscess formation in these spaces ensues

128

proptosis of the ye bc pus in inferior orbit requires (pterygopalatine abscess)

surgical drainage

129

what is the most important communication between the neck and the chest

retropharyngeal space

130

retropharyngeal space

runs longitudinally from the base of the skull to the posterior mediastinum-between the prevertebral fascia posteriorly and the posterior aspect of the pretracheal fascia anteriorly

131

what does the retropharyngeal space communicate with?

parapharyngeal space laterally, where it is bounded by carotid sheaths

132

retropharyngeal abscess

results from lymphatic spread of infection in the pharynx or sinuses to the retropharyngeal lymph nodes . The nodes suppurate, leading to abscess

133

retropharyngeal lymph node abcesses are common in

children age 3 or 4 bc that's when these lymph nodes involute

134

in older children or adults, abscess can occur after

accidental perforatoin such as with a fish bone or lollipop stick

135

retropharyngeal abscesses are polymicrobial

with anaerobes, streptococci, and staphylococcci predominating

136

retropharyngeal abscess symptoms

-chillls and fever after pharyngitis
-dysphagia
-neck pain
-dypnea
-regurgitation

137

children with retropharyngeal abscess may have

insidious onset with irritablility + refusal to eat

138

neck during retropharyngeal abscess

hyperextended with local tenderness

139

retropharyngeal symptoms

muffled voice (Dysphonia) + drooling followed by tachypnea + stridor

140

what is the most important tool for diagnosis of retropharyngeal abscess

lateral neck radiograph

141

what are treatments of retropharyngeal abscess

drainage and high dose penicillin or clindamycin

142

thickened pre-vertebral fascial space

extra space between arrow and vertebral column- entire airway is pushed forward

143

rupture of the abscess can lead to

aspiration of the pus into the lungs, and pneumonia and empyemia

144

an abscess in the danger space between the alar and the prevertebral fascias may drain into the mediastinum , resulting in

mediastinitis

145

hemorrhage suggest

involvement of the major blood vessels, and phlebitis or thrombosis of the internal jugular vein

146

lung abscesses

aspiration of oral contents, anaerobic flora predominates, alcoholics, people who have been in the hospital, little gastric acid may have different flora

147

lung abscesses

staphlococcus aureus, gram negative enterics often colonize the mouth and upper intestinal tract in those who belong to the latter group. thus, anaerobes, and at times S. aureus and gram negatives, are found in lung, again polymicrobial

148

lung abscesses description

-inoculum size must be big enough
-acid may induce a chemical pneumonitis
-occlusion of the airway by food or foreign objects renders the area anaerobic
-synergism of diff bacteria
- nutritional state and integrity of the host defenses are important
-aspiration pneumonia now very common

149

initially, lung abscesses begin with

a necrotizing pneumonia, often after aspiration

150

lung abscesses- microabscesses

form and coalesce

151

2 weeks after aspiration

lung abscess is seen

152

location of lung abscesses depends on the dependent region

lower lobes more comon than upper
=people who have gotten drunk and passed out upside down before aspiration or inhalation of vomitus may be in upper lobes

153

lung abscess drains into

bronchiole, causing foul sputum and foul oral odors

154

if air gets into lung abscess cavity

then an air-fluid lvel may be seen on chest radiograph

155

if a lung abscess drains into the pleura,

an empyema may form

156

lung abscess tx

drain, long course of antibiotics-can be oral after iv

157

bubbles in radiographs are probably

abscesses

158

therapy of abscesses

-activity against anaerobes or aerobes
-bacteroides make beta lactamase limiting penicillin, therefore broad spectrium penicillins (beta lactam) + beta lactamase inhibitor are useful like ampicillin/sulbactam

159

what is also used as therapy for abscesses

metronidazole, clindamycin btu bacteroides are becoming resistant to clinda

160

clindamycin fights

strep, staph, anaerobes

161

1st main cause of sore throat

strep

162

2nd main cause of sore throat

gonorrhea