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Lumps & Bumps

• Lumps :Vague of mass of body tissue


• Swelling : vague term which denote any
enlargement or protuberance in body due
to any cause
ABSCESS
• Abscess : localised collection of pus
(dead & dying neutrophil plus proteinaceous)
CLASSIFICATION

• Pyogenic abcess
• Pyaemic abcess
• Cold abcess
PYOGENIC ABSCESS
• Cause:
• Staphylococcal infecion
• Enter soft tissue through external wound
minor or major.
• Haematogenous spread from dinstant foci
(ex tonsillitis, caties tooth)
Pathophysiology
Symptom & Sign
• Throbbing pain (pressure of pus at
nerve ending).
• Fever with / without Chills & rigor
• Localise swelling
(smooth,soft,fluctuant)
• Visible (pointing) pus
• Calor (warm)
• Rubor (redness)
• Dalor (pain)
• Tumour (swelling)
• Loss function
• Fluctuation
Treatment
• Incission and Drainage (I&D)
• under general anaesthesia preffered
• Local anaesthesia Not preffered if infection
present ,because difficult to act and
difficult to break the loculi without cause
pain.
• stab of incision is made over the most
prominent part abscess.

• pus which come out is collected & sent for


culture & sensitivity.

• sinus forcep / finger is introduce within abscess


cavity & all loculi is broken down

• fresh oozing pus indicate completion procudere


• The abcess cavity is irrigated with saline/
mild antiseptic agent (Iodine, H202).
• H2O2 act by liberating nascent oxygen.
• Nascent oxygen bubble out & helping
remove the slough.
• If large cavity, roller gauze dipped in iodine
need to be packed which it removed after
1-2 days later.
• prevent premature closure of skin, so help
in healing from depth of cavity by
granulation tissue formation.
• Antibiotic & proper dressing can heal the
wound within 5-7days.

• cloxacillin (500mg,6th hourly for 5-7 day)


Modified Hilton's method
• abscess is located in important anatomical
structural like Vessel & Nerve.
• skin & superficial fascia are incised ,
instead of stab incision.
• sinus of abscess open by forcep, to avoid
damage to vital structure.
Differential Diagnosis
• Ruptured aneurysm
• Soft tissue sarcoma
PYAEMIC ABCESS
• Pus-producing organisms in circulation (pyaemia)
• Systemic effect of sepsis.
• Common in diabetic & pt receiving chemotheraphy
and radiotheraphy.
• Characterised :
- Multiple
- Deep-seated
- Minimum tenderness
- Local rise of temperature NOT present
Treatment
• Multiple incisions at abscess site &
drainage + antibiotic
Cold Abcess
• An abscess with no sign of inflammation.
• Commonly due to TB.
• Causes :
- TB
- Actinomycosis
- Leprosy
- Madura foot
Cervical Tuberculous lymphadenitis
• cause : M.tuberculois, M.bovis
• site lymphadenopathy :
- Neck 85%
- Axilla 8%
- Abdomen 5%
- Inguinal 2%
Clinical
• increase painless swelling of 1 or more LN
for few week to few month.
• systemic symptom- fever,LOW,fatigue, night
sweat
Stage TB lymphadenitis
• 1- stage of lymphadenitis
-young adult (20-30yr)
-upper anterior deep cervical LN
enlarge
-Nontender,discrete,mobile,firm
LN
2. Stage of periadenitis
/matting stage
- result due to
involvement of
capsule
- Node move together
(matting)
- Firm & non tender
- matting is
pathognomonic for TB
3. Stage of cold abscess
- caseating necrosis LN cause fluctuant
swelling neck.
- clinical:
-No local rise temperature
-No tenderness
-No redness
-soft,cystic, fluctuant swelling
-Transillumination -ve
-on Sternocledomastoid contraction test,
less prominent. Shows that it deep to deep
fascia.
4. stage of collar stud abscess
- result when a cold abscess which
is below to deep fascia is rupture
through deep fascia, & forming
another swelling in subcutaneous
plane.
- it will fluctuant.
- cross fluctuation test +ve
5. Stage of sinus
- Sinus is blind tract leading from surface
down into tissue.
-Thus, it occur when collar stud abscess
rupture through skin.
-sinus can be multiple & it is wide opening
-Group of LN is palpable underneath the
sinus.
Treatment
• Non dependent aspiration
• Wide bore needle
- caseous material thick.
- avoid a persistent sinus.
• I&D not preferred because it cause persistent
TB sinus.
• Anti-TB treatment given.
SEBACEOUS CYST
(wen, Epidermal cyst)
SEBACEOUS CYST
• Retention cyst.
• due to blockage of duct of sebaceous gland
causing cystic swelling.
• site : face, scalp,scrotum
Contain : yellowish white cheesy material
with fat & epithelium
Consistency: putty like + parasite in wall of cyst.
(Demodex folliculorum)
Line : epidermal layer of squamous epithelium
Contain : yellowish white
cheesy material with fat &
epithelium

Consistency: putty like

Line : epidermal layer of


squamous epithelium
• Stawberry scrotum
Clinical
• Painless swelling :

 smooth surface
 soft consistency
 nontender
 freely mobile
 adherent to skin over summit
 fluctuant
 non-transilluminating with
present of punctum over summit

*punctum= dark spot in center, filled


with keratin.
It indicte blockage of duct .
• Moulds on finger
indentation
• Hair loss over surface
(constant pressure over hair folicle root)
Complication
• Infection & abcess formation
• Ulcerated surface cause painful, fungating mass
with discharge (Cock's peculiar tumour)
• Sebaceous horn- hardening of slowly
discharged sebum through punctum.
Horn is one which has greater length than base
diameter.
sebaceous horn
• Cock peculiar tumor
Treatment
• Elliptical incision - dissection method
• Incision & avulsion cyst wall
• If abscess formed, drainange initially &
later excision done.
• If capsule not removed properly, cyst will
recur
Lymphangioma
• congenital origin
• failure of one of lymphatic to the join major lymph sac
of body.
• The dilated lymphatic will project to skin surface.
• site : - posterior triangle of neck
- axilla
- mediastinum
- groin
TYPE

Capillary Cavernous Cystic


lymphangioma lymphangioma hygroma
Capillary lymphangioma
• Circumscribe lesion : small vesicle/ small
blister/slightly elevated skin patch.
• Lymphangioma circumscription (<5cm)
Lymphangioma diffusion (widely spread)
Lymphoedema ab igne (reticulate pattern
of ridge)
• site : inner thigh, buttock, shoulder, axilla
• lesion area is soft & spongy & not compressible
• multiple cyst/ 1-2 large cyst
• fluctuation,fluid thrill,translucency test (+ve)
• lesion often infected causing pain.
• Lymph drainage not blocked, no skin edema
• regional LN not enlarge.
Cavernous lymphagioma
• Big lymphatic swelling
• more deeper like muscle
• site: face , mouth, lips, tongue
• lesion :
- lobulated
- soft
- fluctuant (+ve)
- Brilliantly translucent
Cystic Hygroma
• most common at neck
• collection of clustered sequestered lymph
sacs presenting in newborn as :
• large swelling
- soft
- smooth
- fluctuant
- brilliant transluminant
- Compressible
Treatment
• Surgical excision
-all loculi / cyst should remove
-careful search has to be made for extension
lymphangioma through muscle fibre to
prevent recurrence