Kevles, Bettyann Holtzmann. Naked to the Bone: Medical imaging in the twentieth century.

New Brunswick, New Jersey: Rutgers University Press, 1997. Zaret, Barry L., ed. The Patients Guide to Medical Tests. Boston: Houghton Mifflin Company, 1997.
PERIODICALS

Abscess

Description
There are two types of abscesses, septic and sterile. Most abscesses are septic, which means that they are the result of an infection. Septic abscesses can occur anywhere in the body. Only bacteria and the bodys immune response are required. In response to the invading bacteria, white blood cells gather at the infected site and begin producing chemicals called enzymes that attack the bacteria by first marking and then digesting it. These enzymes kill the bacteria and break them down into small pieces that can travel in the circulatory system prior to being eliminated from the body. Unfortunately, these chemicals also digest body tissues. In most cases, bacteria produce similar chemicals. The result is a thick, yellow liquidpuscontaining dead bacteria, digested tissue, white blood cells, and enzymes. An abscess is the last stage of a tissue infection that begins with a process called inflammation. Initially, as invading bacteria activate the bodys immune system, several events occur: Blood flow to the area increases. The temperature of the area increases due to the increased blood supply. The area swells due to the accumulation of water, blood, and other liquids. It turns red. It hurts, due to irritation from the swelling and the chemical activity. These four signsheat, swelling, redness, and paincharacterize inflammation. As the process progresses, the tissue begins to turn to liquid, and an abscess forms. It is the nature of an abscess to spread as the chemical digestion liquefies more and more tissue. Furthermore, the spreading follows the path of least resistance, commonly, the tissue that is most easily digested. A good example is an abscess just beneath the skin. It most easily continues along immediately beneath the surface rather than traveling up through the outermost layer or down through deeper structures where it could drain its toxic contents. The contents of an abscess can also leak into the general circulation and produce symptoms just like any other infection. These include chills, fever, aching, and general discomfort. Sterile abscesses are sometimes a milder form of the same process caused not by bacteria but by non-living irritants such as drugs. If an injected drug such as penicillin is not absorbed, it stays where it is injected and may cause enough irritation to generate a sterile abscess. Such an abscess is sterile because there is no infection involved. Sterile abscesses are quite likely to turn into
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Freundlich, Naomi. Ultrasound: Whats Wrong with this Picture? Business Week (15 September 1997): 84-85. Kuhn, M., Bonnin, R.L.L., Davey, M.J., Rowland, J.L., Langlois, S. Emergency Department Ultrasound Scanning for Abdodminal Aortic Aneurysm: Accessible, Accurate, Advantageous. Annals of Emergency Medicine. (September 2000) 36(3):219-223. Sisk, Jennifer. Ultrasound in the Emergency Department: Toward a Standard of Care. Radiology Today (June 4, 2001) 2(1):8-10.
ORGANIZATIONS

American College of Radiology. 1891 Preston White Drive, Reston, VA 20191-4397. (800)227-5463. <http://www.acr.org>. American Institute of Ultrasound in Medicine. 14750 Sweitzer Lane, Suite 100, Laurel, MD 20707-5906. (301) 4984100. <http://www.aium.org>. American Registry of Diagnostic Medical Sonographers. 600 Jefferson Plaza, Suite 360, Rockville, MD 20852-1150. (800) 541-9754. <http://www.ardms.org>. American Society of Radiologic Technologists (ASRT). 15000 Central Avenue SE, Albuquerque, NM 87123-2778. (800) 444-2778. <http://www.asrt.org>. Radiological Society of North America. 820 Jorie Boulevard, Oak Brook, IL 60523-2251. (630) 571-2670. <http://www.rsna.org>. Society of Diagnostic Medical Sonography. 12770 Coit Road, Suite 708, Dallas, TX 75251-1319. (972) 239-7367. <http://www.sdms.org>.

Jennifer E. Sisk, M.A.

ABO blood typing see Type and screen Abrasions see Wounds Abruptio placentae see Placental abruption

Abscess
Definition
An abscess is an enclosed collection of liquefied tissue, known as pus, somewhere in the body. It is the result of the bodys defensive reaction to foreign material.

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Specific types of abscesses

KEY TERMS
CellulitisInflammation infection. of tissue due to

Listed below are some of the more common and important abscesses. Carbuncles and other boils. Skin oil glands (sebaceous glands) on the back or the back of the neck are the ones usually infected. The most commonly involved bacteria is Staphylococcus aureus. Acne is a similar condition involving sebaceous glands on the face and back. Pilonidal cyst. Many people have as a birth defect a tiny opening in the skin just above the anus. Fecal bacteria can enter this opening, causing an infection and subsequent abscess. Retropharyngeal, parapharyngeal, peritonsillar abscess. As a result of throat infections such as strep throat and tonsillitis, bacteria can invade the deeper tissues of the throat and cause an abscess. These abscesses can compromise swallowing and even breathing. Lung abscess. During or after pneumonia, whether its due to bacteria [common pneumonia], tuberculosis, fungi, parasites, or other bacteria, abscesses can develop as a complication. Liver abscess. Bacteria or amoeba from the intestines can spread through the blood to the liver and cause abscesses. Psoas abscess. Deep in the back of the abdomen, on either side of the lumbar spine, lie the psoas muscles. They flex the hips. An abscess can develop in one of these muscles, usually when it spreads from the appendix, the large bowel, or the fallopian tubes.

EnzymeAny of a number of protein chemicals that can initiate chemical reactions at body temperature. Fallopian tubesPart of the internal female anatomy that carries eggs from the ovaries to the uterus. FloraLiving inhabitants of a region or area. PyogenicCapable of generating pus. Streptococcus, Staphocococcus, and bowel bacteria are the primary pyogenic organisms. Sebaceous glandsTiny structures in the skin that produce oil (sebum). If they become plugged, sebum collects inside and forms a nurturing place for germs to grow. SepticemiaThe spread of an infectious agent throughout the body by means of the blood stream. SinusA tubular channel connecting one body part with another or with the outside.

hard, solid lumps as they scar, rather than remaining pockets of pus.

Causes and symptoms

Many different agents cause abscesses. The most common are the pus-forming (pyogenic) bacteria such as Staphylococcus aureus, which is a very common cause of abscesses under the skin. Abscesses near the large bowel, particularly around the anus, may be caused by any of the numerous bacteria found within the large bowel. Brain abscesses and liver abscesses can be caused by any organism that can travel there through the blood stream. Bacteria, amoebae, and certain fungi can travel in this fashion. Abscesses in other parts of the body are caused by organisms that normally inhabit nearby structures or that infect them. Some common causes of specific abscesses are: skin abscesses by normal skin flora dental and throat abscesses by mouth flora lung abscesses by normal airway flora, bacteria that cause pneumonia or tuberculosis abdominal and anal abscesses by normal bowel flora
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Diagnosis
The common findings of inflammationheat, redness, swelling, and paineasily identify superficial abscesses. Abscesses in other places may produce only generalized symptoms such as fever and discomfort. If an individuals symptoms and the results of a physical examination do not help, a physician may have to resort to a battery of tests to locate the site of an abscess. Usually something in the initial evaluation directs the search. Recent or chronic disease in an organ suggests it may be the site of an abscess. Dysfunction of an organ or system, for instance seizures or altered bowel function, may provide the clue. Pain and tenderness on physical examination are common findings. Sometimes a deep abscess will eat a small channel (sinus) to the surface and begin leaking pus. A sterile abscess may cause only a painful lump deep in the buttock where a shot was given.

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Treatment
Since skin is very resistant to the spread of infection, it acts as a barrier, often keeping the toxic chemicals of an abscess from escaping the body on their own. Thus, the pus must be drained from the abscess by a physician. The surgeon determines when the abscess is ready for drainage and opens a path to the outside, allowing the pus to escape. Ordinarily, the body handles the remaining infection, sometimes with the help of antibiotics or other drugs. The surgeon may leave a drain (a piece of cloth or rubber) in the abscess cavity to prevent it from closing before all the pus has drained out. Alternative treatment If an abscess is directly beneath the skin, it will be slowly working its way through the skin as it is more rapidly working its way elsewhere. Since chemicals work faster at higher temperatures, applications of hot compresses to the skin over the abscess will hasten the digestion of the skin and eventually result in its break down and spontaneous release of pus. This treatment is best reserved for smaller abscesses in less sensitive areas of the body such as limbs, trunk, and back of the neck. It is also useful for all superficial abscesses in their very early stages. It will ripen them. Contrast hydrotherapy, alternating hot and cold compresses, can also help assist the body in resorption of the abscess. There are two homeopathic remedies that work to rebalance the body in relation to abscess formation, Silica and Hepar sulphuris. In cases of septic abscesses, bentonite clay packs (bentonite clay and a small amount of Hydrastis powder) can be used to draw an infection from the area.
An amoebic abscess caused by Entameoba histolytica. (Phototake NYC. Reproduced by permission.)

Of special note, abscesses in the hand are more serious than they might appear. Due to the intricate structure and the overriding importance of the hand, any hand infection must be treated promptly and competently.

Health care team roles

First aid providers may unknowingly initiate an abscess by using inappropriate or incorrect techniques. A physician, surgeon, physicians assistant, or nurse practitioner usually diagnoses the presence of an abscess. Radiologists and laboratory personnel may assist in the process of establishing a diagnosis. A physician, surgeon, physicians assistant, or nurse practitioner usually drains an abscess. Nurses provide supportive care, dress the wound, and educate patients about caring for the resulting wound. Occasionally, a physical therapist may be needed to recover lost function.

Prognosis
Once an abscess is properly drained, the prognosis is excellent for the condition itself. The reason for the abscess (other diseases an individual has) will determine the overall outcome. If, on the other hand, an abscess ruptures into neighboring areas or permits the infectious agent to spill into the bloodstream, serious or fatal consequences are likely. Abscesses in and around the nasal sinuses, face, ears, and scalp may work their way into the brain. Abscesses within an abdominal organ such as the liver may rupture into the abdominal cavity. In either case, the result is life threatening. Blood poisoning is a term commonly used to describe an infection that has spilled into the blood stream and spread throughout the body from a localized origin. Blood poisoning, known to physicians as septicemia, is also life threatening.

Prevention
Infections that are treated early with heat (if superficial) or antibiotics will often resolve without the formation of an abscess. It is even better to avoid infections altogether by taking prompt care of open injuries, particularly puncture wounds. Bites are the most dangerous of all, even more so because they often occur on the hand. Resources
BOOKS

Balistreri, William. Liver abscess. In Nelson Textbook of Pediatrics, 16th ed., edited by Richard E. Behrman et al., Philadelphia, Saunders, 2000, 1212. Chesney, Russell W. Brain abscess. In Nelson Textbook of Pediatrics, 16th ed., edited by Richard E. Behrman et al., Philadelphia, Saunders, 2000, 1857-1858. 7

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Finegold, Sydney M. Lung abscess. In Cecil Textbook of Medicine, 21st ed., edited by Goldman, Lee and Bennett, J. Claude. Philadelphia: W.B. Saunders, 2000, 439-442. Herendeen, Neil E and Szilagy, Peter G. Peritonsillar abscess. In Nelson Textbook of Pediatrics, 16th ed., edited by Richard E. Behrman et al., Philadelphia, Saunders, 2000, 1266-1267. Scheld, W. Michael. Bacterial meningitis, brain abscess, and other suppurative intracranial infections. In Harrisons Principles of Internal Medicine, 14th ed., edited by Anthony S. Fauci, et al. New York: McGraw-Hill, 1998, 2419-2434. Schwartz, Seymour, Shires, Tom and Spencer, Frank C.Principles of Surgery, 7th ed. New York, McGraw Hill, 1998. Stern, Robert C. Pulmonary abscess. In Nelson Textbook of Pediatrics, 16th ed., edited by Richard E. Behrman et al., Philadelphia, Saunders, 2000, 1309-1310. Townsend, Courtney M. Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice, 16th ed. Philadelphia, Saunders, 2001.
PERIODICALS

University of California-San Diego: <http://burn.ucsd.edu/remedies/abcess.html>. University of Kansas Medical Center. <http://www.kumc.edu/instruction/medicine/pathology/ed /ch_28/c28_s24.html>.

L. Fleming Fallon, Jr., MD, DrPH

Achromatopsia see Color blindness

Acid-base balance
Definition
Acid-base balance can be defined as homeostasis of the body fluids at a normal arterial blood pH ranging between 7.37 and 7.43.

Balatsouras DG, Kloutsos GM, Protopapas D, Korres S, Economou C. Submasseteric abscess. Journal of Laryngology and Otology 115, no. 1 (2001): 68-70. Chua, F. Clinical picture: paravertebral abscess. Lancet 357, no. 9251 (2001): 168-70. Rockwell PG. Acute and chronic paronychia. American Family Physician 63, no. 6 (2001): 1113-6. Struk DW, Munk PL, Lee MJ, Ho SG, Worsley DF. Imaging of soft tissue infections. Radiology Clinics of North America 39, no. 2 (2001): 277-303. Taiwo B. Psoas abscess: a primer for the internist. Southern Medical Journal 94, no. 1 (2001): 2-5.
ORGANIZATIONS

Description
An acid is a substance that acts as a proton donor. In contrast, a base, also known as an alkali, is frequently defined as a substance that combines with a proton to form a chemical bond. Acid solutions have a sour taste and produce a burning sensation with skin contact. A base is any chemical compound that produces hydroxide ions when dissolved in water. Base solutions have a bitter taste and a slippery feel. Despite variations in metabolism, diet, and environmental factors, the bodys acidbase balance, fluid volume, and electrolyte concentration are maintained within a narrow range.

American Academy of Family Physicians, 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (913) 9066000. <http://www.aafp.org/>. fp@aafp.org. American Society of Clinical Pathologists, 2100 West Harrison Street, Chicago IL 60612. (312) 738-1336. <http://www.ascp.org/index.asp>. info@ascp.org. College of American Pathologists, 325 Waukegan Road, Northfield, IL 60093. (800) 323-4040. <http://www.cap.org/>.
OTHER

Function
Many naturally occurring acids are necessary for life. For example, hydrochloric acid is secreted by the stomach to assist with digestion. The chemical composition of food in the diet can have an effect on the bodys acid-base production. Components that affect acid-base balance include protein, chloride, phosphorus, sodium, potassium, calcium, and magnesium. In addition, the rate at which nutrients are absorbed in the intestine will alter acid-base balance. Cells and body fluids contain acid-base buffers, which help prevent rapid changes in body fluid pH over short periods of time, until the kidneys pulmonary systems can make appropriate adjustments. The kidneys and pulmonary system then work to maintain acid-base balance through excretion in the urine or respiration. The partial pressure of carbon dioxide gas (PCO2) in the pulmonary system can be measured with a blood sample and

American Society of Colon and Rectal Surgeons. <http://www.fascrs.org/brochures/anal-abscess.html>. Merck Manual. <http://www.merck.com/pubs/mmanual/ section3/chapter35/35d.htm>. South Bank University. <http://www.sbu.ac.uk/~dirt/ museum/p6-216.html>. Tuberculosis.Net. <http://www.tuberculosis.net/imagesof/ rulcavity.htm>. University of Bristol. <http://www.brisbio.ac.uk/ROADS/ subject-listing/abcess.html>. 8

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