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Acute tonsillitisDr. Barbara Pieper
Palatine tonsils
Palatine tonsils• Each tonsil is an  ovoid mass of  lymphoid tissue• Situated in the  lateral wall of  oropharynx  between...
Palatine tonsils• Actual size is bigger  than it appears from  the surface• Tonsils extend  upwards in the soft  palate , ...
Palatine tonsils• A tonsil presents two  surfaces - a medial  and a lateral• And two poles an  upper and a lower
Palatine tonsils• The medial surface of the tonsil is covered by  non-keratinising stratified squamous  epithelium which d...
Arterial supply of tonsil
Lymphatic drainage• Drainage goes into upper deep cervical  nodes particularly the iugulodigastric  (tonsillar) nodes situ...
Classification of tonsillitis• Acute catarrhal or superficial tonsillitis, part of  generalised pharyngitis• Acute follicu...
Aetiology of acute tonsillitisMost commonly infecting organisms- haemolytic streptococcus- staphylococcus- pneumococcus- H...
Symptoms of acute tonsillitis• Sore throat• Difficulty in swallowing - the child may  refuse to eat anything• Fever - from...
Signs of acute tonsillitis• Foetid breath, tongue coasted• Hyperaemia of pillars, soft palate and uvula• Tonsils are red a...
Treatment of acute tonsillitis• Patient is put to bed and encouraged to  take plenty of fluids• Analgesics (e.g.Paracetamo...
Complications of acute tonsillitis•   Chronic tonsillitis•   Peritonsillar abscess•   Parapharyngeal abscess•   Cervical a...
Differential diagnosis of membrane           over the tonsil• Diphteria     slower in onset     less local discomfort     ...
Differential diagnosis of membrane           over the tonsil• Infectious mononucleosis - glandular fever     young adults ...
Differential diagnosis of membrane           over the tonsil• Agranulocytosis     •   Ulcerative necrotic lesions elsewher...
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Acute tonsillitis
Acute tonsillitis
Acute tonsillitis
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Acute tonsillitis

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Transcript of "Acute tonsillitis"

  1. 1. Acute tonsillitisDr. Barbara Pieper
  2. 2. Palatine tonsils
  3. 3. Palatine tonsils• Each tonsil is an ovoid mass of lymphoid tissue• Situated in the lateral wall of oropharynx between anterior and posterior pillars
  4. 4. Palatine tonsils• Actual size is bigger than it appears from the surface• Tonsils extend upwards in the soft palate , downwards into base of tongue,• Anteriorly into palatoglossal arch
  5. 5. Palatine tonsils• A tonsil presents two surfaces - a medial and a lateral• And two poles an upper and a lower
  6. 6. Palatine tonsils• The medial surface of the tonsil is covered by non-keratinising stratified squamous epithelium which dips into the tonsils in form of crypts (tube-like invaginations)• The lateral surface presents as well defined fibrous capsule• Foreign material is directly transported to the lymphoid cells via tonsillar crypts
  7. 7. Arterial supply of tonsil
  8. 8. Lymphatic drainage• Drainage goes into upper deep cervical nodes particularly the iugulodigastric (tonsillar) nodes situated below the angle of mandible
  9. 9. Classification of tonsillitis• Acute catarrhal or superficial tonsillitis, part of generalised pharyngitis• Acute follicular tonsillitis, infection spreads into the crypts• Acute parenchymatous tonsillitis, tonsil substance is affected, tonsil is uniformly enlarged and red• Acute membranous tonsillitis, stage ahead of follicular tonsillitis
  10. 10. Aetiology of acute tonsillitisMost commonly infecting organisms- haemolytic streptococcus- staphylococcus- pneumococcus- Haemophilus influenzae
  11. 11. Symptoms of acute tonsillitis• Sore throat• Difficulty in swallowing - the child may refuse to eat anything• Fever - from 38° to 40°C, may be associated with chills and rigors• Earache• Constitutional symptoms include headache, malaise, abdominal pain
  12. 12. Signs of acute tonsillitis• Foetid breath, tongue coasted• Hyperaemia of pillars, soft palate and uvula• Tonsils are red and swollen with yellowish spots (follicular) or whitish membrane (membranous)• Tonsils may be enlarged and congested (parenchymatous)• The iugulodigastric lymph nodes are enlarged and tender
  13. 13. Treatment of acute tonsillitis• Patient is put to bed and encouraged to take plenty of fluids• Analgesics (e.g.Paracetamol) to relieve local pain and bring down the fever• Antimicrobial therapy for 7-10 days penicillin is the drug of choice, alternativly in case of penicillin-allergy erythromycin
  14. 14. Complications of acute tonsillitis• Chronic tonsillitis• Peritonsillar abscess• Parapharyngeal abscess• Cervical abscess• Acute otitis media• Rheumatic fever• Acute glomerulonephritis• Subacute bacterial endocarditis
  15. 15. Differential diagnosis of membrane over the tonsil• Diphteria slower in onset less local discomfort membrane is adherent and removal leaves a bleeding surface culture: corynebacterium diphteriae• Vincent´s angina less fever, less discomfort membrane over one tonsil removal leaves irregular ulcer under membrane culture: fusiform bacili, spirochaetes
  16. 16. Differential diagnosis of membrane over the tonsil• Infectious mononucleosis - glandular fever young adults affected both tonsils enlarged, congested, covered with membrane marked local discomfort enlarged lymphnodes in posterior triangle of neck, hepato- and splenomegaly caused by Epstein-Barr virus failure of antibiotic treatment blood smear: 50% lymphocytes, 10% atypical
  17. 17. Differential diagnosis of membrane over the tonsil• Agranulocytosis • Ulcerative necrotic lesions elsewhere in the oropharynx • Total leucocytic count < 2000/cu mm • Patient is severely ill• Aphtous ulcers any part of oral cavity very painful• Malignancy tonsil• Traumatic ulcer any injury heals by formation of a membrane
  18. 18. Try to get a look inside
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