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Tonsillitis
- 1. Acute Tonsillitis Aavash Mishra NepaleseArmy Institute of Health Sciences- College of Medicine
- 2. Tonsil Histology • Surfaceepithelium (continuous with oropharyngeal lining) • Crypts (tube like invaginations from surface epithelium) • Lymphoid tissue
- 4. Classification • Acute catarrhal/superficialtonsillitis • Acute membranous tonsillitis • Acute follicular tonsillitis • Acute parechymatous tonsillitis
- 5. Acute catarrhal/Superficial tonsillitis • Tonsillitisis a part of generalized pharyngitis • seen in viral infections
- 7. Acute membranous tonsillitis •Stage before Acute Follicular Tonsillitis • Exudation from crypts coalesce to form a membrane on the surface • Whitish membrane on medial surface which can be easily wiped away
- 9. Acute follicular tonsillitis •Infection ➔ Crypts ➔ Fills with purulent material • Presents at openings of crypts as yellowish spots • Tonsills red, swollen
- 11. Acute parenchymatous tonsiltis • Tonsilsubstance affected • Tonsil uniformly enlarged and red, meet in midline (kissing tonsils)
- 13. Etiology • School-ongoing children,Adults • Rare in infants and person >50 years • Primarily bacterial infection or secondary to viral infection
- 14. Bacteria • Hemolytic Streptococcus •Staphylococcus • Pneumococcus • H.influenzae
- 15. Symptoms • Sore Throat •Difficulty swallowing (refuses to eat) • Earache • Fever • Constitutional Symptoms
- 16. Fever • 38-48 ºC •with chills, rigors
- 17. Earache • referred painfrom tonsil • AOM (complication)
- 18. Constitutional Symptoms • headache •general body ache • malaise • constipation • abdominal pain (mesenteric lymphadenitis- AA)
- 19. Signs • fetid breath •coated tongue • hyperemia of pillars, soft palate, uvula • Tonsillar signs (See before) • Jugular Digastric Lymph Nodes enlarged
- 20. Complications • Chronic Tonsillitiswith recurrent acute attacks (due to incomplete resolution) • Peritonsillar, Peripharyngeal Abscess • Cervical Abscess (Suppuration of Jugulodigastric Lymph Nodes) • Acute Otitis media • Rheumatic fever (GAHS) • Subacute bacterial endocarditis (S.viridans) • Acute glomerulonephritis
- 21.
- 23. Treatment • Bed rest •Plenty of fluids • Analgesics (aspirin/paracetamol) • Antimicrobial therapy • Surgery
- 24. Antibiotics • Penicillin (Streptococcus) •If allergic, erythromycin • 7-10 days
- 25. DD of membraneover tonsils • Membranous tonsillitis • Diphtheria • Vincent Angina • Infectious mononucleosis • Candidal infection of tonsil • Agranulocytosis • Leukemia • Apthous ulcers • Malignancy tonsils • Traumatic ulcer