The document discusses acute tonsillitis, describing the anatomy and function of the palatine tonsils, symptoms and signs of acute tonsillitis, typical causative agents, treatment involving analgesics and antibiotics, potential complications, and differential diagnoses for membranous tonsils. It provides details on the tonsils' location in the throat, lymphatic drainage, classifications of tonsillitis, and comparisons to conditions like diphtheria and infectious mononucleosis.

1. Acute tonsillitis
Dr. Barbara Pieper

2. Palatine tonsils

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. 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. Palatine tonsils
• A tonsil presents two
surfaces - a medial
and a lateral
• And two poles an
upper and a lower

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

8. Arterial supply of tonsil

9. Lymphatic drainage
• Drainage goes into upper deep cervical
nodes particularly the iugulodigastric
(tonsillar) nodes situated below the
angle of mandible

10. 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

13. Aetiology of acute tonsillitis
Most commonly infecting organisms
- haemolytic streptococcus
- staphylococcus
- pneumococcus
- Haemophilus influenzae

14. 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

15. 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

16. 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

17. Complications of acute tonsillitis
• Chronic tonsillitis
• Peritonsillar abscess
• Parapharyngeal abscess
• Cervical abscess
• Acute otitis media
• Rheumatic fever
• Acute glomerulonephritis
• Subacute bacterial endocarditis

18. 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

19. 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

20. 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

21. Try to get a look inside