2. १) आचाय सू ुत अनूसार स तदश क ठरोग-
क ठगता तु - रोह यः पंच, ठशालुकं , अ धिज हो,
वलयो, बलास, एकवृंदो, वृ दः, शत नी, गलायुः,
गल व धीः, गलौघः, वर नो, मांसतानो, वदार चे त.
- सु. न. १६/४६
KANTHAGAT ROG
SANKHYA SAMPRAPTI
3. २) आचाय वा भट अनुसार अ टदश ठरोग -
गळे वातरो हणी, प रो हणी, कफरो हणी,
र तरो हणी, सि नपातरो हणी, शालूक, वृ द,
तु डीके र , गळौघ, वलय, गलायुक, शत नी,
गळ व धी, गळाबुद, पवनग गंड, ले मग गंड,
मेदोग गंड, वरा या अ टादश रोगा भवि त.
- इंदू ट का पान १८३
4. ३) आचाय चरक यांनी क ठगत रोग वेगळे न सांगता
संपूण मुखगत ६४ रोगांचे वातज, प ज, कफज व
सि नपा तक कार के ले आहे. परंतु च.सु. १८- शोथीय
अ याय याम ये गल ह नावचा याधी वणन के ला
आहे.
5. गलायु
हेतू -
म यमा हषवराह प शतामकमूलकं ,
माषसूपद ध ीरसु ते ुरसफा णतं,
अवाक श यां च भजतो वषतो द तधावनं,
धूम छदनग डूषानु चतं च सरा यधं.
- वा.उ.२१/१,२.
6. च क सा -
अ) आचाय वा भट अनुसार -
त व च वृ दशालूक तु डीके र गलायुषु.
- वा.उ. २२/६३
१) वेदन - था नक व सावदै हक.
२)लेखन - वेदनो र.
7. ३) तसारण - कटु वगातील य यामधे गृहधूम,
फला, सधव मसळून तसारण करावे.
४)गंडूष - कटु वगातील यां या वाथ याने गंडूष.
५)कवल - वेता, वडंग, दंती, सधव यांनी स ध
तैलानी कवल.
६)न य - कवल य, अपामाग, न बप , जातीप ,
यांनी स ध तैलानी न य
8. ब) आचाय सु ुत अनुसार -
गलायू चापी यो या ध तं च श ेण साधयेत.
सु. च. २२/६६.
9. TONSILLITIS
Tonsil are nothing but mass of Lymphoid
tissue. They can be best presented in
Waldeyer’s ring which is scattered throughout
the pharynx in its subepithelial layer
consisting of -
1) Nasopharyngeal tonsil or Adenoids
2) Palatine tonsils or simply tonsils
3) Lingual tonsil
4) Tubal tonsils
12. Palatine Tonsils
(A) Acute Palatine Tonsillitis :
Aetiology -
Following bacteria can infect tonsil primarily
or secondary to viral infection.
1) Haemolytic Streptococcus
2) Staphylococci
3) Pneumococci
4)Haemophilus influenzae
13.
14. Treatment -
1) Patient is encouraged to rest in bed and
have plenty of fluid.
2) Analgesic like aspirin or paracetamol.
3) Antimicrobial therapy -
a)penicillin V
Children dose - 125-250 mg orally every 6
hourly for 10 days
Adults dose - 500 mg orally every 6 hourly for
10 days.
15. b)In case of penicillin allergy or resistance
Erythromycin is given.
Adult dose - 250-500 mg orally, 6 hourly for 7
to 10 days.
Children dose - 60 mg/kg body weight orally
QDS for 7 to 10 days.
4) Gargle with lukewarm water and salt 4-5
times per day.
16. (B) Chronic Palatine Tonsillitis :
Aetiology -
1)Complication of acute tonsillitis.
2)Subclinical infections of tonsils without an
acute attack.
3)Chronic infection in sinuses or teeth may be
a predisposing factor.
18. Treatment -
1) Conservative treatment -
a) attention to general health
b) diet
c) treatment of coexistent infection of teeth,
nose and sinuses.
2) Tonsillectomy.
19. Tonsillectomy
Indications:
(A) Absolute indications -
1) Recurrent infection of throat :
(a) 7 or more episodes in 1 year OR
(b) 5 episodes per year for 2 years OR
(c)3 episodes per year for 3 years OR
(d) 2 weeks or more lost of school/work in 1
year.
20. 2) Peritonsillar abscess.
3) Tonsillitis causing febrile seizures.
4) Hypertrophy of tonsils causing -
(a) airway obstruction.
(b) difficulty in deglutition.
(c ) interference with speech.
5) Suspicion of Malignancy.
21. (B) Relative indications -
(1) Diphtheria carriers.
(2) Staphylococcal carriers.
(3) Chronic tonsillitis with halitosis.
(4) Recurrent streptococcal tonsillitis in a
patient with Valvular Heart disease.
22. ( C) As a part of related surgery -
1) Palatopharyngoplasty for sleep apnoea.
2) Glossopharyngeal neurectomy.
3) Removal of styloid process.
Contraindications :
1) Hb less than 10 g %.
2) Presence of acute URTI, even in acute
tonsillitis.
23. 3) Children under 3 yrs of age.
4) Over or submucous cleft palate.
5) Bleeding disorder. eg: aplastic anaemia.
Haemophilia, purpura.
6) Epidemic of polio.
7) Uncontrolled systemic disease. eg:
Diabetes, cardiac disease, HTN.
8) During menses.
25. (B) Hot methods -
1) Electrocautery
2) Laser tonsillectomy or tonsillotomy
3) Coblation tonsillectomy
4) Radiofrequency
26. Surgical procedure :
( Dissection and snare method )
- surgery is usually done under G.A. and in
Rose’s position.
- Boyle-Davis mouth gag is introduced and
opened and held in place by Draffin’s bipods.
- Tonsil is grasped with tonsil holding forceps
and pulled medially
- Incision is made in mucous membrane
reflecting from tonsil to anterior pillar.
27. - Blunt curved scissor is used to dissect tonsil
from peritonsillar tissue and separate its
upper pole.
- Now tonsil is held by its upper pole and
traction is applied downwards and medially,
dissection is continued until lower pole is
reached.
- Now wire loop of tonsillar snare is threaded
over tonsil on to its pedicle, tightened, and
pedicle is cut and tonsil is removed.
28. - A gauze sponge is placed in the fossa and
pressure is applied for few minutes
- Bleeding points are tied by silk. Same
procedure is done on other side.
- In post operative care vital signs are
monitored with watch on bleeding from nose,
mouth or both.
- Patient is usually sent home after 24 hrs with
oral hygiene and diet instructions if there is no
complication.
29. Complications :
(A) Immediate -
1) Primary haemorrhage (during surgery)
2) Reactionary Haemorrhage (within 24 hrs)
3) Injury to tonsillar pillars, uvula, soft palate,
tongue or superior constrictor muscle
4) Injury to teeth
5) Aspiration of blood
6) Facial oedema, particularly of eyelids
7) Surgical emphysema
30. (B) Delayed -
1) Secondary haemorrhage
2) Infection
3) Lung complication
4) Scarring in soft palate and pillars
5) Hypertrophy of lingual tonsils
6) Tonsillar remnants
- Sometimes lymphoid tissue is left in plica
triangularis which later gets hypertrophied
therefore should be removed during
tonsillectomy.
