Acute tonsillitis
Dr. Barbara Pieper
Palatine tonsils
Palatine tonsils
• Each tonsil is an ovoid mass of lymphoid tissue
• Situated in the lateral wall of oropharynx between anterior and posterior pillars
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
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 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
Arterial supply of tonsil
Lymphatic drainage
• Drainage goes into upper deep cervical nodes particularly the iugulodigastric (tonsillar) nodes situated below the angle of mandible
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
Aetiology of acute tonsillitis
Most commonly infecting organisms
- haemolytic streptococcus
- staphylococcus
- pneumococcus
- Haemophilus influenzae
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
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
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
Complications of acute tonsillitis
• Chronic tonsillitis• Peritonsillar abscess• Parapharyngeal abscess• Cervical abscess• Acute otitis media• Rheumatic fever• Acute glomerulonephritis• Subacute bacterial endocarditis
Differential diagnosis of membrane over the tonsil
• Diphteria slower in onsetless local discomfortmembrane is adherent and removal leaves a bleeding surfaceculture: corynebacterium diphteriae
• Vincent´s anginaless fever, less discomfortmembrane over one tonsilremoval leaves irregular ulcer under membraneculture: fusiform bacili, spirochaetes
Differential diagnosis of membrane over the tonsil
• Infectious mononucleosis - glandular fever
young adults affected both tonsils enlarged, congested,covered with membrane
marked local discomfortenlarged lymphnodes in posterior triangleof neck, hepato- and splenomegalycaused by Epstein-Barr virusfailure of antibiotic treatmentblood smear: 50% lymphocytes, 10% atypical
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 ulcersany part of oral cavity
very painful
• Malignancy tonsil• Traumatic ulcer
any injury heals by formation of a membrane
Try to get a look inside
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