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Pharyngeal tonsils Tonsils
Tonsils are large lymphoid tissue situated in the lateral wall of the oropharynx. 4 types of tonsil – tubal, palatine, pharyngeal and lingual tonsils. Tonsils have small pockets over the surface is called as CRYPTS.
Tonsillits – inflammation of the tonsils most commonly caused by viral or bacterial infection
causes Viral infection – most common cause Adenovirus Rhinovirus Influenza Coroavirus Respiratory syncytial virus Epstein barr virus, HSV, HIV
Bacterial infection Streptococcus Stap. Aureus Strep pneumoniae
Pathophysiology Due to etiological factors The process of inflammation originate within the tonsil hyperemia and oedema with conversion of lymphoid follicles in to small abscesses which discharge into crypts. Clinical features When inflammatory exudate collects in tonsillar crypts these present as multiple white spots on inflamed tonsillar surface giving rise of follicular tonsillitis.
Classification / types Acute Chronic Bacterial Viral – resolve within one week. Follicular Catarrhal Membraneous Parenchymatous tonsillitis
Follicular tonsillitis It is an inflammation of the tonsils and their crypts. The onset is sudden and the tonsils will appear red, white pus spots over the swollen tonsils
Catarrhal tonsillitis When tonsils are inflamed as part of the generalised infection of the oropharyngeal mucosa it is called catarrhal tonsillitis.
Membranous tonsillitis. Some times exudation from crypts may coalesce to form a membrane over the surface of tonsil, giving rise to membranous tonsillitis.
Parenchymatous tonsillitis When the whole tonsil is uniformly congested and swollen it is called acute parenchymatous tonsillitis
COMPLICATIONS Peri tonsillar Abscess or quincy Para Pharyngeal Abscess SOM Acute nephritis RHEUMATIC Laryngeal Fever edema Septicemia Bacterial endocarditis
Signs and symptoms in throat Swollen congested tonsils Sore throat with white pus Difficulty in filled spots swallowing Halitosis Generalized body Chills ache Sometimes Fever yellowish exudate Earache and Thick from crypts speech Discomfort
Diagnosis History collection Physical examination Throat swabs RSAT – rapid streptococcal antigen test Monospot test – a blood test can detect certain antibodies, which can help confirm that a person symptoms are due to mononucleosis. CBC
Management Analgesics – to reduce pain Sore throat relief measures Antibiotics – penicillin or amoxicillin If viral origin – complete recovery is made within one week. In chronic cases surgery will do. Home mgt
Tonsillectomy Removal of the inflamed tonsil Methods 1. Dissection and snare method – removal of the tonsil by use of a forceps and snare scissors. The tonsils are completely removed and the remaining tissue is cauterized. There will be minimal post operative bleeding
Electrocautery – it uses electrical energy to separate the tonsillar tissue and assists in reducing blood loss through cauterization. But thermal injury to surrounding tissue is common
Radiofrequency ablation – radiofrequency energy is used to the tonsil tissue through probes to remove the tonsil Coblation tonsillectomy – it combines radiofrequency energy with the use of ionized sodium molecules to ablate tissues Harmonic scalpel – it uses ultrasonic energy to vibrate the blade.
Laser assisted serial tonsillectomy (LAST) Microdebrider – powered rotary shaving device with continuous suction
Care of a patient after tonsillectomy Position patient on side until fully awake after general anesthesia or in mid – fowlers position when awake Monitor for signs of hemorrhage: frequent swallowing (inspect throat), bright red vomitus, rapid pulse, restlessness Promote comfort : apply ice collar to neck (reduce the bleeding by vasoconstriction), use acetaminophen
Give appropriate food and fluids Give ice –cold fluids and bland foods during initial period (ex- ice chips, frozen juice bars) Milk is usually not given because it may increase mucus and cause patient to clear throat. Never give dark colored or red colored juices or fluids – because if vomitus contain blood it will be difficult to identify.
Instruct patient to : Avoid attempting to clear throat immediately after surgery (may initiate bleeding) Avoid coughing, sneezing, vigorous nose blowing, and vigorous exercise for 1 -2 weeks Drink lots of fluids (2 -3 L/day). Avoid hard, scratchy foods Report signs of bleeding Expect stool to be black or dark for a few days due to swallowed blood Résumé normal activity immediately