tonsillitis case
TRANSCRIPT
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PROBLEM BASED LEARNINGE.N.T
SAROSH UL HASSAN
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CASE SCENERIO• A 10year old boy comes to OPD with high
grade fever, sore throat and dysphagia to solids for past 4 days.
• Mother informs that he had multiple similar episodes in the past 2 years, always alleviated by taking antibiotics.
• On examination tonsils were inflamed, hypertrophied with whitish membrane. Child looks toxic though.
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WHAT ARE YOUR
DIFFERENTIAL
DIAGNOSIS???
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DIFFERENTIAL DIAGNOSIS
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ANATOMY OF PALATINE TONSILS
• Palatine Tonsil is an ovoid mass of lymphoid tissue situated in the lateral wall of oropharynx between anterior and posterior pillars
• It has Two surfaces – Medial and Lateral, and Two poles – Upper and Lower
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MEDIAL SURFACE• Medial Surface is
covered by nonkeratinizing stratified squamous epithellium which dips into the substance of tonsils in the form of crypts
• One of the crypts, situated near the upper part of tonsils is very large and deep and is called CRYPT OF MAGNA
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LATERAL SURFACE• It is covered by the fibrous
capsule of the tonsil• The tonsillar bed is
separated from the capsule by loose areolar tissue
• This makes it is easy to dissect the tonsil from its bed during tonsillectomy
• It is the site of collection of pus in peritonsillar abscess (quinsy)
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POLES OF TONSILS• UPPER POLE
– It extends into the soft palate
– There is a semilunar fold of mucous membrane which covers the medial part of the upper pole
• LOWER POLE– It is attached to the
tongue– The lower pole is
separated from the tongue by the tonsillolingual sulcus
• This sulcus may harbour carcinoma
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BLOOD SUPPLY
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VENOUS AND LYMPHATIC DRAINAGE
Enlarged non tender jugulodigastric lymph node is a sign of chronic tonsillitis
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Nerve supply - Lesser palatine branch of sphenopalatine ganglion
- Glossopharyngeal nerve
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FUNCTIONS OF TONSIL• It has a protective function in that it prevents
entry of pathogens through the nasal and oral route
• The crypts on the surface of the tonsil serve to increase the surface area and increase the efficiency of protection against pathogens
• It forms a part of Waldeyer’s lymphatic ring
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COMING BACK TO THE
DIFFERENTIAL DIAGNOSIS……
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ACUTE TONSILLITIS
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CATARRHAL TONSILLITIS
MEMBRANOUS TONSILLITISPARENCHYMATOUS TONSILLITIS
FOLLICULAR TONSILLITIS
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MEMBRANE OVER TONSILSMEMBRANOUS TONSILLITIS
DIPTHERIA
VINCENT ANGINA
INFECTIOUS MONONUCLEOSIS
AGRANULOCYTOSIS
LEUKEMIA
APHTHOUS ULCERS
MALIGNANCY TONSILS
TRAUMATIC ULCERS
CANDIDAL INFECTION OF TONSIL
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MEMBRANOUS TONSILLITIS• Occur due to pyogenic
organisms• An exudative membrane
forms over the medial surface of the tonsils
• Features of acute tonsillitis
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DIPTHERIA• Acute infection caused by
Corynebacterium Diptheriae• Formation of false
membrane which extends beyond the tonsils on to the soft palate and posterior pharyngeal wall.
• Dirty gray in color, firmly attached to mucosa.• Cause bleeding when membrane is removed• Diphtheria is slower in onset with less local discomfort
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VINCENT ANGINA
• Insidious in onset with less fever and less discomfort in throat
• Gray membrane forms usually over one tonsils can be easily removed revealing an irregular ulcer on the tonsil.
• Throat swab will show both organisms typical of this disease, that are:
• Fusiform Bacilli• Spirochetes
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INFECTIOUS MONONUCLEOSIS
• Also called as glandular fever, caused by epstein barr virus.
• Both tonsils are enlarged, congested and covered with mombrane.
• Lymph Node enlarged in the posterior triangle of neck along with speenomegaly
• Blood smear show more than 50% lymphocytes, out of which 10% are atypical.• White cell count is normal in first week but rises in the second week
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LEUKEMIA• In children, 75% of leukemias
are acute lymphoblastic and 25% acute myelogenous or chronic
• Peripheral blood shows TLC>100,000/CU MM.
• It may be normal or less than normal.
AGRANULOCYTOSIS• Ulcerative necrotic lesions
not only on the tonsils but also in the oropharynx.
• Patient is severely ill.• In acute form, total
leucocytic count is dec. to <2000/cu mm
APHTHOUS ULCERS• They may involve any part of
oral cavity or oropharynx• Very painfull• It is solitary & may involve
the tonsil and pillars• May be small or large
MALIGNANCY TONSILS• Oral or pharyngeal tumors
are the excessive growth of cells in these regions.
• They may be benign or malignant.
• Most oral/pharyngeal tumors are malignant
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CHRONIC TONSILLITIS
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QUINSY• Also called as peritonsillar abscess. • It the collection of pus in the
peritonsillar space.FEATURES:• Dysphagia• High grade fever• Muffled and thick speech also
called HOT POTATO VOICE • Trismus• Swollen soft palate• Uvula swollen and edematous.
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