急慢性扁桃体炎学案概论

扁桃体炎

Tonsillitis定义：

扁桃体作为咽淋巴环的重要结构，位于呼吸道和消化道的上端，最先接触自口鼻进入的病原，在机体抵抗力下降时容易受到病原体侵犯而发炎。主要包括急﹑慢性扁桃体炎。Definition:

Tonsilistheimportantstructureofthepharyngeallymphaticcircle,locatedattheupperofrespiratorytractanddigestivetract,whichisfirstcontactwithpathogenfrommouth/nose.Thatiseasilyinvadingbypathogen,thentakesplaceinflammation,includingacute/chronictonsillitis.急性扁桃体炎

Acutetonsillitis定义：腭扁桃体的急性非特异性炎症，常伴有急性咽炎，是一种咽部常见病，多发于儿童﹑青年，在季节更替，气温变化时容易发病。可分为卡他性﹑化脓性两型。Definition:Theacutenon-specialinflammationofPalatinetonsil,beinglinkedtopharyngitis.Thatisthecommondiseaseandmoretakesplaceinchildren/youth,includingcatarrh/suppuratingtype.病因

Etiology感染主要致病菌为乙型容血性链球菌葡萄球菌肺炎双球菌腺病毒厌氧菌机体防御能力下降常见诱因受凉﹑劳累﹑潮湿﹑烟酒传染性飞沫或直接接触传染，通常呈散发性，偶有爆发流行InfectionThemaingermswasBstreptococccusStaphylococciPneumonia-diplococcusAdenoviruses/AnaerobesTheabilityofbodydefencewasdescentCommonfactorcold/tired/wetness/smoking/drinkingInfectivitydroplet/directlycontacting临床特征

Clinicalfeature急性卡他性扁桃体炎：咽痛低热轻度全身症状：乏力﹑酸痛﹑精神差粘膜急性充血肿胀，扁桃体表面无渗出物血象：白细胞总数及中性白细胞升高AcutecatarrhaltonsillitisPharyngealpain/LowfeverLightlytotalsymptom:achingpain/inertiaAcutecongestionofmucosa,havinglittleexudatesontonsilsurfaceBlood:TheamountofWBC/neutrophilwashigh.临床特征

Clinicalfeature急性化脓性扁桃体炎起病急，局部和全身症状较重咽痛剧烈，反射痛，吞咽困难畏寒﹑高热：幼儿可高热抽搐，呕吐﹑昏睡扁桃体肿大，周围充血，表面有脓点或假膜，假膜不超出扁桃体范围，易擦拭去，不出血下颌角淋巴结肿大﹑压痛血象：白细胞总数及中性白细胞升高Actuesuppurativetonsllitis

Rapidlyillness,havingmoresymptomsoftotal/localbody.Pharyngealpainintensity/flectingpain/disphagiaFeelingcool/highfever:tic/vomiting/lethargySwellingoftonsil/peri-tonsilhyperemia,havingpusandfalsemembraneontonsilsurface.swellingoflymphaticnodesiaangleofmandible,havingpressingpain.Blood:TheamountofWBC/neutrophilwashigh.急性化脓性扁桃体炎急性化脓性扁桃体炎诊断

Diagnosis典型病史+咽部检查鉴别诊断：咽炎猩红热溃疡性咽炎Typicalhistory/pharyngealexaminationDifferentialdiagnosisPharyngitisScarletfeverUlcerativepharyngitis.并发症

Complication局部并发症：扁桃体周围脓肿急性中耳炎：儿童常见急性淋巴结炎咽旁脓肿：较少见全身并发症:(机体对链球菌所产生的Ⅲ型变态反应)风湿热急性关节炎﹑心肌炎急性肾炎Localcomplications:

peritonsillarabscessAcuteotitismediaAcutelymphadenitisParapharyngealabscessComplicationsoftotalbody:(theⅢtypeofallergicreactioninducedbystreptococcus)RheumaticfeverAcutearthritisAcutenephritis治疗

Treatment抗菌消炎是本病的治疗原则，青霉素是首选药物。对症治疗是解热镇痛局部治疗是含漱液+含片Thetherapeticprincipleofthisdiseaseisanti-bacteriaandeliminatinginflammation,penicillinisthefirst-lineofclinicaldrug.Reliefoffeverandpainwerethesecondtreatment.Localtreatmentwereusinggargle预防

prevention锻炼身体，增强体质，提高机体抵抗力。注意病人隔离，防止传染。Bodybuildingandreinforcementhealth,thenrisingresistanceofbody.Attentiontoinsulationofpatients,thatpreventsfrominfection慢性扁桃体炎

Chronictonsillitis由急性扁桃体炎反复发作或隐窝口内细菌﹑病毒孳生感染而演变成的腭扁桃体慢性炎症。Theinflammationofpalatintonsilinducedbytherepetitionattackingofacutetonsillitisorinfectionofbacteria/virusfromcrypt.病因

Etiology感染：乙型溶血性链球菌﹑腺病毒→反复急性发作→慢性炎症免疫因素：微生物→扁桃体→自身变态反应→慢性炎症Infection:streptococcusB/adenovirus→repetitionofacuteattacking→chronicinflammationImmuninginfactors:microorganism→tonsil→self-allergicreaction→infammation病理

pathology早期：隐窝口粘膜受损→上皮增生﹑溃疡﹑炎性渗出物后期：扁桃体疤痕形成→开口受阻→小脓肿Earlierperiod:themucosaofcryptsdamaged→epithelialproliferation,ulcering,inflammatoryexudatesAnaphase:theformationofscarintonsil→aperturehindering→thelittleabscess临床表现

Clinicalsituation反复急性发作病史咽部不适症状扁桃体肥大引起的症状全身慢性中毒症状体症：扁桃体慢性充血，疤痕粘连；隐窝口封闭，有时可见黄白色干珞样或点状分泌物；颌下淋巴结肿大。actueattacckingagainandagainTheupsetsymptomsinpharynxThesymptomsinducedbytonsilhypertrophyChronictoxicosisoftotalbodySings:Chroniccongestion/scarCryptswereclosed,havingsomewhitedischargesSwellingofsubmandbularlymphnodes诊断

Diagnosis病史+体症+症状鉴别诊断：扁桃体生理性肥大扁桃体角化症：白色沙砾样角化物，触之坚硬，不能拭去。扁桃体肿瘤：腺体肿大且有溃疡，需行活检确诊。History+signs+symptomDifferentialdiagnosissPhysiologichypertrophyoftonsilKeratosisoftonsil:thesmallwhitesand-likemasses,whicharedifficulttoremovebyswabbing.tumoroftonsil:theswellingandulceringoftonsil,pathologicevidenceisthefinaldiagnosis.并发症

Complication并发症：隐窝口内的细菌和毒素→变态反应→并发症风湿性关节炎风湿热肾病心脏病Complication:

bacteriaanditstoxins→allergicreaction→complicationRheumaticarthritisRheumaticfeverNephrosisCardiacdisease治疗

Treatment保守治疗：免疫疗法辅以抗变应性措施：疫苗脱敏，胎盘丙种球蛋白，转移因子冲洗隐窝口手术治