急、慢性扁桃体炎学案概论

1、解放军第89医院 唐少松,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: Tonsil is the important structure of the pharyngeal lymphatic circle, located at the upper of respiratory tract and digestive tract, which is first contact with pathogen from

2、mouth/nose. That is easily invading by pathogen, then takes place inflammation, including acute / chronic tonsillitis.,急性扁桃体炎 Acute tonsillitis,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: The acute non-special inflammation of Palatine tonsil, being linked to p

3、haryngitis. That is the common disease and more takes place in children/youth, including catarrh/ suppurating type.,解放军第89医院 唐少松,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,Infection The main germs was B streptococccus Staphylococci Pneumonia-

4、diplococcus Adenoviruses/Anaerobes The ability of body defence was descent Common factor cold/tired/wetness/smoking/drinking Infectivity droplet/directly contacting,解放军第89医院 唐少松,临床特征 Clinical feature,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,Acute catarrhal tonsillitis Ph

5、aryngeal pain/Low fever Lightly total symptom: aching pain/inertia Acute congestion of mucosa, having little exudates on tonsil surface Blood: The amount of WBC/ neutrophil was high.,解放军第89医院 唐少松,临床特征 Clinical feature,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

6、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,Actue suppurative tonsllitis Rapidly illness, having more symptoms of total/local body. Pharyngeal pain intensity / flecting pain / disphagia Feeling cool /high fever: tic/vomiting / lethargy Swelling of tonsil / peri-tonsil hyperemia,having pus and false me

7、mbrane on tonsil surface. swelling of lymphatic nodes ia angle of mandible,having pressing pain. Blood: The amount of WBC/neutrophil was high.,解放军第89医院 唐少松,急性化脓性扁桃体炎,解放军第89医院 唐少松,急性化脓性扁桃体炎,解放军第89医院 唐少松,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,Typical history/ pharyngeal examination Differential di

8、agnosis Pharyngitis Scarlet fever Ulcerative pharyngitis.,解放军第89医院 唐少松,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型变态反应) 风湿热 急性关节炎心肌炎 急性肾炎,Local complications: peritonsillar abscess Acute otitis media Acute lymphadenitis Parapharyngeal abscess Complications of total

9、body:( the type of allergic reaction induced by streptococcus) Rheumatic fever Acute arthritis Acute nephritis,解放军第89医院 唐少松,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,The therapetic principle of this disease is anti-bacteria and eliminating inflammation, penicillin is the first-line

10、of clinical drug. Relief of fever and pain were the second treatment. Local treatment were using gargle,解放军第89医院 唐少松,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。,Body building and reinforcement health, then rising resistance of body. Attention to insulation of patients, that prevents from infectio

11、n,解放军第89医院 唐少松,慢性扁桃体炎 Chronic tonsillitis,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。,The inflammation of palatin tonsil induced by the repetition attacking of acute tonsillitis or infection of bacteria/ virus from crypt .,解放军第89医院 唐少松,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,Infecti

12、on : streptococcus B /adenovirus repetition of acute attacking chronic inflammation Immuning infactors: microorganism tonsil self- allergic reaction infammation,解放军第89医院 唐少松,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,Earlier period: the mucosa of crypts damaged epithelial proliferation,

13、ulcering, inflammatory exudates Anaphase: the formation of scar in tonsil aperture hindering the little abscess,解放军第89医院 唐少松,临床表现 Clinical situation,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。,actue attaccking again and again The upset symptoms in pharynx T

14、he symptoms induced by tonsil hypertrophy Chronic toxicosis of total body Sings: Chronic congestion/scar Crypts were closed, having some white discharges Swelling of submandbular lymph nodes,解放军第89医院 唐少松,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+

15、signs+symptom Differential diagnosiss Physiologic hypertrophy of tonsil Keratosis of tonsil: the small white sand-like masses, which are difficult to remove by swabbing. tumor of tonsil: the swelling and ulcering of tonsil, pathologic evidence is the final diagnosis.,解放军第89医院 唐少松,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: bacteria and its toxins allergic reaction complication Rheumatic arthritis Rheumatic fever Nephrosis Cardiac disease,解放军第89医院 唐少松,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 手术治疗： 扁桃体切除术,Conservative treatment I