急、慢性扁桃體炎

1、扁 桃 體 炎Tonsillitis,定義： 扁桃體作為咽淋巴環(huán)的重要結(jié)構(gòu)，位于呼吸道和消化道的上端，最先接觸自口鼻進入的病原，在機體抵抗力下降時容易受到病原體侵犯而發(fā)炎。主要包括急﹑慢性扁桃體炎。,Definition: Tonsil is the important structure of the pharyngeal lymphatic circle, located at the upper of respirato

2、ry tract and digestive tract, which is first contact with pathogen from mouth/nose. That is easily invading by pathogen, then takes place inflammation, including acute / chronic tonsillitis.,急性扁桃體炎Acute tonsillitis,定義：

3、腭扁桃體的急性非特異性炎癥，常伴有急性咽炎，是一種咽部常見病，多發(fā)于兒童﹑青年，在季節(jié)更替，氣溫變化時容易發(fā)病?？煞譃榭ㄋ冤p化膿性兩型。,Definition: The acute non-special inflammation of Palatine tonsil, being linked to pharyngitis. That is the common disease and more takes place

4、in children/youth, including catarrh/ suppurating type.,病 因Etiology,感染主要致病菌為乙型容血性鏈球菌葡萄球菌肺炎雙球菌腺病毒厭氧菌機體防御能力下降常見誘因受涼﹑勞累﹑潮濕﹑煙酒傳染性飛沫或直接接觸傳染，通常呈散發(fā)性，偶有爆發(fā)流行,InfectionThe main germs was B streptococccusStaphylococc

5、iPneumonia-diplococcusAdenoviruses/AnaerobesThe ability of body defence was descentCommon factorcold/tired/wetness/smoking/drinkingInfectivitydroplet/directly contacting,臨床特征Clinical feature,急性卡他性扁桃體炎：咽痛低熱輕度全身

6、癥狀： 乏力﹑酸痛﹑精神差粘膜急性充血腫脹，扁桃體表面無滲出物血象：白細胞總數(shù)及 中性白細胞升高,Acute catarrhal tonsillitis Pharyngeal pain/Low fever Lightly total symptom: aching pain/inertia Acute congestion of mucosa, having little exudates on

7、 tonsil surface Blood: The amount of WBC/ neutrophil was high.,臨床特征Clinical feature,急性化膿性扁桃體炎起病急，局部和全身癥狀較重咽痛劇烈，反射痛，吞咽困難畏寒﹑高熱：幼兒可高熱抽搐，嘔吐﹑昏睡扁桃體腫大，周圍充血，表面有膿點或假膜，假膜不超出扁桃體范圍，易擦拭去，不出血下頜角淋巴結(jié)腫大﹑壓痛血象：白細胞總數(shù)及中性白細胞升高,Ac

8、tue 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 t

9、onsil / peri-tonsil hyperemia,having pus and false membrane on tonsil surface. swelling of lymphatic nodes ia angle of mandible,having pressing pain. Blood: The amount of WBC/neutrophil was high.,急性化膿性扁桃體炎,急性化膿性扁桃體炎

10、,,診 斷Diagnosis,典型病史+咽部檢查鑒別診斷：咽炎猩紅熱潰瘍性咽炎,Typical history/ pharyngeal examinationDifferential diagnosis Pharyngitis Scarlet fever Ulcerative pharyngitis.,并發(fā)癥Complication,局部并發(fā)癥：扁桃體周圍膿腫急性中耳炎：兒童常見急性淋巴結(jié)炎咽旁膿腫：

11、較少見全身并發(fā)癥:(機體對鏈球菌所產(chǎn)生的Ⅲ型變態(tài)反應(yīng))風濕熱急性關(guān)節(jié)炎﹑心肌炎急性腎炎,Local complications: peritonsillar abscess Acute otitis media Acute lymphadenitis Parapharyngeal abscessComplications of total body:( the Ⅲ type of allergic reaction i

12、nduced by streptococcus) Rheumatic fever Acute arthritis Acute nephritis,治 療Treatment,抗菌消炎是本病的治療原則，青霉素是首選藥物。對癥治療是解熱鎮(zhèn)痛局部治療是含漱液+含片,The therapetic principle of this disease is anti-bacteria and eliminating inflamma

13、tion, penicillin is the first-line of clinical drug. Relief of fever and pain were the second treatment. Local treatment were using gargle,預(yù) 防prevention,鍛煉身體，增強體質(zhì)，提高機體抵抗力。注意病人隔離，防止傳染。,Body building and reinforc

14、ement health, then rising resistance of body. Attention to insulation of patients, that prevents from infection,慢性扁桃體炎Chronic tonsillitis,由急性扁桃體炎反復(fù)發(fā)作或隱窩口內(nèi)細菌﹑病毒孳生感染而演變成的腭扁桃體慢性炎癥。,The inflammation of palatin tonsil induc

15、ed by the repetition attacking of acute tonsillitis or infection of bacteria/ virus from crypt .,病 因Etiology,感染： 乙型溶血性鏈球菌﹑腺病毒→反復(fù)急性發(fā)作→慢性炎癥免疫因素： 微生物→扁桃體→自身變態(tài)反應(yīng)→慢性炎癥,Infection : streptococcus B /adenovirus →repe

16、tition of acute attacking →chronic inflammation Immuning infactors: microorganism →tonsil →self- allergic reaction →infammation,病 理pathology,早期： 隱窩口粘膜受損→上皮增生﹑潰瘍﹑炎性滲出物后期： 扁桃體疤痕形成→開口受阻→小膿腫,Earlier period:the

17、mucosa of crypts damaged →epithelial proliferation,ulcering, inflammatory exudates Anaphase: the formation of scar in tonsil →aperture hindering → the little abscess,臨床表現(xiàn)Clinical situation,反復(fù)急性發(fā)作病史咽部不適癥狀扁桃體肥大引起的癥

18、狀全身慢性中毒癥狀體癥：扁桃體慢性充血，疤痕粘連；隱窩口封閉，有時可見黃白色干珞樣或點狀分泌物；頜下淋巴結(jié)腫大。,actue attaccking again and again The upset symptoms in pharynx The symptoms induced by tonsil hypertrophy Chronic toxicosis of total body Sings: Chr

19、onic congestion/scar Crypts were closed, having some white discharges Swelling of submandbular lymph nodes,診 斷Diagnosis,病史+體癥+癥狀鑒別診斷：扁桃體生理性肥大扁桃體角化癥：白色沙礫樣角化物，觸之堅硬，不能拭去。扁桃體腫瘤：腺體腫大且有潰瘍，需行活檢確診。,History+signs

20、+symptomDifferential diagnosissPhysiologic hypertrophy of tonsilKeratosis of tonsil: the small white sand-like masses, which are difficult to remove by swabbing.tumor of tonsil: the swelling and ulcering of tonsil, p

21、athologic evidence is the final diagnosis.,并發(fā)癥Complication,并發(fā)癥： 隱窩口內(nèi)的細菌和毒素→變態(tài)反應(yīng)→并發(fā)癥風濕性關(guān)節(jié)炎風濕熱腎病心臟病,Complication: bacteria and its toxins → allergic reaction → complication Rheumatic arthritisRheumatic fever

22、NephrosisCardiac disease,治 療Treatment,保守治療：免疫療法輔以抗變應(yīng)性措施：疫苗脫敏，胎盤丙種球蛋白，轉(zhuǎn)移因子沖洗隱窩口手術(shù)治療：扁桃體切除術(shù),Conservative treatmentImmuno-therapyWashing cryptsOperation tonsillectomy,扁桃體切除術(shù)適應(yīng)癥,１．反復(fù)炎癥發(fā)作或并發(fā)扁桃體周圍膿腫２．過度肥大，妨礙功能