急慢性扁桃體炎學(xué)案概論

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(jìn)入的病原，在機(jī)體抵抗力下降時(shí)容易受到病原體侵犯而發(fā)炎。主要包括急慢性扁桃體炎。 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 mouth/nose. That is easily

2、invading by pathogen, then takes place inflammation, including acute / chronic tonsillitis.急性扁桃體炎Acute tonsillitis定義：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(shí)容易發(fā)病?？煞譃榭ㄋ曰撔詢尚汀?The acute non-special inflammation of Palatine tonsil, being linked to pharyngitis. That is the common disease and

3、more takes place 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(jī)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nThe main germs was B streptococccusnStaphylococcinPneumonia-diplococcusnAdenoviruses/Anaerobesncold/tired/wetness/smoking/drinkingnd

4、roplet/directly contacting臨床特征Clinical featureClinical feature急性卡他性扁桃體炎： 咽痛 低熱 輕度全身癥狀： 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(xì)胞總數(shù)及 中性白細(xì)胞升高n Pharyngeal pain/Low fevern Lightly total symptom: aching pain/inertian Acute congestion of mucosa, having little exudates on tonsil surfacen Blood: The amount of WBC/

5、neutrophil was high.臨床特征Clinical featureClinical 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(diǎn)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(xì)胞總數(shù)及中性白細(xì)胞升高n Rapidly illness, having more symptoms of total/local body.n Pharyngeal pain intensity / flecting pain / disphagian Feeling co

6、ol /high fever: tic/vomiting / lethargyn Swelling of tonsil / peri-tonsil hyperemia,having pus and false membrane on tonsil surface.n swelling of lymphatic nodes ia angle of mandible,having pressing pain.n 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診 斷DiagnosisDiagnosis典型病史+咽部檢查鑒

7、別診斷： 咽炎 猩紅熱 潰瘍性咽炎n Pharyngitisn Scarlet fevern Ulcerative pharyngitis.并發(fā)癥ComplicationComplication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：較少見全身并發(fā)癥:(機(jī)體對(duì)鏈球菌所產(chǎn)生的型變態(tài)反應(yīng)) 風(fēng)濕熱 急性關(guān)節(jié)炎心肌炎 急性腎炎n peritonsillar abscessn Acute otitis median Acute lymphadenitisn Parapharyngeal abscess( the type of allergic reaction i

8、nduced by streptococcus)n Rheumatic fevern Acute arthritisn Acute nephritis治 療TreatmentTreatment 抗菌消炎是本病的治療原則，青霉素是首選藥物。 對(duì)癥治療是解熱鎮(zhèn)痛 局部治療是含漱液+含片n The therapetic principle of this disease is anti-bacteria and eliminating inflammation, penicillin is the first-line of clinical drug.n Relief of fever and p

9、ain were the second treatment.n Local treatment were using gargle預(yù) 防preventionprevention鍛煉身體，增強(qiáng)體質(zhì)，提高機(jī)體抵抗力。注意病人隔離，防止傳染。n Body building and reinforcement health, then rising resistance of body.n Attention to insulation of patients, that prevents from infection慢性扁桃體炎Chronic tonsillitisChronic tonsillit

10、is由急性扁桃體炎反復(fù)發(fā)作或隱窩口內(nèi)細(xì)菌病毒孳生感染而演變成的腭扁桃體慢性炎癥。n The inflammation of palatin tonsil induced by the repetition attacking of acute tonsillitis or infection of bacteria/ virus from crypt .病 因EtiologyEtiology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 streptococcus B /adenovirus repetition of acute attacki

11、ng chronic inflammation microorganism tonsil self- allergic reaction infammation病 理pathologypathology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the mucosa of crypts damaged epithelial proliferation,ulcering, inflammatory exudates the formation of scar in tonsil aperture hindering the little abscess臨床表現(xiàn)

12、Clinical situationClinical 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狀 全身慢性中毒癥狀 體癥：l扁桃體慢性充血，疤痕粘連；l隱窩口封閉，有時(shí)可見黃白色干珞樣或點(diǎn)狀分泌物；l頜下淋巴結(jié)腫大。n actue attaccking again and againn The upset symptoms in pharynxn The symptoms induced by tonsil hypertrophyn Chronic toxicosis of total bodyn Sings:l Chronic congestion/scarl

13、Crypts were closed, having some white dischargesl Swelling of submandbular lymph nodes診 斷DiagnosisDiagnosislPhysiologic hypertrophy of tonsillKeratosis of tonsil: the small white sand-like masses, which are difficult to remove by swabbing.ltumor of tonsil: the swelling and ulcering of tonsil, pathol

14、ogic evidence is the final diagnosis.并發(fā)癥ComplicationComplication并發(fā)癥： 隱窩口內(nèi)的細(xì)菌和毒素變態(tài)反應(yīng)并發(fā)癥 風(fēng)濕性關(guān)節(jié)炎 風(fēng)濕熱 腎病 心臟病bacteria and its toxins allergic reaction complication nRheumatic arthritisnRheumatic fevernNephrosisnCardiac disease治 療TreatmentTreatment 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)nI

15、mmuno-therapynWashing cryptsn tonsillectomy扁桃體切除術(shù)適應(yīng)癥 反復(fù)炎癥發(fā)作或并發(fā)扁桃體周圍膿腫 過度肥大，妨礙功能 成為病灶 角化癥及白喉帶菌者保守?zé)o效 腫瘤扁桃體切除術(shù)禁忌癥 急性炎癥期（23周后手術(shù)） 血液系統(tǒng)疾病 全身疾病未經(jīng)控制 急性傳染病流行季節(jié)或流行地區(qū) 婦女經(jīng)期、妊娠期 自身或家屬中免疫疾病、白細(xì)胞低 扁桃體手術(shù)后急性扁桃體炎Acute tonsillitis定義：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(shí)容易發(fā)病。可分為卡他性化膿性兩型。 The acute non-speci

16、al inflammation of Palatine tonsil, being linked to pharyngitis. That is the common disease and more takes place in children/youth, including catarrh/ suppurating type.急性化膿性扁桃體炎診 斷DiagnosisDiagnosis典型病史+咽部檢查鑒別診斷： 咽炎 猩紅熱 潰瘍性咽炎n Pharyngitisn Scarlet fevern Ulcerative pharyngitis.病 因EtiologyEtiology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 streptococcus B /adenovirus repetition of acute attacking chronic inflammation microorganism tonsil self- allergic reaction infammation病 理pathology