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    UKKIEmodul tht lbm 4 (tonsilitis) 2013

    M a n g b e w o k . t k - @ s i m a n g b e w o k Page 1

    LBM 4 PAINFUL SWALLOWING

    STEP 1

    Detritus : hasil eksudat yang berisi leukosit, bakteri, dan epitel yangterlepas di kanal berwarna bercak kuning.

    Kripte : muara saluran limfoid yang dapat terlihat pada tonsil

    STEP 2

    1. Anatomi, fisiologi, dan histologi faring dan tonsil?2. Mengapa pasien merasakan seperti sensasi terbakar dan nyeri telan pada

    tenggorokan?

    3. Mengapa pasien demam dan mengalami penurunan nafsu makan?4. Apa interpretasi dari pemeriksaan orofaringeal : tonsil : T4/T4, mukosa

    hiperemis, kripte melebar +/+, detritus +/+ dan pada faring ditemukan

    mukosa hiperemis dan terdapat granul di posterior?

    5. Causa detritus dan kripte (definisi, patofis)?6. Obat warung apa yang kira-kira sudah dikonsumsi untuk mengurangi

    gejala?

    7. Pemeriksaan penunjang untuk menegakkan diagnosis?8. Penatalaksanaan yang tepat untuk pasien tersebut?9. DD?10.Komplikasi yang dapat timbul dari diagnosis?

    STEP 3

    1. Anatomi, fisiologi, dan histologi faring dan tonsil?ANATOMI

    Faring : berbentuk seperti corong, kurang lebih 15 cm, dibentuk oleh jarfibromuskular

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    Nasofaring :Batas depan : choanae

    Atas : basis crania

    Belakang : vertebra cervical yg dipisahkan facia prevertebralis

    Bawah : palatum mole

    Lateral : dinding medial leher

    Ada bangunanostium tuba eusthacii, adenoid, recessus faring

    OROFARINGAtas : nasofaring

    Depan : cavum oris dan uvula

    Belakang : vertebra cervical II-III

    Lateral : dinding medial leher

    Bawah : tepi atas epiglottis

    Bangunantonsila palatine, fossa supra tonsilaris, tonsila lingualis

    LaringofaringAtas : orofaring

    Depan : tepi blkg epiglottis

    Belakang : dinding belakang orofaring

    Bawah : porta esophagus

    Ruang di sekitar faring:

    Retrofaring : ada mukosa faring, fossa faringobulbolaris, seringtjd supurasi, jk pecahabses retrofaring

    Parafaring : dibagi 2 ruangan oleh os. Stiloidpre dan poststiloid

    Pre stiloid : gampang tjd supurasi

    Post : banyak pemb darah

    TONSILAda cincin waldeyer : tonsil palatine, tonsil faringeal, tonsil lingual, tonsil

    tuba

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    Tonsil palatine : ada di fossa tonsil, dibatasi pilar anterior : m.palatoglossus, posterior : m. palatofaringeus. Panjang 2-4 cm.

    masing2 tonsil 10-30 kriptus. Lateral ; m. konstriktor faring superior,

    anterior : m. palatoglossus, posterior : m. pakatofaringeus, superior :

    palatum mole, inf : tonsil lingua.

    Vaskularisasi : a. maksila eksterna, a. maksila interna, a. lingualis cab

    a. lingua dorsal, a. faringeal ascenden

    Tonsil faringeal ; di dinding belakang nasofaring, tidak mempunyaikripte

    Tonsil lingual : di dasar lidah, dibagi 2 oleh lig. glossoepliglotikaHISTOLOGI

    Pada nasofaring mukosanya bersilia dan epitel mengandung sel goblet, sedangkan

    orofaring dan laringofaring mukosa tidak bersilia.

    Pada faring banyak jar limfoid untuk proteksi.

    Ada palut lender/mucous blanketdi bagian nasofaring, di atas cilia, berfungsi

    untuk menangkap partikel dari udara, mengandung lisozim. Bergerak ke posterior.

    Terdapat otot2 sirkuler dan longitudinal.

    Sirkuler : m. konstriktor faring sup, media, infuntuk konstriksi Longitudinal : m. stiloideus dan m. palatofaringuntuk melebarkan faring

    dan mengangkat faring. Dipersarafi n IX.

    Di palatum mole ada 5 pasang otot :

    M. levator veli palatinemenyempitkan isthmus faring, melebarkan tubaeusthacii. Dipersarafi n X

    M. tensor veli palatinemengencangkan anterior palatum mole danmenyempitkan tuba eusthacii

    M. palatoglossusmenyempitkan isthmus faring M. palatofaring

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    M. azigos uvulamemperpendek dan menaikkan uvulaFISIOLOGI

    Fungsi menelan3 fase :

    ORALbolus di mulut berjalan ke faring, volunteer

    FARINGEALtransfer bolus melewati faring, involunteer

    ESOFAGEALbolus bergerak peristaltic dari esophagus keg aster,

    involunteer

    2. Mengapa pasien merasakan seperti sensasi terbakar dan nyeri telan padatenggorokan?

    Invasi bakteripertahanan utama : tonsil , karena terdapat jaringan limfe

    virulensi tinggiinflamasitonsil edemtonsil membentuk cincin ,

    susah menelannutrisi berkurang , kelemahan . mengobstruksi tuba

    eustacii jugakurang oendengaran .

    Bias juga menyebar menjadi otitis.

    Sensasi terbakarinflamasi tonsil dan mukosa di orofaring

    Nafsu makanKarena ada nyeri di tenggorokan , nyeri telannafsu makan menurun

    Derajat tonsil:

    T0T4

    Pada scenarioT4sehingga mengobstruksi makanan, nyeri telan

    Jika kronistidak ada nyeri telan

    3. Mengapa pasien demam dan mengalami penurunan nafsu makan?Di no 2

    4. Apa interpretasi dari pemeriksaan orofaringeal : tonsil : T4/T4, mukosahiperemis, kripte melebar +/+, detritus +/+ dan pada faring ditemukan

    mukosa hiperemis dan terdapat granul di posterior?

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    Hiperemis mukosaada peradangan, dilatasi pemb darah Detritusadanya peradangan tonsilpenumpukan leukosit,

    bakteri mati, epitel mati. Terlihat bercak kuning

    Kriptusmuara sal limfoid terisi detritus lama kelamaan tjdpengerutan

    Granulapembengkakan organ limfoid faringAda bakteri/virusmenginvasi mukosa faring, tjd inflamasi local,

    kuman /bakteri mengikis epitel, jar. Limfoid bereaksi

    pembendungan infiltrate leukosit PMN

    Stadium awal : hiperemi, edema, sekresi banyak. Awal eksudat

    serosa, menebal, kering menempel di dinding faring

    Derajat tonsil

    T0 : Tonsil sudah diambil

    T1 : Normal

    T2 : Pembesaran tonsil tidak sampai linea media

    T3 : hipertrofi mencapai garis tengahsesak napas

    T4 : pembesaran tonsil lebih dari linea media, mengganggu deglutio

    Estidak bersihbanyak bakteriinflamasi pada tonsil

    ChikiMSG jd Iritan di tonsil ..

    5.

    Causa detritus dan kripte (definisi, patofis)?Tonsil dibungkus oleh kapsul di fossa tonsil , di tonsil banyak jar limfe yg

    disebut folikel, tiap folikel pny kanal yang bermuara pada perm tonsil.

    Muara tersebut terlihat muara yaitu kripte.

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    Folikel peradangantonsil membengkakmembentuk eksudat yang

    mengalir dalam kanalkeluar ke kripteterlihat kotoran putih/ bercak

    kuning (Detritus)

    6. Obat warung apa yang kira-kira sudah dikonsumsi untuk mengurangigejala?

    Hanya mengatasi simptomnya saja

    Paracetamol, ibuprofen

    Antibiotic

    7. Pemeriksaan penunjang untuk menegakkan diagnosis? CT Scan MRI Biopsi Darah rutin : leukositosis, Hb turun Uji swabuntuk mengetahui bakteri

    8. Penatalaksanaan yang tepat untuk pasien tersebut? Farmakologi : antibiotic cefadroxil 1 minggu, analgesic, antipiretik,

    kortikosteroid

    Non farma : edukasi, minum air putih, pengontrolan makananGOLONGAN ANTIBIOTIK ? GENERASI?SEDIAAN..

    9. DD?TONSILITIS

    Tonsillitis akuto Viral : haemophillus influenzaeo Bacterial : streptococcus beta hemoliticus

    Tonsillitis membranaceao T. diphteriCorynebacterium diphteri

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    Demam, nyeri kepala, nyeri telan, badan lemas

    o T. septicstrep hemoliicuso T. angina plaut Vincentbakteri spirochaetao T. karena kelainan darahleukimiao Proses spesifik luas dan TB

    Kronis Tonsilitis diphteri

    Dari sal pernapasan atas, usia 10 th

    Ada 3 gejala :

    Local : membrane semu, pembesaran limfe / bull neck

    Sistemik : Demam, nyeri kepala, nyeri telan, badan lemas

    Eksotoksin : jantungmiokarditis

    Diagnose : gejala local, px mikrobiologi

    10.Komplikasi yang dapat timbul dari diagnosis?11.Batasan operasi pada anak2?

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    STEP 7

    1. Anatomi, fisiologi, dan histologi faring dan tonsil?

    Nasopharynx

    The upper portion of the pharynx, the nasopharynx, extends from the base of the skull to

    the upper surface of the soft palate. It includes the space between the internal nares and

    the soft palate and lies above the oral cavity. The adenoids, also known as the pharyngeal

    tonsils, are lymphoid tissue structures located in the posterior wall of the nasopharynx.

    The nasopharynx, oropharynx, and laryngopharynx or larynx can be seen clearly in this

    sagittal section of the head and neck.

    Polyps or mucus can obstruct the nasopharynx, as can congestion due to an upper

    respiratory infection. The eustachian tubes, which connect the middle ear to the pharynx,

    open into the nasopharynx. The opening and closing of the eustachian tubes serves to

    equalize the barometric pressure in the middle ear with that of the ambient atmosphere.

    The anterior aspect of the nasopharynx communicates through the choanae with the nasal

    cavities. On its lateral walls are the pharyngeal ostia of the auditory tube, somewhat

    triangular in shape, and bounded behind by a firm prominence, the torus tubarius or

    cushion, caused by the medial end of the cartilage of the tube that elevates the mucous

    membrane. Two folds arise from the cartilaginous opening:

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    the salpingopharyngeal fold, a vertical fold of mucous membrane extending from the

    inferior part of the torus and containing the salpingopharyngeus muscle

    the salpingopalatine fold, a smaller fold extending from the superior part of the torus to

    the palate and containing the levator veli palatini muscle. The tensor veli palatini is lateralto the levator and does not contribute the fold, since the origin is deep to the cartilaginous

    opening.

    Behind the opening of the auditory tube is a deep recess, the pharyngeal recess (also

    referred to as the fossa of Rosenmller). On the posterior wall is a prominence, best

    marked in childhood, produced by a mass of lymphoid tissue, which is known as the

    pharyngeal tonsil. Superior to the pharyngeal tonsil, in the midline, an irregular flask-

    shaped depression of the mucous membrane sometimes extends up as far as the basilar

    process of the occipital bone, this is known as the pharyngeal bursa.

    Oropharynx

    The oropharynx lies behind the oral cavity, extending from the uvula to the level of the

    hyoid bone. It opens anteriorly, through the isthmus faucium, into the mouth, while in its

    lateral wall, between the Palatoglossal arch and the Palatopharyngeal arch, is the palatine

    tonsil. The anterior wall consists of the base of the tongue and the epiglottic vallecula; the

    lateral wall is made up of the tonsil, tonsillar fossa, and tonsillar (faucial) pillars; the

    superior wall consists of the inferior surface of the soft palate and the uvula. Because both

    food and air pass through the pharynx, a flap of connective tissue called the epiglottis

    closes over the glottis when food is swallowed to prevent aspiration. The oropharynx is

    lined by non-keratinised squamous stratified epithelium.

    Laryngopharynx

    The laryngopharynx, (Latin: pars laryngea pharyngis), is the caudal part of the pharynx; it is

    the part of the throat that connects to the esophagus. It lies inferior to the epiglottis and

    extends to the location where this common pathway diverges into the respiratory (larynx)

    and digestive (esophagus) pathways. At that point, the laryngopharynx is continuous with

    the esophagus posteriorly. The esophagus conducts food and fluids to the stomach; air

    enters the larynx anteriorly. During swallowing, food has the "right of way", and air passage

    temporarily stops. Corresponding roughly to the area located between the 4th and 6th

    cervical vertebrae, the superior boundary of the laryngopharynx is at the level of the hyoid

    bone. The laryngopharynx includes three major sites: the pyriform sinus, postcricoid area,

    and the posterior pharyngeal wall. Like the oropharynx above it, the laryngopharynx serves

    as a passageway for food and air and is lined with a stratified squamous epithelium. It is

    innervated by the pharyngeal plexus.

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    The vascular supply to the hypopharynx includes the superior thyroid artery, the lingual

    artery and the ascending pharyngeal artery. The primary neural supply is from both the

    vagus and glossopharyngeal nerves. The vagus nerve provides a branch termed "Arnolds

    Nerve" which also supplies the external auditory canal, thus hypophayrngeal cancer canresult in referred otalgia. This nerve is also responsible for the ear-cough reflex in which

    stimulation of the ear canal results in a person coughing.

    Pharyngeal lymphatic ring(waldeyer lymphatic ring):1. inner ring2. outer ring

    Applied anatomy of pharynx, Wang Peihua, Department of Otorhinolaryngology,9th peoples hospital, School of medicine, Shanghai Jiaotong University.

    Tonsils are lymphoepithelial organs at the opening of the upper aerodigestive tract.

    From above downwards, they can be divided into

    1. pharyngeal tonsil, adenoid, which lies on the roof and posterior wall of the

    nasopharynx

    2. tubal tonsil which lies around the eustachain tube

    3. palatine tonsil which lies between the anterior and posterior faucial pillars

    4. lingual tonsil which lies at the base of the tongueThese lymphoid organs developed from the epithelium of the primitive oronasal cavity,

    the mesenchymal stroma and lymphoid cells then infiltrate these areas. Although the

    tonsils are present at embryonal stage, they only acquire their typical structure in

    thepostnatal period. They begin increasing rapidly in size between the first and third year

    of life, with peaks in the third and seventh year. They involute slowly at early puberty. In

    contrast to other lymphoid aggregates, tonsils do not filter lymph.

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    The palatine tonsil is supplied by the facial artery, ascending pharyngeal artery, lingual

    artery and the maxillary artery. Venous drainage is by the lingual and pharyngeal veins.

    2. Mengapa pasien merasakan seperti sensasi terbakar dan nyeri telan padatenggorokan?

    Bacteria and virus enter the body through the nose

    and mouth

    Bateria and viruses are filtered

    in the tonsils

    tonsils work by surrounding bacteria and

    virus with white blood cells

    Precipitating factors

    Age Sex Race Unhealthy Lifestyle Environment

    Predisposing Factors

    Cold loss of sleep constipation

    infection and inflammation causes

    enlarge tonsils

    Signs

    Red and swollen tonsils and uvula Redness of throat Presence of purulent materials Tenderness on the jugulodiagastric

    lymph nodes

    Gray furry tongue

    Symptoms

    Sore throat Dysphagia Fever Earache Loss of appetite Constitutional symptoms

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    emedicine.medscape.com

    3. Mengapa pasien demam dan mengalami penurunan nafsu makan?Virus; Bacteria; Group A beta hemolytic streptococcusActivation of macrophages by

    IFN- production of endogenous pyrogen IL-1, IL-4, IL-6, TNF-endogenous pyrogens

    enter the systemic circulation and penetrate hematoencephalic barrier reacts to the

    hypothalamusEffects of endogenous pyrogen on hypothalamic cytokines causethe

    production of arachidonic acidand prostaglandins Prostaglandins stimulate the cerebral

    cortex (behavioral response) leptin causes stimulation of the

    hypothalamussuppressed appetite.

    ACUTE TONSILLO PHARYNGITIS EXUDATIVE, CAPITOL MEDICAL CENTER COLLEGES INC.,

    CORRAL, Priscilla Chantal M.

    4. Apa interpretasi dari pemeriksaan orofaringeal : tonsil : T4/T4, mukosahiperemis, kripte melebar +/+, detritus +/+ dan pada faring ditemukan

    mukosa hiperemis dan terdapat granul di posterior?

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    Standardized tonsillar hypertrophy grading scale. (0) Tonsils are entirely within the tonsillar

    fossa. (1+) Tonsils occupy less than 25 percent of the lateral dimension of the oropharynx

    as measured between the anterior tonsillar pillars. (2+) Tonsils occupy less than 50 percent

    of the lateral dimension of the oropharynx. (3+) Tonsils occupy less than 75 percent of the

    lateral dimension of the oropharynx. (4+) Tonsils occupy 75 percent or more of the lateraldimension of the oropharynx.

    Wang RC, Elkins TP, Keech D, Wauquier A, Hubbard D. Accuracy of clinical evaluation in

    pediatric obstructive sleep apnea. Otolaryngol Head Neck Surg. 1998;118:6973.

    Widen crypt:

    The human palatine tonsils (PT) are covered by stratified squamous epithelium that

    extends into deep and partly branched tonsillar crypts, of which there are about 10 to 30.

    The crypts greatly increase the contact surface between environmental influences and

    lymphoid tissue.

    The tonsillar crypts often provide such an inviting environment to bacteria that bacterial

    colonies may form solidified "plugs" or "stones" within the crypts. In particular, sufferers of

    chronic sinusitis or post-nasal drip frequently suffer from these overgrowths of bacteria in

    the tonsillar crypts.[medical citation needed] these small whitish plugs, termed

    "tonsilloliths" and sometimes known as "tonsil stones".

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    Barnes, Leon (2000). Surgical Pathology of the Head and Neck (2nd ed. ed.). CRC Press. p.

    404.

    Detritus:

    Infiltration of bacteria on the epithelial tissue lining the tonsils will cause an inflammatoryreaction in the form of the release of polymorphonuclear leukocytes to form detritus. This

    detritus is a collection of leukocytes, dead bacteria and epithelial apart. Clinically this

    detritus filling kripte tonsils and appear as yellowish spots.

    Staf Pengajar Ilmu Penyakit THT FKUI. Buku Ajar Ilmu Kesehatan Telinga Hidung Tengorok

    Kepala Leher Edisi ke 6 Cetakan ke 1, Balai Penerbit FKUI, Jakarta, 1990.

    Granule in the posterior wall:

    Acute pharyngitis Looks at mucosal thickening and hypertrophy of the lymph nodes

    underneath and behind the posterior pharyngeal arch (lateral band). The existence of the

    uneven mucosa of the posterior wall of the so-called granular.

    Staf Pengajar Ilmu Penyakit THT FKUI. Buku Ajar Ilmu Kesehatan Telinga Hidung Tengorok

    Kepala Leher Edisi ke 6 Cetakan ke 1, Balai Penerbit FKUI, Jakarta, 1990.

    5. Causa detritus dan kripte (definisi, patofis)?6.

    Obat warung apa yang kira-kira sudah dikonsumsi untuk mengurangigejala?

    7. Pemeriksaan penunjang untuk menegakkan diagnosis?Diagnosis of tonsillitis is based on a medical history and a physical exam of the throat.

    An accurate medical history is needed to find out whether tonsillitis is recurrent, which

    may affect treatment choices.

    If your symptoms suggest strep throat, your doctor may want to confirm this diagnosis

    by doing a throat culture. Strep throat is more likely if 3 or 4 of the following signs or

    symptoms are present:Fever

    White or yellow spots or coating on the throat and/or tonsils (tonsillar exudates)

    Swollen or tender lymph nodes on the neck

    Absence of coughing or sneezing

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    If a strep infection is suspected, your doctor may do a rapid strep test or a throat

    culture or both. Both of these tests can be done in a doctor's office. You may want to

    discuss the advantages and disadvantages of each test to see which test is appropriate.

    The results of these tests will determine whether antibiotic treatment is needed. These

    results combined with an accurate medical history will be considered in deciding whethersurgery to remove the tonsils (tonsillectomy) is recommended.

    If the Epstein-Barr virus, which can cause mononucleosis, is suspected as a cause for the

    tonsillitis, a test for mononucleosismay be done.

    http://www.emedicinehealth.com/tonsillitis-health/page6_em.htm

    8. Penatalaksanaan yang tepat untuk pasien tersebut?

    http://www.nzdl.org/

    9. DD?

    http://www.emedicinehealth.com/tonsillitis-health/page6_em.htmhttp://www.emedicinehealth.com/tonsillitis-health/page6_em.htmhttp://www.nzdl.org/http://www.nzdl.org/http://www.nzdl.org/http://www.emedicinehealth.com/tonsillitis-health/page6_em.htm
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    Tonsilitis

    The most active phase of tonsils is between age 3 to 10 years and after that involutionbegins. Although hyperplasia of tonsils is not a disease, these organs are found to have a

    higher incidence of pathogenic bacteria around the poorly-drained tonsillar crypts resulting

    in tonsillitis. Majority of childhood tonsillitis are caused by group A ]-haemolytic

    streptococcus (GABHS). Its frequency and serious consequences such as acute rheumatic

    fever and glomerulonephritis make this an important infection. Viral causes are also

    common including coxsackievirus, herpesvirus and Epstein-Barr virus. However, it was

    found that with recurrent attacks of tonsillitis, the type and number of organisms changes

    from a commensal to greater varieties of bacteria and thus requiring different broad-

    spectrum antibiotics. Therefore the use of throat culture to arrive at the diagnosis isinaccurate.

    Clinically, the patients presented with sorethroat, fever and malaise. Physical

    examination may nor may not show enlarged tonsils, but exudates, erythema are seen.

    Cervical lymph nodes may be enlarged and tender.

    Definition of recurrent acute tonsillitis is varible. We take more than 4 episodes in one

    year or 7 episodes in 1 year, 5 episodes per year for 2 years or 3 episodes per year for 3

    years .

    Recurrent acute tonsillitis and chronic tonsillitis can give rise to peritonsillar abscess.

    Further spread of the infection beyond the peritonsillar space and lateral aspect of tonsillarfossa can lead to parapharyngeal space abscess. In addition, children under age 3 with

    tonsillitis are more susceptible to retropharyngeal space infection. Affected children will

    present as irritability, fever, difficulty in breathing and torticollis.

    The most common drug used to treat tonsillitis is amoxicillin. But with increasing

    resistance, the use of beta-lactamase inhibitor i.e. augmentin or unasyn may be needed.

    Only 32% responds to medical treatment with 6 months prophylaxis or a prolonged course

    of 30-days antibiotics.

    Decision for surgical intervention in patients with recurrent tonsillitis should be

    individualized. When treating paediatric patients, surgeon should have good

    communication with parents and provide full explanation of the procedure. Always ask for

    family history of bleeding tendency and other medical problems. Cervical XR should be

    done for children with Down's syndrome.

    ACUTE TONSILLO PHARYNGITIS EXUDATIVE, CAPITOL MEDICAL CENTER COLLEGES INC.,

    CORRAL, Priscilla Chantal M.

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    10.Komplikasi yang dapat timbul dari diagnosis?

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    ACUTE TONSILLO PHARYNGITIS EXUDATIVE, CAPITOL MEDICAL CENTER COLLEGES INC.,

    CORRAL, Priscilla Chantal M.

    Tonsillectomy or adenoidectomy is indicated only if the patient has had any of the

    following problems: repeated bouts of tonsillitis; hypertrophy of the tonsils and adenoids that could cause obstruction and obstructive

    sleep apnea;

    repeated attacks of purulent otitis media; suspected hearing loss due to serous otitis media that has occurred in association with

    enlarged tonsils and adenoids;

    and some other conditions, such as an exacerbation of asthma or rheumatic fever.emedicine.medscape.com

    1. Infection:

    Recurrent, acute tonsillitis (>6 episodes per year or 3 episodes per year >2 years)

    Recurrent acute tonsillitis associated with other conditions

    Cardiac valvular disease associated with recurrent streptococcal tonsillitis

    Recurrent febrile seizures

    Chronic tonsillitis that is unresponsive to medical therapy associated with

    Halitosis

    Persistent sore throat

    Tender cervical adenitis

    Streptococcal carrier state unresponsive to medical therapy

    Peritonsillitis abscess

    Tonsillitis associated with abscessed cervical nodes

    Mononucleosis with severely obstructing tonsils that is unresponsive to medical therapy

    2. Obstruction:

    Excessive snoring and chronic mouth breathing

    Obstructive sleep apnoea or sleep disturbances

    Adenotonsillar hypertrophy associated with

    Cor pulmonale

    Failure to thrive

    Dysphagia

    Speech abnormalities

    Craniofacial growth abnormalities

    Occlusion abnormalities

    3. Other:

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    Suspected neoplasia-asymmetric tonsillar hypertrophy

    There are different methods of tonsillectomy including the use of a cold knife, hot knife,

    diathermy, laser and harmonic scalpel. The operation lasts for about one hour. Postop,

    the patients recover rapidly and can resume tonsillar diet immediately. Most important

    is to look out for post-op bleeding. Postoperative haemorrhage ranges from 0.5-2%. Nosignificant immunological consequence has ever been documented. Changes in speech

    or velopharyngeal insufficiency are mainly temporary. In general, nearly all our patients

    can be discharged safely from hospital three days after the operation.

    ACUTE TONSILLO PHARYNGITIS EXUDATIVE, CAPITOL MEDICAL CENTER COLLEGES INC.,

    CORRAL, Priscilla Chantal M.

    Tonsillectomy Complications:

    Peritonsillar abscess. Acute otitis media. Lancefield's GABS can cause rheumatic fever, Sydenham's chorea, glomerulonephritis

    and scarlet fever.

    Streptococcal infection may cause a flare-up of guttate psoriasis. Enlarged and chronically infected tonsils interfere with children's sleep. Complications of tonsillectomy include otitis media and haemorrhage which can be

    very difficult, especially where there is an undiagnosed bleeding tendency such as

    haemophilia. Altered taste sensation has been reported.

    Patients who have had tonsillectomy are more susceptible to bulbar poliomyelitis.Smithard A, Cullen C, Thirlwall AS, et al; Tonsillectomy may cause altered tongue

    sensation in adult patients. J Laryngol Otol. 2009 May;123(5):545-9. Epub 2008 Jul 30.

    BACTERIA vs VIRAL

    These symptoms are generally mild in viral infection and very severe in bacterial infection.

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    ACUTE TONSILLO PHARYNGITIS EXUDATIVE, CAPITOL MEDICAL CENTER COLLEGES INC.,CORRAL, Priscilla Chantal M.