急、慢性扁桃体炎.ppt

1、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 mouth/nose. Th

2、at 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 pharyngitis. That

3、 is the common disease and more takes place in children/youth, including catarrh/ suppurating type.,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,InfectionThe main germs was B streptococccusStaphylococciPneumonia-diplococcusAdenoviruses/AnaerobesThe abilit

4、y of body defence was descentCommon factorcold/tired/wetness/smoking/drinkingInfectivitydroplet/directly contacting,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 Pharyngeal pain/Low fever Lightly total symptom: aching pain/inertia A

5、cute congestion of mucosa, having little exudates on tonsil surface Blood: The amount of WBC/ neutrophil was high.,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,

6、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 membrane on tonsil surface. swelling of lymphatic nodes ia angle of mandible,having pressi

7、ng pain. Blood: The amount of WBC/neutrophil was high.,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,Typical history/ pharyngeal examinationDifferential diagnosis Pharyngitis Scarlet fever Ulcerative pharyngitis.,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

8、)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 abscessComplications of total body:( the type of allergic reaction induced by streptococcus) Rheumatic fever Acute arthritis Acute nephritis,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

9、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 of clinical drug. Relief of fever and pain were the second treatment. Local treatment were using gargle,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 reinf

10、orcement health, then rising resistance of body. Attention to insulation of patients, that prevents from infection,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/ vi

11、rus from crypt .,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 : streptococcus B /adenovirus repetition of acute attacking chronic inflammation Immuning infactors: microorganism tonsil self- allergic reaction 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,E

12、arlier period:the mucosa of crypts damaged epithelial proliferation,ulcering, inflammatory exudates Anaphase: the formation of scar in tonsil aperture hindering the little abscess,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

13、again and again The upset symptoms in pharynx The 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,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

14、体肿瘤：腺体肿大且有溃疡，需行活检确诊。,History+signs+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, pathologic evidence is the final diagnosis.,并发症Comp

15、lication,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 arthritisRheumatic feverNephrosisCardiac disease,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 treatmentImmuno-therapyWashing cryptsOperation tonsillectomy,扁桃体切除术适应症,反复炎症发作或并发扁桃体周围脓肿过度肥大，妨碍功能成为病灶角化症及白喉带菌者保守无效肿瘤,扁桃体切除术禁忌症,急性炎症期（23周后手术）血液系统疾病全身疾病未经控制急性传染病流行季节或流行地区妇女经期、妊娠期自身或家属中免疫疾病、白细胞低,扁桃体手术后,