PHARYNGITIS
– inflammation of the throat
Pain
can radiate to the ear via the 9th cranial nerve with pharyngitis
Catarrhal
phayringitis
Viral
infection of the upper respiratory tract
S&S
of URI
Low
grade fever is possible
Throat
is dry and sore*
Influenzal
type
Signs
of the flue with low-grade fever, malaise and body aches
Moderately
sore throat
Mucosa
is dull red and slightly swollen, as are the faucial pillars
Swelling
of the lymphoid islands*
Gradual
improvement in 3-4 days
*lymphoid
islands: network of lymph nodes behind
the posterior pharyngeal wall
seen as discrete elevations with the
flu
Chronic
pharyngitis- chronic throat pain
Typically
due to resistant strains of bacteria or recurrent viral infections, post-nasal
drip, allergic rhinitis, mouth-breathing, smoking and alcohol
May
also be due to TMJ disorders as referred pain
Acute
Tonsillitis
Most
often due to strep or staph
S&S:
systemic illness
Vomiting
is common
Sudden
onset of fever, chills, malaise
Dysphagia,
halitosis, cervical lymphadenopathy
Usually
resolves in 5-7 days
Often
pain radiating to the ears
Tonsils
are red and swollen with white, thin exudate that peels without bleeding
Chronic
Tonsillitis
From
recurrent or unresolved infection
The
symptoms are less than an acute infection, therefore, it is not as red or
severe
Dull,
hyperemic tissues instead of very red and swollen
Mild
to scratchy sore throat instead of very sore
Tonsils
and pillars are mildly swollen
Tonsils
have pits and some exudate
Cough
and fetid breath
The
patient may find just white chunks coming out of tonsils sometimes [old pus].
Tonsillectomy
indicated : 7 episodes in one year, 5
episodes per year for two years, three episodes per year for three years, two
weeks of lost school or work time in one year, airway obstruction,
peritonsillar abscess, febrile seizures secondary to the tonsillitis.
The
removal of the adenoids appears to decrease the frequency of eustachian tube
dysfunction.
Infectious
mononucleosis
Epstein-Barr
Virus- a herpes
Once infected, the antibodies remain for life
If reinfected, cannot perform monospot as it will
always be positive from the initial infection.
A monospot will not be positive in all cases.
Initially, leukopenia and eventually leukocytosis of
10 to 20K WBC
Not highly contagious
Patient remains contagious for months after
resolution
Primarily oral-respiratory transfer
4 to 7 week incubation
S&S: initially vague malaise, fatigue, headache,
chill
Then
high fever, sore throat, generalized lymphadenopathy
With
white to gray exudate.
Almost
any organ can be affected
Hepatomegaly, splenomegaly,
meningitis, Bell’s Palsy, pericarditis, myocarditis
Pectechiae
on palates may be noted
.
Note: This may look like a mild, nonspecific
infection at first.
It
may start like a catarrhal pharyngitis and progress to the appearance of acute
bacterial pharyngitis.
It
can begin with a low grade fever and sore throat.
In
a few days, the fever may be up to 103 though this is a viral infection.
The
tonsils are grosssly enlarged, red and swollen and covered with a membranous
exudate [white to gray].
The
petechial hemorrhages can still occur on the palate.
Streptococcal
pharyngitis or acute bacterial pharyngitis
Many
are carriers of strep- found in pharynx of assymptomic volunteers
20
% of those who develop symptoms show the following:
Fever
over 101 degrees
Red,
swollen mucosa
Petechiae
White
to yellow exudate
Tender
high lymph nodes- cervical and submandibular
Pain
may radiate to the ear via the 9th cranial nerve
No
laryngitis, cough or runny nose
Fever
usually resolves in a few days
Complete
recovery within two weeks
Lab:
elevated ESR, WBC 12 to 20 K, 75-90% neutrophils
Proteinuria
may be noted if fever is present
Complications:
septicemia, pneumonia, endocarditis
Those
who do not develop the full blown strep S&S may have one or more of the
following:
Headache
Malaise
Nausea
Vomiting
Fever
Sore
throat
Tachycardia
Convulsions
can occur in children
Chidren
under 4 may only have a runny nose
Diptheria
Incubation
1-4 days
Prodrome
12 –24 hours
Begins
with mild sore throat, dysphagia, low-grade fever, rising heart rate
Red
and swollen pharyngeal mucosa, the laryngeal tissue may also be edematous
The
edema may become severe enough to obstruct respiration
White
tonsillar membrane that turns gray-
It
is difficult to remove and bleeds on removal
Systemic
signs of severe infection
Corynebacterium
diphtheriae go to the nasopharynx and tonsils
There
byproduct exotoxins are toxic to adjacent cells and are carried through the
bloodstream to other organs; kidneys, myocardium, nervous system.
Vincent’s
Angina
‘Necrotizing
ulcerative stomatitis’
‘Trench
mouth’
Borrellia
Vincenti- organism, localized infection
Not
contagious
Usually
limited to the gums and is very painful
fetid
breath
punched
out ulcerations, with red edematous rims, and a gray membrane of the gums noted
the
ulcerations bleed with irritation abrupt onset with malaise but no fever
as
it progresses, it may envelope the tonsillar tissue and form a grey membrane
the
membrane is easily removed
no
systemic signs and symptoms
due
to stress, heavy metal and nutrition problems
it
may spread to bone and other pharyngeal structures
tx: antibiotics, hydrogen peroxide washing,
improved hygeine
Retropharyngeeal
Abscess
An
abscess formation in the fascial space of the posterior pharyngeal wall and the
prevertebral fascia.
It
is due to a suppuative lymph node infection after a tonsillar, nasal or sinus
infection.
A
palpable fullness in the posterior pharyngeal wall is noted.
The
patient will carry the head in extension and appears rather ill with fever and
dysphagia.
An
infection of the vertebrae or blockage of the airway may occur.
Peritonsillar
Abscess ‘Quinsy’
The
patient may present with the head laterally flexed toward the side of
involvement.
The
tonsil will move toward midline dragging the pillar and soft palate with
it. [True uvular deviation occurs with
this pathology. Some people have
deviated uvulas but the soft palate is not lowered on the side opposite of the
uvular deviation. These are normal.]
A
complication of acute tonsillitis.
Pus
forms between the tonsillar capsule and the superior constrictor [pharyngeal
muscle].
The
patient has symptoms of a severe unilateral sore throat.
There
is terrible pain if the tonsillar capsule ruptures.
The
condition is preceded by peritonsillar cellulitis.