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IDENTITY PATIENT
Name : NRR
TTL : 18/09/2007
Age : 6 years 6 months 22 days
Gender: Female
Address : Bantren RT 01 / 02 Hamlet Bayat Klaten
Religion : Islam
RM Number : 814 725
BB : 20 Kg
History
Main complaints : Pain swallowing
Disease History Now :
Patients come to the poly ENT RSST Klaten complained of pain with
swallowing ( + ) since 2 days ago . Pain is felt gradually swallow and felt
more pain for 2 days . Swallow the pain felt like there are cuts in the base of
the mouth and feels hot . Become rather smelly breath and breath air into
heat . Swallow the pain is felt when swallowing food and drinks as well as
saliva . Pain is considered improved if swallowed drink lots of water and lots
of rest . Pain swallowing become heavy if the patient feels fatigue , lack of
sleep , drink ice , eating spicy and fried food . Patients not taking medicine
before.
In addition , the patient complained of a lump in the throat ( + ) along with
pain perceived swallow . Flavor prop felt since 2 days ago . The taste is felt
as a lump in the throat that no objects getting bigger . The taste was
advancing when the patient feels a lump fatigue , drink ice , eating spicy and
oily as well as improved if a lot of rest .
The patient also complained of a headache since 2 days ago . Front head felt
dizzy and become heavy if the afternoon until the evening . Felt dizzy at any
time and does not improve with rest . Patients also complained about the
heat since 2 days ago . Heat at night and felt a little down in the morning or
afternoon . Heat is felt throughout the body . Heat does not improve with rest
and become heavy at night and when the patient fatigue .
kanan kiri
Auricula
Normal
Normal
Planummastoidium Normal
Normal
Gld. Lymphatica
Normal
Normal
Normal
Normal
Normal
Normal
Discharge
Negatif
Positif
HIDUNG
kanan kiri
Discharge
Negatif
Concha
Normal
Normal
Septum
Normal
Normal
Negatif
Tumor Negatif
Negatif
Sinus paranasalis
Normal
Normal
NASOFARINGkanan kiri
Dinding Belakang
Choanae
Normal
Normal
Normal
Normal
Normal
Adenoid
Normal
Normal
Tumor Negatif
Normal
Negatif
Normal
Normal
Uvula Normal
Tonsila Palatina
Normal
MembesarT3,
Detritus(+), Detritus(+)
kriptamembesar,
Tonsila Lingualis
Normal
Membesar T4
kripta membesar
Normal
Dinding Belakang
Normal
Normal
LARINGO FARING
Dinding Belakang
Parafaring
Normal
Normal
LARING
Epiglottis
Normal
Arytenoid
Normal
Negatif
Subglottis
Normal
Trachea
Normal
Investigations
- Not done
DIAGNOSIS
- Acute exacerbation of chronic tonsillitis
THERAPY
- Oral antibiotics group : Penicillin tab . 500 mg no.XV s.3.d.d tab. I
- Anti - Inflammatory Analgesics such as Na . Diclofenac tab . 25 mg no. XV
s.p.r.n.3.d.d tab 1
- Antipyretics like Paracetamol tab . 500 mg no.XV s.p.r.n.3.d.d tab 1/2
suggestion Therapy
- Surgery ( Tonsillectomy ) performed after the acute phase of recovery
EDUCATION
Maintaining oral hygiene
- Patients are reminded not to drink ice cold drinks aatau .
- Patients should not eat fried foods and spicy .
- Rest enough .
DISCUSSION
DEFINITION
Chronic tonsillitis is a condition where there is enlargement of the tonsils
accompanied by repeated attacks of infection. Tonsillitis is an inflammation
of the palatine tonsils that are part of the Waldeyer ring . Waldeyer ring
consists of lymph nodes that found in the oral cavity , namely : pharyngeal
tonsils ( adenoids ) , palatine tonsils ( faucial tonsils ) , the lingual tonsils
( tonsils base of the tongue ) , tonsils Eustachian tube ( lateral pharyngeal
wall band / Gerlach's tonsil ) . The spread of infection through the air (air
-borne droplets) , hands , and kisses . It can occur at any age , especially in
children .
Predisposing factors of chronic tonsillitis are chronic stimulation of
cigarettes ,fried foods , poor oral hygiene , the effects of weather , physical
exhaustion and treatment of acute tonsillitis inadequate .
Etiology
Microorganism that cause acute tonsillitis are Grup A Streptococcus beta
haemolyticus, pneumococci ,
S. viridans and S. piogenes . However, sometimes the bacteria can turn into
a group of gram-negative .
Pathogenesis
Pain in the throat is sometimes severe and may last more than 48
hours, along with pain on swallowing.
Headache.
The throat is reddened, the tonsils are swollen and may be coated or
have white flecks of pus on them.
Relative indications :
Drugs
1.Antipyretic analgesics such as paracetamol and ibuprofen are of value.
2.For most patients, antibiotics have little effect on the duration of the
condition or the severity of symptoms. The National Institute for Health and
Clinical Excellence (NICE) suggests that indications for antibiotics include:
Unilateral peritonsillitis.
100% susceptible to penicillin. A recent meta-analysis confirmed that a 10day course was superior to shorter courses in terms of bacterial eradication.
Macrolides including erythromycin and azithromycin can be used where
there is allergy, and a course need be only 5 days. They can also be used
for treatment failures, which do occur with penicillin. Between 5% and 35%
of patients do not have bacteriological eradication. [9] This may be due to
commensal infection with bacteria that produce beta lactamase.
COMPLICATIONS
Chronic inflammation of the tonsils can cause complications to the
surrounding areas such as chronic rhinitis , sinusitis or otitis media
perkontinuitatum . Complications occur much hematogenous or limfogen and
can arise endocarditis , arthritis , myositis , nephritis , uveitis , iridocyclitis ,
dermatitis , pruritus , urticaria and furunculosis .
Acute tonsillitis
DEFINITION
Acute tonsillitis is an inflammation of the palatine tonsils . Acute tonsillitis is
often caused by the bacteria streptococcus group A -haemolytic , but
various types of other organisms can also be a cause . In some cases it can
also be caused by a virus .
Etiology
Acute tonsillitis can be caused by bacteria , virus and even fungi . Most often
caused by the -haemolytic streptococcus group A ( GABHS ) ,
pneumococci , staphylococci , Haemophilus influenzae and also viral
pathogens may be involved . Sometimes non -haemolytic streptococci or
Streptococcus viridans was found in the culture , usually in severe cases .
The virus can be a precursor to the mucosal inflammation , crypt
obstruction , and ulcerations that cause secondary bacterial invasion .
Epstein - Barr virus ( EBV ) can cause serious acute tonsilofaringitis .
Pathogenesis
Pathogenesis of infection and inflammation of the tonsils based on the tonsils
function as immune organs , managing infectious materials and other
antigens , and then became the focus of infection or inflammation. Viral
infection with secondary bacterial infection may be a mechanism that
initiates chronic disease , but the effects of the environment , host factors ,
the widespread use of antibiotics , ecological considerations , and diet , can
all play a role .
Recent studies have revealed that inflammation and loss of integrity of the
epithelial crypt produces chronic inflammation and obstruction crypt ,
increase the accumulation of debris and antigens .
Clinical Symptoms
The patient complained of sore throat , pain on swallowing , malaise , fever
( usually high temperature , can be up to 40 C ) , and breath odor . There
may be otalgia in the form of referred pain . There is tenderness along the
cervical adenopathy .
Trere are enlargement and inflammation of tonsils . Tonsils are usually
spotted and sometimes covered by exudate . This exudate may be a grayish
or yellowish . This exudate can get together and form a membrane , and in
some cases local tissue necrosis can occur .
Not all signs and symptoms appear in all patients, many clinicians rely on the
positive results of the throat culture or rapid strep antigen test for GABHS as
the sole criteria for the diagnosis of acute tonsillitis . This is still under debate
whether the throat culture is needed when there are definite signs of
infection. In the patients who are ill with inflammation of the tonsils caused
by bacterial infections or EBV ( infectious mononucleosis ) need to be
considered and treated .
DIAGNOSIS
Diagnosis based on anamnesis , clinical examination and investigations
( Rapid strep test and throat swab culture ) .
MANAGEMENT
In general , patients with acute tonsillitis and fever should be bed rest ,
adequate fluid administration , and a light diet . Local applications such as
drug throat , is considered to have a relatively minor significance . Oral
analgesics are effective in controlling bad taste . Antibiotic therapy was
associated with proper culture and sensitivity . Penicillin is still the drug of
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Publishers , 2007.
2 . Soekardono , S. Concise Textbook of Medical Sciences ENT - TOS .
Yogyakata : UGM .
3 . Lalwani , A. Current Diagnosis and Treatment in Otolaryngology - Head &
Neck Surgery . United States : Mc Graw Hill , 2004.
4 . Lauro , Joseph , and Erik D. Barton . " Tonsillitis . " eMedicine Health . Eds .
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<http://www.emedicinehealth.com/tonsillitis/article_em.htm> .
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