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    Recurrent Tonsilitis

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    Ayen Fornolles
    - The 13-year-old female patient presented with a history of recurrent tonsillitis and was admitted for a bilateral tonsillectomy. - On physical examination, she had grade 4 tonsils bilaterally with no other abnormal findings. Laboratory tests were unremarkable. - She underwent an uncomplicated bilateral tonsillectomy and was discharged on post-operative day 3 with instructions to continue medications for pain and to prevent bleeding.

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    Recurrent Tonsilitis

    Uploaded by

    Ayen Fornolles
    29 views16 pages
    - The 13-year-old female patient presented with a history of recurrent tonsillitis and was admitted for a bilateral tonsillectomy. - On physical examination, she had grade 4 tonsils bilaterally with no other abnormal findings. Laboratory tests were unremarkable. - She underwent an uncomplicated bilateral tonsillectomy and was discharged on post-operative day 3 with instructions to continue medications for pain and to prevent bleeding.

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    - The 13-year-old female patient presented with a history of recurrent tonsillitis and was admitted for a bilateral tonsillectomy. - On physical examination, she had grade 4 tonsils bilaterally with no other abnormal findings. Laboratory tests were unremarkable. - She underwent an uncomplicated bilateral tonsillectomy and was discharged on post-operative day 3 with instructions to continue medications for pain and to prevent bleeding.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    29 views16 pages

    Recurrent Tonsilitis

    Uploaded by

    Ayen Fornolles
    - The 13-year-old female patient presented with a history of recurrent tonsillitis and was admitted for a bilateral tonsillectomy. - On physical examination, she had grade 4 tonsils bilaterally with no other abnormal findings. Laboratory tests were unremarkable. - She underwent an uncomplicated bilateral tonsillectomy and was discharged on post-operative day 3 with instructions to continue medications for pain and to prevent bleeding.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 16

    Recurrent Tonsillitis

    Chronic Hypertrophy Bilateral


    General Data
    • SL
    • 13 year old
    • Female
    • Roman Catholic
    • Cogon Compostela Cebu
    • Admitted for the 1st time in UCMed
    Chief Complaint
    • Recurrent tonsilitis
    Prenatal, Natal, Postnatal History
    • Born to a 33 year old G3P3 mother with unremarkable maternal history
    • Delivered full term via NSD with birthweight of 3.2 kg
    • No perinatal complications
    • Purely Breastfed for 12 months of age
    • Semisolids started at the age of 5 months
    – Immunizations c/o LHC: BCG
    – Hep B x 3
    – DPT x 3
    – Hib x 3
    – OPV x 3
    – AMV x 1
    – MMR X 1
    Past Medical History
    • No previous history of hospitalizations
    • No previous history of surgical
    procedures
    • Non-hypertensive
    • Non-diabetic
    • Non-asthmatic
    • No allergies to food or medications
    Family History
    • Hypertension on maternal side
    History of Present Illness
    • 5 years PTA, patient had onset of recurrent tonsillitis occurring once
    every year. Sought consult with AP and treated with Co-amoxiclav.
    • 2 months PTA, patient had onset of tonsillitis associated with 2-3 day
    fever with Tmax of 38.2. Sought consult with AP and prescribed with
    oral Co-amoxiclav for 7 days. Patient took the medications
    religiously. Patient also complained of occasional abrupt awakenings
    with choking and mother noticed loud snoring.
    • 1 month PTA, the patient had another onset of tonsillitis associated
    with 1 episode of fever with tmax of 38. Self-medicated with
    Amoxicillin (took only 3 doses). No consult done.
    • About 3 weeks PTA, patient sought consult with AP and was referred
    to Surgery. The patient was seen by GS and was prescribed with
    Difflam Forte oromucosal solution 3x daily and Mosaspray
    Mometasone 2x daily and was advised for surgical procedure thus,
    subsequently admitted for the contemplated procedure.
    Physical Examination
    • Vital signs: T 36.3, PR 89, RR 20, BP 120/80, Weight 58 cm, Ht
    158cm, BMI 23.23 kg/m2
    • Skin: warm, good turgor, no skin lesions
    • HEENT: + grade 4 tonsils, bilateral, non-exudative, non-
    hyperemic, (-) LAD
    • C/L: ECE, CBS, no rales, no wheeze
    • CVS: DHS, RRR, no murmur
    • Abdomen: nondistended, NABS, soft, nontender, no
    organomegaly
    • Extremities: warm, SPP, CRT <2s
    Impression
    • Recurrent Tonsilitis
    Lab tests
    CBC (OP)
    Result Normal
    WBC 8.8 4.0-10.5
    Labs
    Neutrophil 59 23-53
    Blood type B+
    Lymphocytes 30.4 23-53
    HBsAg Non-reactive
    Monocytes 6.1 2-11
    SARS-CoV 2 RT- PCR Negative
    Eosinophil 4.0 0-6
    Basophils 0.5 0-2
    RBC 4.33 4.10-5.3
    Hemoglobin 123 120-150
    Hematocrit 0.35 0.35-0.45
    MCV 82 78-95
    Chest X-ray (OP)
    MCH 28 26-32
    Negative RDW-CV 12.0 11-16
    Platelet count 277 150-450
    Urinalysis (OP)

    Lab Tests Color Yellow


    Clear
    Ph 6.0
    S.G 1.015
    Protein Negative
    Glucose Negative
    Ketones Negative
    Blood Negative
    Urobilinogen Normal
    Nitrite Negative
    Leukocytes +1
    Bilirubin Negative
    RBC 0-1
    WBC 3-5
    Epithelial cells Few
    Mucus threads Rare
    Bacteria Many
    At the ER…
    • Venoclysis started with D5LR @ MR
    • Started on Co-amoxiclav 600mg IV drip with AD of 20.1
    mkd
    • Referred to Pedia for CP Clearance and co- management
    and cleared for the procedure
    • Scheduled for bilateral tonsillectomy
    Post-op Day 1
    S O A P
    Complains of mild VS: T 36.8, PR 90, RR 20, BP Recurrent tonsillitis Co-amoxiclav IV drip AD
    dysphagia with pain score 90/60 (Chronic hypertrophied) 20.1 mkd
    of 4/10. s/p Bilateral Tonsillectomy Dexamethasone 5mg q8h
    No febrile episodes. Difflam forte gargle 3 x a
    Tolerated soft cold diet. HEENT: no bleeding at the day
    post-op site Paracetamol 1 gm q8h (AD
    C/L: ECE, CBS, No rales 17 mkd)
    Parecoxib 20mg q12h x 4
    doses (AD 0.34 mkd)
    Nalbuphine 5mg slow IVTT
    Q12 X 2 doses then q12h
    PRN for PS >= 4/10 (AD
    0.09mkd
    Ondansetron 4mg IVTT q8h
    (AD 0.07 mkd)
    Celecoxib 200mg OD PO
    (AD 3.4 mkd)
    Tramadol + PCM PO TID X 3
    days
    Post-op Day 2
    S O A P
    No bleeding at the VS: T 37.1, PR 82, Recurrent tonsillitis Started on
    post-op site RR 20, BP 120/70 (Chronic Esomeprazole 40
    Complains of mild hypertrophied) mg IVTT (AD 0.7
    dysphagia with s/p Bilateral mkd)
    pain score of 4/10. HEENT: no bleeding Tonsillectomy
    at the post-op site,
    + swollen uvula
    C/L: ECE, CBS, No
    rales
    Post-op Day 3
    S O A P

    No bleeding at the VS: T 37.1, PR 82, RR Recurrent tonsillitis Cleared for discharge:
    post-op site 20, BP 120/70 (Chronic Co-amoxiclav 625 BID
    Complains of mild hypertrophied) PO (AD 21.6mkD)
    dysphagia with pain s/p Bilateral Arcoxia 90 mg PO OD
    score of 2-3/10. HEENT: no bleeding Tonsillectomy (AD 1.6mkd)
    at the post-op site, + Tramadol+ PCM 1 tab
    swollen uvula TID PO X 5 days
    C/L: ECE, CBS, No Difflam gargle TID
    rales Tranexamic acid
    500mg po TID for 3
    days (AD 8.6mkd)
    Thank you

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