Partikel asing di mukus yang stag menempel pada adenoid

Streptococcus Group A bacteria

Memiliki lipoteichoic acid pada pili & F protein (fibronectin binding property)

-Culture test on lab result (+) -Gram staining indicated

Etiologi
Mucociliary clearance Repeated mechanism over the last 2 consecutive years -Squamous -Respiratory epithel Easily to become secondary infection (bacterial) Antigen bakteri ditangkap oleh pharyngeal tonsil pada specialized epithelium Menempel dgn gylcoprotein fibronectine receptor pada epithelial pharyngeal tonsil Infection 4-5x/year

Minum obat terus

Flora normal () fungsi menekan pertumbuhan patogen ()

Infeksi virus (flu) -2 years ago-

Kerja adenoid

Me-release exotoxin and other antigenic structure Bacterial pathogenic easily to entry and growing

cellular structures

Breathing through his mouth

Merusak epithelial palatine tonsil

Faktor resiko : -environment -host factors -diet

Adenoid enlargement

Difficult to breathing through his nose

Recurrent infection (remember what happened in the last 2 consecutive years)

-Squamous -Respiratory epithel

Mechanical defense

Tonsil become infected and enlarged

Chronic Tonsilopharyngitis

Antigen dikenali oleh lymphoid cells

Activation of B and T cells

Aggregation to site of infection

Release cytokine (co : IL 1, TNF)

Induce release inflammatory mediator (histamine, leukotrine, PGE, Nitric Oxide, bradikinin)

Memediasi respon inflamasi

Raise body temperature in the new of hypothalamic thermostate set point

Blood vessel dilatation

permeabilitas vascular

Tonsilar epithelial repair and remodeling

blod flow fever hidrostatic pressure exudation of fluid that rich of protein ( osmotic pressure)

fibrosis

Peningkatan struktur selular

Widening of the cryptae, hyperemic, full of debris Adenoid enlargement

Calor (heat) dan rubor (hyperemic pharynx)

edema Fill the entire space of nasopharyx (airway obstruction)

Tonsil membesar (T3) Pada saat menelan Tersumbatnya saluran hidung

Soft palate tertarik Pharynx berkontraksi (superior, middle, inferior contrictor muscle akan menekan sel-sel inflamasi)

Bolus bergesekan dengan sel-sel inflamasi

Proses resonansi terganggu

Getaran soft palate/uvula/ tonsillar pillar

Difficult to breath through the nose

Mensensitisasi free nerve ending of glosopharyngeal nerve and vagus nerve

Hyponasal voice

Snored while sleeping at night

Increase breathing effort increase Respiratory rate (RR)

Pain on swallowing

TONSILOPHARINGITIS ON ACUTE EXCACERBATION WITH ADENOID HYPERTHROPY - FADHLI RAJIF-A3