Tonsils - Clinical Anatomy (Palatine, lingual, tubal, adenoids)

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"The tonsils are part of what is called Waldeyer’s ring. Generally when talking about tonsils we are talking about the palatine tonsils situated on both sides of the throat. There are also the adenoids, tubal tonsils and lingual tonsils which make up the Waldeyer's ring. The tonsils are a lymphoid organ containing macrophages, t-cells and b-cells. These cells are important in learning and building up the immune response. The tonsils are important in the early years of life because the lymphoid tissues containing the immune cells are continuously exposed to many antigens. That is why until the age of 6 tonsils are typically hyperplastic and tend to regress by 12 years of age. The palatine tonsils have a strong blood supply from five different vessels, that is why there is a risk of a lot of bleeding with tonsillectomy. The tonsils have deep crypts and lymph nodules. The crypts are normally colonized by many species of bacteria and also exposed to many viral organisms. The lymph nodules containing immune cells such as t-cell, b cells and macrophages.

Many viral and bacterial organisms can cause tonsillitis, which is inflammation of the tonsils causing tonsillar oedema, hypertrophy, erythema and pain. The inflammation may affect other areas of the back of the throat, including the adenoids and the lingual tonsils. This inflammatory response produces exudate either white, grey, or yellow discharge. Cultures are not often useful in distinguishing the offending pathogen because even you grow something they are probably commensal organisms anyway.

Generally with acute tonsillitis the pharynx is also inflamed and so a better definition is pharyngotonsillitis rather than acute tonsillitis. The two important causes of tonsillitis to remember are EBV and GAS"

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