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Faringitis aguda y crónica

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Generalidades. Faringitis aguda y crónica. Otorrinolaringología. Medicina General.

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Faringitis aguda y crónica

  1. 1. Faringitis Aguda
  2. 2. Consideraciones  Se trata de infecciones-inflamaciones, de origen vírico o bacteriano, que afectan a la pared posterior de la orofaringe, pero raramente de modo exclusivo a dicha zona.  Por lo general, el cuadro afecta a toda la orofaringe, debiendo hablarse de faringoamigdalitis.  Se asocia una viriasis rinítica, rinofaríngea y laríngea.  Con frecuencia, la mucosa del paladar también se afecta.
  3. 3. Etiologia Viral. Grupo A Streptococo -hemolitico. Corynibacterium diphtheriae. Neisseria gonorroheae. Trauma: cuerpo extraño, quemaduras y/o danos faringeos. Inhalantes irritantes: cloro, humo, vapor.
  4. 4. Faringitis Viral Causa mas comun de faringitis. Adenovirus. Influenza. Enterovirus. Parainfluenza. Herpes simplex. Epstein-Barr virus.
  5. 5. Tratamiento Auto-limitadas. Tratamiento sintomatico.
  6. 6. Mononucleosis Infecciosa  Causada por el virus Epstein Barr.  Afecta mayormente pacientes entre 10-25 años.  Presentación clinica: - Dolor de garganta / fiebre / malestar / fatiga. - Dolor abdominal. - Nausea.  Examen fisico: - Faringitis exudativa. - Adenopatia posterior cervical dolorosa. - Hepato-esplenomegalia. - Dolor en el hombro izquierdo (Kehr’s sign), pensar en  ruptura de bazo.
  7. 7. Mononucleosis Infecciosa Laboratorios: - Tinción periferica de sangre: linfocitosis > 50%, linfocitos atipicos > 10%. - Mono-test: anticuerpo heterofilo, puede tener falso negativo si es < de 4 anos.
  8. 8. Tratamiento  Auto-limitante.  Antipireticos, fluidos, descanso.  Puede afectar la via aerea.  Esteroides: - Indicaciones: - Obstrucción de la via aerea. - Anemia hemolitica severa. - Trombocitopenia. - Encefalitis / Guillain-Barre - Prednisona 2.5 mg/Kg/d por 5 dias o decadron 0.5 mg/Kg hasta un máximo de 10 mg en 5 dias.
  9. 9. Disposición Evitar deportes de contacto por un mes. Regresar a la sala de emergencias si: - Dolor abdominal. - Disfagia. - Dificultad respiratoria.
  10. 10. Faringitis por Herpes Simplex Afecta a jovenes adultos. Infeccción primaria / Reactivación. Vesiculas agrupadas en una base eritematosa. Lesiones dolorosas que erosiona para formar ulceras superficiales.
  11. 11. Tratamiento Paciente inmunocomprometido: aciclovir. Paciente inmunocompetente: aciclovir puede ayudar, pero no esta probado. Analgesicos / Antipireticos.
  12. 12. Faringitis Gonorreica Jovenes / adultos que sostienen sexo oro-genital. Neonatos por parto vía vaginal. Existe co-infección con clamidia, por lo que tiene que tratarse tambien.
  13. 13. Tratamiento Ceftriaxona 125 mg im & Azitromicina 12 mg/kg una vez al dia por 5 dias. Ciprofloxacina (contraindicado si menor de 18 anos) u ofloxacina (dosis sencilla). Antipireticos / analgesicos por las primeras 72 horas.
  14. 14. Difteria  Condición rara asociada a falta de vacuna DPT.  Periodo de incubación: 1 semana.  Invasión infecciosa produce necrosis del tejido  pseudomembrana en la faringe posterior.  Puede producir obstrucción de la via aerea.  Complicaciones extrafaringeas: - Miocarditis / Bloqueo AV / Endocarditis. - Nefritis / hepatitis. - Neuritis: ptosis, estrabismo, paralisis de musculos del paladar (primero en paralizarse).
  15. 15. Cuadro Clinico Comienzo agudo de dolor de garganta. Fiebre, malestar general. Apariencia toxica, taquicardico. Faringitis exudativa. Pseudo-membrana adherente (blanca-gris). Adenopatia cervical marcada (“Cuello de Toro”). Aliento fetido. Descarga sero-sanguinolenta por la nariz.
  16. 16. Laboratorios CBC: trombocitopenia. Tinción Gram: (+). Cultivo de Loeffler’s: (+).
  17. 17. Tratamiento Estabilizar via aerea. Penicilina parenteral o eritromicina. Antitoxina de suero de caballo. Admisión con aislamiento respiratorio. Recomendaciones para contactos cercanos.
  18. 18. Estreptococo Grupo A -Hemolitico Pacientes < 20 anos. Epoca: Invierno. Raro en ninos < 3 anos. Cuadro Clinico: - Fiebre. - Adenopatia cervical anterior dolorosa. - Tonsilitis exudativa. -Vomitos - Dolor abdominal. - Dolor de cabeza.
  19. 19. Diagnostico Diagnostico certero: solo por cultivo. Pruebas rapidas de estreptococo: utiles solo si son positivas. Si es negativa: cultivo de garganta. Criterios de Centor: - fiebre > 38°C  1. - Auscencia de tos 1. - Adenopatia cervical anterior dolorosa  1. - Inflamación tonsilar o exudado  1. - Edad < 15  1. - Edad > 45 anos  -1. - Puntuación: -1 o 0 (1%), 1 (10%), 2 (17%), 3 (35%), 4 (51%), 5 (51%).
  20. 20. Complicaciones Infección del espacio faringeo: tratamiento con antibioticos disminuye la incidencia. Fiebre reumatica: - Periodo latente de 2.5-5 semanas. - Tratamiento de faringitis dentro de 9 dias  esta complicación. - Cuadro clinico: - Dolor migratorio en articulaciones. - Carditis, dano valvular (mitral).
  21. 21. Complicaciones Glomerulonefritis: - Periodo latente de 1-3 semanas. - tratamiento con antibioticos no evita esta complicación. - Edema facial, oliguria / anuria / orina color te. - El lab mas importante es U/A: rbc, wbc, cast. - Anemia normocromica, hiperkalemia.
  22. 22. Tratamiento GABHS  Penicilina benzatinica 1.2 M U im. - 600,000 U im para < 27 kilos Penicilina V 1 gm PO bid o 500 mg PO bid, si es menor de 27 kilos. Amoxicilina 60 mg/kg/d dividido en tres dosis;10 dias. Eritromicina etilsuccinato 50 mg/kg/d dividido en 3 dosis, por 10 dias. Cefprozil 30 mg/kg/d dividido en 2 dosis; 10 dias. Cefuroxime 30 mg/kg/d dividida en 2 dosis; 10 dias. Azitromicina 12 mg/kg una vez por dia, por 5 dias.
  23. 23. Tratamiento Esteroides son utiles en faringitis con hinchazon de moderada a severa.
  24. 24. Faringitis Crónica
  25. 25. DEFINICIÓN:  Es la inflamación repetida de la mucosa faríngea, sin componente infeccioso, por periodos prolongados y repetidos, que puede ocasionar modificaciones permanentes y evolutivas, las cuales terminan lesionando la mucosa, submucosa y tejidos linfoides.
  26. 26. Causas más comunes  Alergias, que además se relaciones con factores ambientales como contaminación atmosférica y el tabaquismo  Irritantes o tóxicos como el alcohol y tabaco o vapores tóxicos  Insuficiente ventilación nasal unida a factores adversos (sequedad o humedad extremas, ambientes laborales contaminados, etc)  Reflujo grastroesofágico  Abuso y mal uso de la voz
  27. 27. Signos y Síntomas Sensación de sequedad Sensación de cuerpo extraño No existe dolor Mucosa seca y muy adelgazada Secreción faringéa densa e incolora
  28. 28. Según el modo de reacción de la mucosa faríngea, las faringitis crónicas se dividen en: Faringitis crónica simple Faringitis crónica hipertrófica  crónica granulosa  crónica lateral o cordonal Faringitis crónica atrófica
  29. 29. www.reeme.arizona.edu
  30. 30. Faringitis crónica simple  La mucosa de la pared posterior y de los pilares faríngeos adquiere una coloración rojo-violácea con abundante vascularización superficial. Mucosidad viscosa y adherente sobre la superficie.
  31. 31. Faringitis crónica hipertrófica  GRANULOSA: Presenta formaciones redondeadas brillantes de diámetro de 0,5 a 1,5 cm. sobre la pared posterior de la faringe que corresponden a folículos linfoepiteliales hipertrofiados. - Propia de personas Jóvenes - Secreción catarral que tapiza la faringe - Adenopatías en cuello
  32. 32. Faringitis crónica hipertrófica  LATERAL O CORDONAL: Muestra una gran hipertrofia de la mucosa de los márgenes laterales de la pared posterior faríngea, que está junto a los pilares posteriores, que se presentan también inflamados como el resto de la pared posterior. - Sensibilidad marcada - Sordera progresiva y zumbidos - Constante necesidad de carraspear
  33. 33. Faringitis crónica atrófica  Al examen se observan mucosas secas, lisas, esclerosas, recubiertas en parte por una tela costrosa, y se puede observar una mucosa hipertrófica. - Propiamente del adulto mayor - Suele ser etapa final de las formas clínicas anteriores - Sensación de tener algo pegado en la faringe y necesidad de tragar constantemente
  34. 34. Diagnostico Anamnesis Exploración de la cavidad faringea Observación de las lesiones típicas, correlacionadas con la sintomatología del paciente.
  35. 35. Diagnostico diferencial Debe establecerse fundamentalmente con las neoplasias faringeas. Faringoamigdalitis crónica
  36. 36. Tratamiento GENERALES Eliminación de factores predisponentes Permeabilidad y ventilación nasal Lavados con suero salino o productos similares que arrastren las secreciones N-acetilcisteina Hidratación Eliminar focos infecciosos de vecindad
  37. 37.  Faringitis crónica granulosa: Puntos de electrocoagulación en los folículos linfoideos diseminados en la faringitis granulosa  Faringitis crónica lateral: - Tratar el estado general congestivo - AINEs - Electrocoagulación de los cordones laterales en caso de ser muy desarrollados - Gargarismos y duchas de borato y bicarbonato sódico ESPECÍFICOS
  38. 38. Faringitis crónica atrófica: - Se trata de vitalizar en lo posible las mucosas con yodo - Vitamina A

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