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