Retropharyngeal Abscess (RPA)

7/23/2019 Retropharyngeal Abscess (RPA)

1/15

RETROPHARYNGEA


2/15

BACKGROUND

- Retropharyngea a!"#e"" (RPA) pro$%#e" the "y&pto&" o' "ore t'eer ne#* "t+,ne"" an$ "tr+$or

Retropharyngea a!"#e"" po"e" a $+agno"t+# #haenge 'or the e&phy"+#+an !e#a%"e o' +t" +n're.%ent o##%rren#e an$ ar+a!e pre"e

Eary re#ogn+t+on an$ aggre""+e &anage&ent o' retropharyngea

are e""ent+a !e#a%"e +t "t+ #arr+e" "+gn+/#ant &or!+$+ty an$ &or


3/15

The retropharyngea "pa#e +" po"ter+opharyn0 !o%n$ !y the !%##opharyngeanter+ory the preerte!ra 'a"#+a po"tthe #arot+$ "heath" ateray

A!"#e""e" +n th+" "pa#e #an !e #a%"e$

'oo1+ng organ+"&"2 Aero!+# organ+"&" "%#h a" !eta-he&

"trepto#o##+ an$ Staphylococcus aur

Anaero!+# organ+"&" "%#h a" "pe#+eo' Bacteroidesan$ Veillonella

Gra&-negat+e organ+"&" "%#h a" H

parainfuenzae and Bartonella hense

The h+gh &orta+ty rate o' retropharyngea a!"#e"" +" o1+ng to +t" a"

1+th a+r1ay o!"tr%#t+on &e$+a"t+n+t+" a"p+rat+on pne%&on+a ep+$%r

a!"#e"" 4%g%ar eno%" thro&!o"+" ne#rot+5+ng 'a"#++t+" "ep"+" an$+nto the #arot+$ artery
http://emedicine.medscape.com/article/353329-overviewhttp://emedicine.medscape.com/article/784690-overviewhttp://emedicine.medscape.com/article/784690-overviewhttp://emedicine.medscape.com/article/353329-overview


4/15

EP6DE76OLOGY

Retropharyngea a!"#e"" +" &ore #o&&on +n &ae" than +n 'e&aegeneray reporte$ &ae prepon$eran#e o' 89-88:

6n+t+ay retropharyngea a!"#e"" 1a" tho%ght to !e a $+"ea"e +h+$ren !%t no1 +t +" !e+ng en#o%ntere$ 1+th +n#rea"+ng 're.%en#a$%t"


5/15

H6STORY H+"tory +" ar+a!e $epen$+ng on the age gro%p Sy&pto&" o'

retropharyngea a!"#e"" are $+,erent 'or a$%t" #h+$ren an$ +n'a

Symptoms inadults

;Sore throat

:)

:)@8

Ne#* "t+,ne"" (?>:)@8

O$ynophag+a (88:)@8

Co%gh

Symptominfan


6/15

PHYS6CAL Pat+ent" 1+th retropharyngea a!"#e"" &ay pre"ent 1+th "+gn" o' a+r1a

o!"tr%#t+on !%t o'ten they $o not 6n$++$%a" 1ho $o not e0h+!+t "+gn"a+r1ay o!"tr%#t+on +n+t+ay &ay progre"" to a+r1ay o!"tr%#t+on The o&&on pre"ent+ng "+gn" &ay !e $+,erent 'or a$%t an$ pe$+atr+# pat+

Physical signs in adults

Po"ter+or pharyngea e$e&a (9:)

N%#ha r+g+$+ty

Cer+#a a$enopathy


7/15

CAUSEADULTS

Beta-he&oyt+# "trepto#o##+

Streptococcus viridans

Peptostreptococcus"pe#+e" @F

Fusobacterium"pe#+e" @F

S aureus

7eth+#++n-re"+"tant Staphylococcus

aureus (7RSA) @FF

Klebsiella pneumoniae

CH6LDREN AND 6N


8/15

PREHOSP6TAL-CARE S%ppe&enta o0ygen an$

attent+on to %pper a+r1aypaten#y are the e""ent+a#o&ponent" o' preho"p+ta #are+n pat+ent" 1+th "%"pe#te$retropharyngea a!"#e""

6' a #h+$ e0h+!+t" re"p+ratory$+"tre"" the "n+ng po"+t+on&ay !e !ene/#+a

O##a"+onay en$otra#hea+nt%!at+on or #r+#othyroto&y&ay !e re.%+re$ +' the pat+ente0h+!+t" "+gn" o' %pper a+r1ayo!"tr%#t+on


9/15

7ED6CAT6ONThe goa" o' phar&a#otherapy are to era$+#ate the +n'e#t+on to re

&or!+$+ty an$ to preent #o&p+#at+on" 6ntraeno%" !roa$-"pe#tant+!+ot+# #oerage +" +n$+#ate$ +n the treat&ent o' retropharyngea!"#e""

Ampicillin and sulbactam (Unasyn)

Clindamycin (Cleocin)

Penicillin G (PzerpenG)

Piperacillin and tazobactam (!osyn)

"etronidazole (#lagyl$ "etro)


10/15

On#e the $+agno"+" o' retropharyngea a!"#e"" +" e"ta!+"he$ +n+t+ntraeno%" ant+!+ot+#" an$ a$&+t the pat+ent to the ho"p+ta

6' any "+gn" o' re"p+ratory $+"tre"" are pre"ent a$&+t the pat+ent t+nten"+e #are %n+t

The ENT phy"+#+an $e#+$e" 1hether to +n#+"e an$ $ra+n the a!"#e"operat+ng roo& or 1hether a tr+a o' &e$+#a therapy +" +n$+#ate$ /

retropharyngea #e%+t+")


11/15

PROGNOS6S Progno"+" generay +" goo$ +' retropharyngea a!"#e"" +" +$ent+/e$

&anage$ aggre""+ey an$ #o&p+#at+on" $o not o##%r

The &orta+ty rate &ay !e a" h+gh a" >-8: +n pat+ent" +n 1ho& #o&p+#at+on" $eeop


12/15

CO7PL6CAT6ON A+r1ay o!"tr%#t+on

7e$+a"t+n+t+"

Ep+$%ra a!"#e""

Sep"+"

A#%te re"p+ratory $+"tre"" "yn$ro&e(ARDS)

Ero"+on o' the "e#on$ an$ th+r$ #er+#a erte!rae

Cran+a nere $e/#+t" (#ran+a nere" 6I-I66 are #onta+ne$ +n the #er'a"#+a)

Sept+# thro&!o"+" o' 4%g%ar e+n or he&orrhage "e#on$ary to ero"+#arot+$ artery@9

Co&pre""+on o' #arot+$ artery an$ +nterna 4%g%ar e+n@9


13/15

TER67

AKAS6H


14/15

Th+" $r%g #o&!+nat+on o' !eta-a#ta&a"e +nh+!+tor 1+th a&p+#++n 1+th !a#ter+a #e 1a "ynthe"+" $%r+ng a#t+e rep+#at+on #a%"+ng!a#ter+#+$a a#t++ty aga+n"t "%"#ept+!e organ+"&" 6t +" an aternaa&o0+#++n +n pat+ent" 1ho are %na!e to ta*e &e$+#at+on oray

C+n$a&y#+n +" a "e&+"ynthet+# ant+!+ot+# pro$%#e$ !y (S)-#horo

"%!"t+t%t+on o' (R)-hy$ro0y gro%p o' parent #o&po%n$ +n#o&y#+!a#ter+a gro1th po""+!y !y !o#*+ng $+""o#+at+on o' pept+$y tRNr+!o"o&e" #a%"+ng RNA-$epen$ent prote+n "ynthe"+" to arre"t J$+"tr+!%te" +n the !o$y 1+tho%t penetrat+on o' CNS Prote+n !o%n$ e0#rete$ !y the +er an$ *+$ney"


15/15

Se#on$ DOC pen+#++n G +nter'ere" 1+th the "ynthe"+" o' #e 1a&%#opept+$e $%r+ng a#t+e &%t+p+#at+on re"%t+ng +n !a#ter+#+$aaga+n"t "%"#ept+!e &+#roorgan+"&"

Ant+p"e%$o&ona pen+#++n p%" !eta-a#ta&a"e +nh+!+tor 6nh+!+t" !+o"ynthe"+" o' #e 1a &%#opept+$e an$ +" e,e#t+e $%r+ng the "

a#t+e &%t+p+#at+on

7etron+$a5oe +" a#t+e aga+n"t ar+o%" anaero!+# !a#ter+a an$ proCe" o' &+#roorgan+"&" that #onta+n n+trore$%#ta"e a!"or! &etroUn"ta!e +nter&e$+ate #o&po%n$" are then 'or&e$ that !+n$ DNA+nh+!+t "ynthe"+" #a%"+ng #e $eath

Retropharyngeal Abscess (RPA)

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