1.2- Cervical Lymph Nodes And Neck Lumps Flashcards
What are the 3 main functions of the lymphatic system?
- Remove excess fluid from interstitial space
- Immune defence and surveillance (lymphocytes)
- Returns small proteins, pathogens and fluid that leaked from capillaries
What is lymphoedema?
Swelling as a result of obstruction of lymphatic vessels or lymph nodes and the accumulation of large amounts of lymph in the affected region
What is lymphadenopathy?
Swollen lymph nodes due to infection or malignancy ( primary or secondary)
How is the flow of lymph affected as it passes through a lymph node?
Lymph slows down. There are many afferent lymph vessels leading to the lymph node and only one efferent vessel. The lymph node acts as a bottle neck, restricting the flow and reducing the speed of the travel of the lymph.
Why is it important for the speed of lymph to change as it enters the lymph node?
Must slow down to give time for the the lymph node to act as an effective physical and phagocytic filter, and give time to react by proliferating lymphocytes such as T and B cells in response to antigens.
Why do lymph nodes swell and enlarge during infections?
As pathogens are carried back to lymph nodes, b lymphocytes detect their foreign antigens, and activate and proliferate T and B cells.
In which body regions might lymph nodes be palpable during infection?
Cervical
Axillary
Femoral
What are the most common causes for lymphadenopathy?
Infection
Malignancy
Congenital/ developmental conditions (cysts)
What 2 different regions can lymph nodes be organised into?
Regional ( or superficial )
Terminal ( or deep )
Where are regional lymph nodes located in the neck?
Superficially, within the superficial cervical fascia
Where are terminal lymph nodes located in the neck?
Deep to the investing layer of the deep cervical fascia
most associated with IJV along its length within the carotid sheath
What drains into deep cervical nodes?
All lymph from the head and neck, from:
- tissues and structures deep to the investing layer of fascia
- regional lymph nodes
What vascular structures are the deep cervical lymph nodes related to?
Carotid sheath
Internal jugular vein
How does lymphadenopathy vary depending on cause?
Infection : tender, mobile, soft
Metastatic malignant cancers: hard, matted, non-tender
Lymphoma : rubbery, mobile, fast-growing, non-tender
What is lymphoma?
Blood cancer that develops when white blood cells (lymphocytes) grow out of control.
what investigations are done if a patient has an enlarged cervical lymph node?
- comprehensive history
- examine area of tissue it drains
- if systemic disease/malignancy suspected then examine other lymph nodes and body systems
what are the 8 palpable lymph nodes in the head and neck?
8 superficial lymph nodes. 5 in head are: - submental ln - submandibular ln - preauricular ln - postauricular ln - occipital ln 3 in neck - superficial cervical (EJV) - posterior cervical (EJV) - anterior cervical (AJV)
what structures drain directly into the deep lymph nodes of the neck?
thyroid
posterior tongue
what are the deep cervical lymph nodes of the neck?
jugulo-digastric
jugulo-omohyoid
supraclavicular lymph nodes
what structures are deep cervical lymph nodes of the neck associated with?
IJV
carotid sheath
which lymph nodes may be enlarged in infections of the eye?
pre-auricular lymph nodes
which lymph node might be swollen in ulcers on the gums?
sub-mental
which lymph node might be enlarged in tonsilitis?
jugulodigastric lymph node
what is Waldeyer’s ring?
an annular collection of lymphoid tissue that surrounds the back of the of the throat/ upper aerodigestive
what lymphoid tissue forms Waldeyer’s ring?
pharyngeal tonsil/adenoid
tubal tonsils
palatine tonsils
lingual tonsil
what are the possible causes of a superficial neck lump?
sebaceous cyst
dermoid cyst
lipoma
skin abscess
what are common benign causes of lymphadenopathy?
tonsillitis
mouth ulcer
what congenital lesions can cause a neck lump?
thyroglossal cyst
brachial cyst
laryngocoele
pharyngeal pouch
what are the 7 main reasons for a neck lump?
superficial
inflammatory / infective lymph node
congenital lesions
thyroid pathology
primary or secondary malignant disease involving a lymph node
salivary gland pathology
other (chronic infection/carotid artery aneurysm)
what are red flags for lymphadenopathy?
persisting more than 6 weeks
fixed, hard, irregular lump
rapidly growing in size
associated with generalised lymphadenopathy
associated with systemic signs/symptoms such as weight loss/night sweats
associated with change in voice/hoarseness or difficulty swallowing
what is Virchow’s node?
left supraclavicular lymph nodes. accept drainage of lymph from abdomen and thorax
what structures drain into the right supraclavicular node
mid section chest
oesophagus
lungs
what structures drain into the jugulo-digastric lymph node?
palatine tonsil
oral cavity
tongue
what structures drain into the jugulo-omohyoid?
tongue oral cavity trachea oesophagus thyroid gland
how can ramsey hunt syndrome be distinguished from Bell’s palsy?
both cause paralysis of the facial nerve
only Ramsey hunt syndrome causes vestibular rash in the ear and hearing loss.
where can the carotid pulse be felt?
Palpate the carotid artery by placing your fingers near the upper neck between the sternomastoid and trachea roughly at the level of cricoid cartilage.
