Chapter 4 Lymph MDT Flashcards
Enlarged lymph nodes
Lymphadenopathy
Normal lymph nodes are generally less than:
1 cm
Only one region involved
Localized
More than one region involved
Generalized
May be a feature of a number of systemic diseases like:
HIV TB Infectious Mono Lupus Malignancy
Generalized lymphadenopathy
Lymphadenopathy:
Localizing signs or symptoms suggest:
Infection or malignancy
Constitutional symptoms such as fever, night sweats, or weight loss suggest:
TB, lymphoma, or other malignancy
Medications that can cause lymphadenopathy
Atenolol
Cephalosporins
Penicillin
Sulfonamides
Lymph node exam should include:
Location
Size
Consistency
Fixation vs mobile
Tenderness
Hard nodes are found in:
Cancers
Firm, rubbery nodes are found in:
Lymphomas
Abnormal nodes can become fixed to adjacent tissues by:
Invading cancers
Tenderness in nodes is commonly caused by:
Infection
Patients with localized lymphadenopathy can be observed for
3-4 weeks
Evaluation of patients with generalized lymphadenopathy without suspected diagnoses should start with:
CBC
Chest radiograph
HIV testing
Painless persistent edema of one or both lower extremities, primarily in young women
Putting edema without ulceration, varicosities, or stasis pigmentation
There may be episodes of lymphangitis and cellulitis
Lymphedema
Primary form of lymphedema is due to:
Congenital developmental abnormalities (lymphatic hypoplasia)
Secondary form of lymphedema involves inflammatory or mechanical lymphatic obstruction from:
Trauma
Regional lymph node resection
Irradiation
Extensive involvement of regional nodes by malignant disease or filariasis
Symptoms/Physical findings:
- Aching discomfort with sensation of heaviness or fullness
- Hypertrophy of the limb with markedly thickened and fibrotic skin and subcutaneous tissue in very advanced cases
- Pitting edema
Lymphedema
Imaging for:
Lymphedema
MRI
Lymphangiography
U/S for DVT
Treatment for:
Lymphedema
Referral
Elevation, especially during sleeping hours
Compression stockings
Diuretics
- Furosemide 40mg PO daily
- Bumetanide 1mg PO daily
Eliminates toxic byproducts by end organs (kidneys, liver, colon, skin, lungs)
Lymphatic system
Organized lymphoid tissue which filters lymph fluid to identify and fight infection
Lymph node
Commonly occurs secondary to bacterial infection usually caused by Streptococci or Staph Aureus (or both)
Generally, in response to an infected wound
Lymphangitis
Lymphadenitis
Symptoms and Exam:
- Throbbing pain
- Fever, Chills, Malaise, Anorexia
- Red streaking from the wound
- Indurated and painful tissue at site of cellulitis
- Regional lymph nodes enlarged and tender
- Tachycardia
Lymphadenitis and lymphangitis
Lab findings:
Leukocytosis with left shift
Positive cultures of purulent material
U/S of infected site
Lymphadenitis and lymphangitis
Treatment for Lymphadenitis and lymphangitis
General measures
- Heat
- Elevation
- Immobilization
- Acetaminophen and NSAIDS
Antibiotic treatment for:
Lymphadenitis and lymphangitis caused by strep or staph
Cephalexin
Trimethoprim/sulfamethoxazole (Bactrim)
