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Term 2 > Hi Res (Salivary Glands, Neck & Lymph Nodes) > Flashcards

Hi Res (Salivary Glands, Neck & Lymph Nodes) Flashcards

1
Q

Salivary Glands

A
  • release secretions into ducts that lead to mouth
  • 3 main pairs (parotid, submandibular, sublingual)
  • also numerous sm salivary glands scattered around mouth
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2
Q

Parotid Glands

A
  • each side of face (below external acoustic meatus)

- each one has a parotid duct opening into the mouth at the second molar

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3
Q

Submandibular Glands

A
  • lie on each side of the face under the angle of the jaw

- 2 submandibular ducts open to the floor of mouth (each side of the frenulum of tongue)

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4
Q

Sublingual Glands

A
  • under mucous membrane of the floor of mouth in front of submandibular glands
  • numerous small ducts that open into the floor of mouth
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5
Q

Structure of Salivary Glands

A
  • fibrous capsule
  • lobules made of sm acini, lined with secretory cells
  • secretions are poured into ductules (join to form larger ducts leading to the mouth)
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6
Q

Arterial Supply

A

-branches from the external carotid arteries

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7
Q

Venous Drainage

A

-external jugular veins

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8
Q

Composition of Saliva

A

-combined secretions from salivary glands and mucus secreting glands of oral mucosa

  • water
  • mineral salts
  • digestive enzymes (salivary amylase)
  • mucus
  • lysozyme
  • immunoglobins
  • blood clotting factors
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9
Q

How much saliva is produced each day?

A

1.5 litres

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10
Q

Mumps

A
  • disease of salivary glands
  • acute inflammatory condition of salivary glands (especially parotid)
  • caused by mumps virus
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11
Q

Parotitis

A

-inflammation of parotid gland

May be:

  • viral (mumps)
  • bacterial (develop into abscess)
  • autoimmune (sjogren’s syndrome)
  • calculus
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12
Q

Parotitis on US

A
  • usually bilateral
  • enlarges
  • heterogenous
  • increased vascularity
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13
Q

Reactive lymphnodes (embedded in the parotid gland) are ______ to parotitis.

A

-secondary

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14
Q

Sialtis

A

-inflammation of salivary gland or duct

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15
Q

Sialectasis

A
  • dilation of salivary duct
  • resulting from duct obstruction of parotid or submandibular glands
  • pain and swelling
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16
Q

Parotitis

A

-inflammation of parotid gland

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17
Q

Calculus Formation

A
  • calculi (stones) formed by crystallization of mineral salts in saliva
  • partially/completely block ducts (inflammation, swelling, infection, atrophy)
  • unknown cause
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18
Q

Where do salivary gland stones occur?

A
  • 8/10 in submandibular

- rare in sublingual

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19
Q

Why are stones less common in parotid glands?

A

-parotid glands make thinner saliva

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20
Q

The calculus is easily seen in the ______ duct as it exits the main body of the parotid gland heading medially. Parotid duct calculi are ______.

A
  • Stenson’s

- rare

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21
Q

Parotid Adenoma on US

A
  • well circumscribed

- posterior enhancement

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22
Q

Carcinoma

A
  • malignant tumors most commonly affect the parotid glands
  • have a tendency to infiltrate nerves in the surrounding tissue (causes pain)
  • lymph spread is to cervical nodes
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23
Q

Sjogrens Disease

A

-autoimmune disorder affecting moisture producing exocrine glands (tears, saliva)

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24
Q

2nd Most Common Rheumatic Disorder

A

-sjogrens disease

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25
Q

Most Common Rheumatic Disorder

A

-rheumatoid arthritis

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26
Q

Symptoms of Sjogrens Disease

A

-dryness of eyes/mouth (sicca syndrome)

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27
Q

What can occasionally develop in the parotid glands of the sjogre’s patients?

A

-MALT lymphoma

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28
Q

Role of US

A
  • palpable lump in gland/neck
  • pain
  • mumps
  • illness (mouth/dental infections)
  • mouth dryness
  • abnormality on previous xray, CT or sialogram
  • guidance of injection, aspiration or biopsy
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29
Q

Assess the gland for…

A
  • size
  • increased vascularity
  • abnormality surrounding lymph nodes
  • duct dilation (use doppler, so you don’t mistake a vessel to be a dilated duct)
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30
Q

What is between the parotid and submandibular glands?

A

-kuttner lymph node

31
Q

Appearance of Glands

A
  • hypoechoic

- homogenous echotexture (similar to muscle)

32
Q

What do the intraglandular ducts look like on US?

A

-small, linear hypoechoic parallel stripes

33
Q

How do you document pathology?

A
  • in 2 planes, with measurements

- measure vascularity as well

34
Q

Submandibular duct (Wharton’s duct) is generally no more than ______ in diameter and is often not visible along it’s entire length.

A

2mm

35
Q

Why is the parotid more attentive than the submandibular?

A

-fat content

36
Q

Are ducts easily visualized?

A

-only if dilated

37
Q

Are the sublingual glands easy to see?

A
  • very small
  • can sometimes only see if there is a pathology
  • obscured anteriorly by mandible
38
Q

Average Size of Normal Sublingual Gland

A

32 x 12 mm

39
Q

Sublingual Glands on US

A
  • homogenous, hyperechogenicity similar to the parotid gland

- best seen in TRV and SAG planes obtained from the submental position

40
Q

Lymphatic System

A

-network of tissues and organs that primarily consist of lymph vessels, lymph nodes and lymph

41
Q

What system are the tonsils, adenoids, spleen and thymus part of?

A

-lymphatic system

42
Q

How many lymph nodes are in the body (filter lymph before it returns to circulatory system)?

A

-600 to 700

43
Q

Functions of Lymphatic System

A
  • transport clean fluids back to blood
  • drains excess fluid from tissue
  • removes debris from body cells
  • transports fats from digestive system
44
Q

Which way does lymph flow?

A
  • 1 direction
  • towards neck
  • into the venous system through the SCV’s
45
Q

Where are the lymphatic drainage areas (2)?

A
  • Rt drainage area handles the Rt arm and chest

- Lt drainage area handles the rest of the body (legs, lower trunk, upper Lt portion of chest, Lt arm)

46
Q

Lymphangitis

A

-inflammation of lymph vessels

47
Q

Lymphadenitis

A

-infection of lymph nodes

48
Q

Lymphadenopathy

A

-enlargement of lymph nodes

49
Q

Splenomegaly

A

-enlargement of the spleen

50
Q

Lymphoedema

A

-swelling in tissues whose lymphatic drainage has been instructed in some way

51
Q

Normal Appearance of Lymph Nodes

A
  • small
  • oval
  • hilum present
  • moderate echogenicity
  • sharp margins, no structural changes
  • soft tissue edema
  • central vessel on doppler
  • single vascular pedicle
  • regular vascular pattern
  • low impedance
52
Q

What is the difference on US between the appearance of normal and reactive lymph nodes?

A

-they look the same

53
Q

Reactive Lymph Nodes

A
  • enlargement of the cervical lymph nodes commonly occurs with viral infections
  • usually sm, firm and non tender
  • may persist for weeks/months
54
Q

Abnormal Lymph Node Appearance

A
  • lg
  • rounded
  • hilum absent
  • hypoechoic
  • irregular, angular, blurred margins
  • structural changes
  • no edema
  • peripheral vessels on doppler
  • multiple vascular pedicles
  • chaotic vascular pattern
  • high impedance
55
Q

Lymphoedema

A

-chronic swelling of limbs caused by accumulation of lymph fluid (if lymphatic system is damaged/not functioning properly)

56
Q

How may lymphoedema develop?

A
  • following cancer therapy (especially breast)
  • recurrent infections
  • injuries
57
Q

What parts of the body are involved in lymphedema?

A

-limbs, face, neck, abdomen

58
Q

Tumors

A
  • may grow into and block lymph vessel/node, obstructing the flow
  • a lg tumor outside the lymphatic system may cause pressure to stop the flow of lymph
59
Q

Why might lymph nodes be surgically removed?

A
  • cancer cells may spread to them

- to prevent growth of secondary tumors in local lymph nodes and the spread of disease through the lymphatic system

60
Q

Minor Lymphadenitis

A

-accompany infections (measles, typhoid, cat scratch fever, wound, skin infection)

61
Q

Chronic Lymphadenitis

A

-follows unresolved acute infections (TB, syphilis, low grade infections)

62
Q

Lymphomas

A
  • malignant tumor of lymphoid tissue

- classified as Hodgkin’s or non Hodgkin’s lymphomas

63
Q

Hodgkin’s Disease

A
  • progressive, painless enlargement of lymph nodes

- superficial lymph nodes in the neck are usually noticed 1st

64
Q

Is Hodgkin’s disease malignant or benign?

A

-malignant

65
Q

What is the cause of Hodgkin’s disease?

A

-unknown

66
Q

Why does Hodgkin’s disease cause reduced immunity?

A

-lymphocyte function is depressed, therefore recurrent infection is common

67
Q

Non Hodgkin’s Lymphoma

A
  • tumors
  • multiple myeloma and Burkitt’s lymphoma may occur in any lymphoid tissue and in bone marrow
  • expanding lymph nodes may compress adjacent tissues/organs
  • anemia and leukopenia
68
Q

How are non Hodgkin’s lymphomas classified?

A
  • type of cell involved

- degree of malignancy

69
Q

What is the most common anomaly of the head and neck?

A

-thyroglossal (duct) cyst

70
Q

Thyroglossal (duct) Cyst

A
  • cyst beneath the skin of the anterior midline of the neck (below hyoid bone)
  • moves superior if patient moves their tongue
  • infected cyst ruptures through skin to drain (thyroglossal sinus)
71
Q

What is the most common benign lymphadenopathy?

A

-thyroglossal (duct) cyst

72
Q

What is the 2nd most common cause of a neck mass in children?

A

-thyroglossal (duct) cyst

73
Q

Thyroglosssal (duct) Cyst on US

A

-low level intraluminal reflectors (due to bleeding/infection)

74
Q

branchial Cleft Cyst

A
  • abnormal persistence of remnant of the branchial apparatus
  • results in cysts, sinuses and fistulas
  • cystic neck mass, along the medial border of SCM (upper neck)

Term 2 (19 decks)

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