Lecture 2 Cervical lymph system Flashcards
Functions of the lymphatic system
- Remove excess fluid from the interstitial space
- Immune defence and surveillance - source of lymphocytes (T and B cells) and phagocytic and physical barrier
- Returns small proteins including pathogens and fluid that leaks from capillaries
Lymphoedema
Pooling of lymph
Lymphadenopathy
Swollen lymph nodes due to infection or malignancy
Why do lymph nodes enlarge secondary to infection
The immune defence is stimulated by antigens therefore T and B lymphocytes are activated and proliferate causing swelling
Difference between lymphadenopathy due to infection and malignancy
In infection lymph nodes are:
- tender
- mobile
Malignancy:
- hard
- matted
- non tender
- rubbery - lymphoma
- less mobile
- fast growing
Where are superficial lymph nodes found
Within superficial cervical fascia
Not normally palpable
Where are deep lymph nodes found
Deep to the investing fascia in the carotid sheath
Associated with the IJV route
Lymphatic drainage
Deep structure such as the thyroid gland, trachea, larynx , pharynx and oesophagus directly drain into deep lymph nodes
Superficial lymph nodes drain into deep lymph nodes
Superficial lymph nodes
Preauricular Postauricular Submental Submandibular occipital
Which superficial lymph nodes are associated with the EJV route
Posterior cervical lymph nodes
posterior truangle
Which superficial lymph nodes are associated with the AJV route
Anterior cervical lymph nodes
anterior triangle
Which lymph nodes swell if a patient has conjunctivitis
Preauricular lymph nodes
Which lymph nodes swell if a patient has an ear infection
Post auricular lymph nodes
Deep cervical lymph nodes
Jugulo-digastric
Jugulo-omohyoid
Supraclavicular
Features of deep cervical lymph nodes
Deep to the SCM
Run along the route of the IJV in the carotid sheath
Which lymph nodes swell if a patient has tonsilitis?
Jugulo-digastric lymph nodes as they drain the posterior tongue and tonsils
Which lymph nodes swell if a patient has thyroiditis?
Jugulo-omohyoid lymph nodes as they drain the thyroid
Which structures do the supraclavicular lymph nodes drain?
(in the posterior triangle)
- chest
- abdomen (upper GI)
- oesophagus
- stomach
Therefore raised in stomach, chest and oesophageal cancers
Which lymph nodes swell if a patient has a lip or anterior tongue ulcer?
Submental
Lips are superficial
What is Waldeyer’s ring?
A ring of lymphoid tissue surrounding the upper aerodigestive tract
What tonsils make up the Waldeyer’s ring?
Pharyngeal tonsils - adenoids
Tubal
Palatine - visible
Lingual
Dermal cyst
Midline Immobile High up in anterior triangle Pea sized Superficial
Requires surgery to remove
Thyroglossal cyst
Midline
High up
Fills with fluid
Moves when you stick out tongue or swallow
Thyroid pathology
Midline
Goitre
Cancer - lymph nodes will be immobile
Salivary gland pathology
Lateral
Submandibular (common)
Pain when eating
Brachial cyst
Lateral Congenital Anterior border of SCM Large Filled with fluid
Red flag signs for lymphadenopathy
Persisting for 6+ weeks Fixed, hard and irregular Lumps in other places of body Rapidly growing Associated systemic signs and symptoms e.g. weight loss Hoarseness of voice Dysphagia
Pharynx or larynx cancer
Dysphagia
Food sticks
Easier to drink fluid than to eat solids
First line investigation for neck lump
USS
Left supraclavicular node
Drains abdomen and thorax via Virchow’s node
Right supraclavicular node
Mid section of the chest
Oesophagus
Lungs
