lymph pathology Flashcards
What is Lymphangitis & Lymphadenitis ?
lymphadenitis - infection of one or more lymph nodes
SYMPTOMS
- lymph node -swollen, red (skin over node), tender, hard - does have to be all of them
- Rubbery , soft, smooth node if abscess formation present.
- Pain
- Enlargement
- tenderness
- pain and tenderness distinguish it from lymphadenopathy.
- contained within lymph nodes
Lymphangitis - infection of vessels connecting lymph nodes (lymph vessels ) - inflammation is spreading past lymph node.
0 usually an acute bacterial infection - Streptococcal
- in some patients you will see red streaks on skin showing inflammation. (red , irregular , warm , tender streaks form on extremity from lesion - where bacteria entered - to regional lymph node.
throbbing pain
- fever
0 malaise , headache , loss appetite - Treatment - Antibiotics.
What is Lymphadenopathy ?
Palpable enlargement (by more than 1cm) of one or more lymph nodes.
local - in one area
generalized - in 2 or more areas.
CAUSES
0 infection
0 cancer
0 idiopathic -self limiting.
differing symptoms btw acute appendicitis vs mesenteric lymphadenitis ?
shifting tenderness -pain upon palpation - mesenteric lymph nodes move with movement of the patient / change in posture.
complications of lymphadenopathy
lymphandenopthy - used to describe both lymphangitis and lymphadenitis .
Mangement of lymphadenopathy ?
suspected upper airway obstruction - arrange emergency hospital admission :
0 Lymphadenopathy associated with :
- stridor
- dysphagia upon aspiration
- signs of superior vena cava obstruction
Mangement of lymphadenopathy ?
suspected upper airway obstruction - arrange emergency hospital admission :
0 Lymphadenopathy associated with :
- stridor
- dysphagia upon aspiration
- signs of superior vena cava obstruction
Lymphadenopathy -suspected infected cause
- Arrange review :
0 suspected upper viral respiratory tract infection.
0 becomes systematically unwell
0 lymphadenopathy grows progressively over 7 days - may indicate non -infective swelling of abscess.
0 suspected bacterial infection - assess need for antibiotic
- if lymphadenopathy not reserved within 2 -4 weeks urgently refer to ears , nose , throat surgeon for further investigation.
clinical feature f malignant primary tumour e.g
- asymptomatic nodule/ mass e.g in glandular tissue e.g. parathyroid , salivary . thyroid glands
0 urgently refer to head and neck - 2 week suspected cancer pathway. - if lymphanepathy unexplained and generalized
0 arrange urgent full blood count - within 48hrs to check for leukaemia
0 consider referral - 2 week suspected cancer pathway - to exclude lymphoma - unexplained lymphadenopathy or splenomegaly for 25 and over
48 hrs for those below 25.
What are Diverticula ?
small buldges or pockets that can develop in the lining of the intestines as you get older.
formation - linked to fibre deficiency
Diverticulosis - diverticula with no symptoms
Diverticular disease - diverticula with symptoms
o left lower pain - get worse during eating or just after / relived by pooing / farting
o occasional blood in poo
o Constipation
o Diarrhoea
Diverticulitis - diverticula become inflamed and infected.
- Hight temp
- Pain in lower left stomach becomes more painful
- ## mucus/ poo in faeces / rectal bleeding
Treatment of Diverticular disease , Diverticulitis ?
Diverticular disease - high fibre diet
- beans , starchy foods, cereals , fruit and veg , pulses
paracetamol
(ibuprofen , aspirin - may make stomach pain worse - ask GP or pharmacist first )
DIVERTICULITIS
Antibiotics
- low fibre diet - to rest digestive system while recovering - can return to high fibre diet after recovery.
- paracetamol.
- no ibuprofen or aspirin.
If serious complications
o abcess formation - (most common complication ) percanteous drainage
o Colectomy - removal of the affected part of in bowel.
(Symptoms of Diverticular D & Diverticulitis - similar to Coeliac D , IBS, Bowel cancer.
Diagnosis of Diverticula (and the different subtypes )
Colonoscopy - most common
- laxative given to clear out bowel before.
CT scan ( can be with / without colonoscopy )
When can Crohns’s disease be suspected ?
0 Persistent diarrhoea (including nocturnal diarrhoea) with possible blood or mucus in the stool.
0 Abdominal pain or discomfort.
0 Weight loss, faltering growth or delayed puberty (in children).
0 Non-specific symptoms
- fatigue
- malaise
- anorexia
- fever.
OE-
Abdominal tenderness or mass, for example in the right lower quadrant.
Perianal pain or tenderness, anal or perianal skin tags, fissure, fistula, or abscess.
Signs of malnutrition and malabsorption.
Abnormalities of the joints, eyes, liver, and skin.
if systemically unwell - emergency admission to hospital
if well - urgent referral to
gastroenterologi st
Differential diagnosis Crohn’s disease ?
Ulcerative colitis
Infective colitis - infection of the colon
Pseudomembranous colitis - (C difficile) bacteria infection .
o caused by overgrowth of C. Difficile
o linked to antibiotic usage - reduce population of gut flora which compete with C.diff.
Diarrhoea - common side effect of antibiotic treatment.
( if C.diff infection suspected - stool sample taken
- if not suspected or negative C.diff test - antibiotic stopped - if apporiate )
- if positive - antibiotics to treat specificallt C.diff infection
- risk of C.diff outbreak assessed,
0 Microscopic Colitis - (IBD)
that affects the large bowel (colon and rectum).
-typically presents with chronic watery diarrhoea in older people, and may be associated with the use of drugs, such as lansoprazole, aspirin, sertraline, ranitidine, and simvastatin.
0 Intestinal ischemia
0 Acute appendicitis
0 Diverticulitis
0 Coeliac disease
0 IBS
0 Anal fissure
0 malignancy (Colorectal / anal /
- lower gastrointestinal cancers - symptoms
o appetite loss
o unexplained weight loss
o Rectal bleeding
o Occult bleeding in faeces (blood you cant see with naked eye )
o unexplained change in bowel habit
o unexplained abdominal pain
o Abdominal mass or rectal mass
o Anaemia
o Deep vein thrombosis.
O Endometriosis
0 Laxative misuse
Treatment of Crohns’s disease ?
To induce remission of symptoms
o Corticosteriods (short term - dose gradually tapered )
o Immunosuppression
Azathiopine , mercaptopurine - 1st line
Methotrexate - 2nd line
Added to corticosteriod therapy if 2 or more exacebations in a year of if corticosteriod therapy cannot be tolerated.
Anti- tumour necrosis factor alpha monoclonal antibody
o Infliximab
o Adalimumab
used if conventional therapy not working .
Sulfaslazine , mesalzine - aminosalicylates - can be used if corticosteriods contrainsicated , not tolerated.
What is ulcerative colitis ?
chronic, relapsing-remitting, non-infectious inflammatory disease of the gastrointestinal tract
Effects the large intestine & rectum.
Symptoms
- Recurring diarrhoea - may contain blood , mucus or pus
- Stomach pain
- Frequent need to empty bowels.
May experience
- extreme tiredness , loss of appetite , weight loss.
extra -intestinal manifestation.
o uveitis
o inflammatory arthritis,
o erythema nodosum
o pyoderma gangrenosum.
When should you expect Ulcerative Colitis ?
A history of bloody diarrhoea for more than 6 weeks,
o rectal bleeding
o faecal urgency and/or incontinence
o nocturnal defecation
o tenesmus
o abdominal pain
o weight loss
o non-specific symptoms such as :
- Fatigue
- malaise,
- anorexia
- fever.
Examination findings of pallor, clubbing; abdominal distension, tenderness, or mass.
Diagnosis of UC ?
- FBC
- inflammatory markers,
- U &E,
- LFTs
- TFT
- ferritin,
- vitamin B12
- folate
- vitamin D levels
- coeliac serology.
Stool microscopy and culture including Clostridium difficile toxin, and faecal calprotectin.
