Lymphadenopathy and Splenomegaly Flashcards
1
Q
Where is the hydrostatic pressure greater? At the arterial end or the venous end?
A
-
Arterial end
- Hydrostatic pressure > Oncotic pressure
-
Venous end
- Osmotic pressure > Hydrostatic pressure
2
Q
Describe the lymphatic system.
A
- Interstitial fluid is absorbed by lymph capillaries.
- Lymph capillaries are thin-walled, endothelial tubes.
- Avascular structures (epidermis, cornea, cartilage) do not have lymph vessels either.
- Capillaries join and form lymph vessels.
- Lymph in the vessels is filtered by lymph nodes.
3
Q
Describe the structure of lymph vessels.
A
- The lymph vessels, similar to veins, have valves inside of them.
- Valves prevent retrograde flow of lymph.
- A route for spread of disease:
- Seed in the nodes
- Distant metastasis - not a good sign for prognosis
- ALWAYS examine the regional lymph nodes.
4
Q
What is the sentinel lymph node?
A
- The sentinel lymph node is the hypothetical first lymph node or group of nodes draining a cancer.
5
Q
Describe the anatomy of the spleen.
A
- Lymphoid organ below the left diaphragm,
- Red pulp - sinuses lined by macrophages.
- Receives red cells.
- White pulp - similar to lymph node.
- Receives plasma and white cells.
6
Q
Describe the function of the spleen.
A
- Red cell phagocytosis - e.g. old, damaged, antibody-coated cells removed.
- Site of haematopoiesis in foetus and if ‘additional’ space is needed in adults.
- Blood pooling - platelets > red cells.
7
Q
What size are normal nodes?
What size are para-aortic or mediastinal nodes before they cause symptoms?
A
- Normal nodes are up to 10mm (15mm in the groin) in short axis (imagine a kidney bean).
- Normal nodes are easliy palpable in slim individuals (the worried well).
- Internal nodes e.g. mediastinum or para-aortic are often 5-10cm before causing symptoms.
8
Q
What are the red flags associated with lymphadenopathy?
A
- Persistent lymph node or nodes for >6 weeks.
- Firm, hard lymph node.
- Lymph node >2cm in size.
- Rapidly increasing in size.
- Significant unintentional weight loss, night sweats, appetite loss.
- Exposre to HIV or hepatitis.
- Unexplained fever in a returning traveller.
- Breast lumps or symptoms suggestive of common cancers.
9
Q
Describe the surgical sieve.
A
- Possible causes - MEDIC HAT PIN.
- Metabolic - conditions relating to metbolism, biochemistry etc.
- Endocrinological - conditions relating to various secretory systems.
- Degenerative - conditions relating to age-related or stress-related destruction of tissue.
- Inflammatory / infective - conditions that primarily present in a way that involves the profane activation of the immune system.
- Congenital - conditions present from birth.
- Haematological - conditions relating to the blood system.
- Autoimmune - conditions relating to the inappropriate activation of the immune system.
- Traumatic - conditions relating to a physical impact between two or more objects or environmental exposure.
- Psychological - conditions related to a chemical imbalance or a disorder of thought process.
- Idiopathic or iatrogenic - conditions without a known cause / caused by a doctor or resulting from treatment.
- Neoplastic - conditions relating to cancers.
10
Q
Describe the features of infective lymphadenopathy.
A
- Regional response to infection - look for ‘red streak’.
- Systemic infections, e.g. EBV / CMV / toxoplasma / HIV.
- Nodes often tender / short history / variable size.
- History / examination / passage of time / ?viral serology or PCR should help.
11
Q
What diseases can cause inflammatory lymphadenopathy?
A
- Local or systemic response to inflammation, e.g. eczema.
- Auto-immune conditions e.g. rheumatoid arthritis or lupus.
- Sarcoidosis (skin / lungs / lymph nodes).
- Castleman’s disease (Human herpes virus-8 (HHV*) associated).
12
Q
Describe the features of neoplastic lymphadenopathy.
A
- Secondary
- Existing malignancy or new diagnosis (latter e.g. melanoma / ENT / lungs).
- Consider nodal drainage patterns.
- Often hard, fixed nodes.
- Fine needle aspiration (FNA) often useful.
- Treatment plan depends on type and extent of tumour.
- Primary lymphoproliferative disease
- Often rubbery, mobile, non-tender nodes - local / systemic.
- Check for ‘B symptoms’ - fever to 38°, drenching sweats, weigh loss >10% in <6 months.
- FBC - ?chronic lymphocytic leukaemia.
- Lactate dehydrogenase - non-specific marker of cell turnover.
- FNA unhelpful, ?core or excision biopsy.
13
Q
Give an overview of the staging of lymph node involvement in malignancy.
A
14
Q
What factors are included in the prognostic index for Hodgkin’s disease?
A
- Age
- Stage
- Hb
- Albumin
- Male
- Lymphopenia
- Low WBC
15
Q
What factors are included in the prognostic index for Diffuse large B cell lymphoma (DLBCL)?
A
- Age
- Stage
- LDH
- Performance status
- Number of extra-nodal sites
20
Q
How do you quantify splenomegaly?
A
- Spleen size relates to age and height.
- 90% confidence interval of maximum spleen length by abdominal USS by height of the person.
