Lymphadenopathy, Coagulation and bleeding disorders (Pales CIS) Flashcards
what populates lymph nodes
populated by macrophages, dendritic cells, B lymphocytes, and T lymphocytes.
what are the functions of lymph nodes
Participate in antigen processing, antigen presentation, antigen recognition, and proliferation of effector B and T lymphocytes as part of the normal immune response
why do lymph nodes enlarge
Proliferation of WBCs inside of lymph nodes leads to lymph node enlargement.
In young children, palpable lymphadenopathy is the rule.
In adults, lymph nodes larger than 1 to 2cm in diameter are generally considered abnormal. (except for groin, where they can be bigger normally)
localized lymphadenopathy
Local lymphadenopathy reflects the area those lymph nodes drain
generalized lymphadenopathy
Generalized lymphadenopathy occur with a systemic disorders
supraclavicular on the right
left
R mediastinum, lungs
L - abdomen
axillary lymph nodes
arm, breast, thorax, neck
Infections
Cat scratch disease
Cellulitis
Cancer
Breast
Other metastasis
Silicone breast implants
( may cause both supraclavicular and axillary lymphadenopathy)
inguinal lymph nodes drainage
problems?
lower extremity
genitalia
buttock
abdominal wall below umbilicus
Lower extremity infection
Sexually transmitted diseases
Cancer Skin of the lower extremities and trunk Cervix, vulva, and ovary Rectum and anus Penis
what are some causes of peripheral lymphadenopathy
bacterial viral mycobacterial fungal protozoal spirochetal
Cancer
lymphoproliferative
immunologic
endocrine
miscellaneous
localized lymphadenopathy of the cervical region?
anterior or posterior worse?
Anterior– usually benign
Localized strep** or staph infections, rubella, dental
Systemic infections: Epstein-Barr virus (EBV), cytomegalovirus infection, or toxoplasmosis
Posterior – could be benign, but malignancy*** is more common than with anterior lymph nodes
EBV infection, tuberculosis, lymphoma, or head and neck malignancy
supraclavicular lymphadenopathy
what does right side drain
left side?
High risk for malignancy***
Right
Cancer of mediastinum, lungs or esophagus
Left (Virchow’s node***) Abdominal malignancy (stomach**, gall bladder, pancreas, kidneys, testicles, ovaries, or prostate
mediastinal localized lymphadenopathy causes
Infectious
TB, fungal infection, anthrax
Neoplastic
Lymphoma, lung cancer, germ cell tumor
Other
Sarcoidosis
with HIV what kinds of lymph nodes do you see
when do they develop
Nontender.
Primarily axillary, cervical, and occipital nodes
Usually develops during the second week** of acute symptomatic HIV infection.
The nodes then decrease in size but a modest degree of adenopathy persists.
with mycobacterial infection what kinds of lymph nodes do you see
Can present with lymphadenopathy alone, especially in the neck (scrofula)
M. tuberculosis in adults
Atypical mycobacteria (M. avium complex and M. scrofulaceum) in kids
Nontender
Enlarge over weeks to months without prominent systemic symptoms
Can progress to matting and fluctuation (necrosis, casseation)
what kind of LAD is seen in the infectious mononucleosis
Triad of fever, pharyngitis, and lymphadenopathy***
Symmetric enlargement
Posterior cervical more than anterior cervical***
Axillary and inguinal are common too (as opposed to other causes of pharyngitis
Lymphadenopathy peaks in the first week and then gradually subsides over two to three weeks
Generalized LAD of SLE
In approximately 50 percent of patients
Lymph nodes are soft, nontender
Cervical, axillary, and inguinal areas
Usually develops at the onset of disease or in association with an exacerbation.
what are some drugs that cause LAD
allopurinol atenolol carbamazepine cephalosporins phenytoin quinidine
Castleman’s disease
Uncommon lymphoproliferative disorder Massive lymphadenopathy with Fever Hepatomegaly Splenomegaly polyclonal hypergammaglobulinemia Amyloidosis
Kikuchi’s disease
Rare, benign condition of unknown cause***
Affect young women***
Cervical lymphadenopathy only or generalized
Fever
Kawasaki disease
Childhood vasculitis
Cervical lymphadenopathy with
Fever Conjunctivitis Mucositis (strawberry tongue) Rash Coronary artery aneurysms*** heart attacks in young age. need to take aspirin
angioimmunoblastic T cell lymphoma
Systemic disease Generalized lymphadenopathy with Fever Hepatosplenomegaly Hemolytic anemia Polyclonal hypergammaglobulinemia
inflammatory pseudotumor
Syndrome of lymphadenopathy in one or more node groups
Systemic symptoms.
Nodes usually show a fibrosing and inflammatory process
generalized LAD of amyloidosis
Systemic disease with deposition of specific type of protein called Amyloid.
Most often will have amyloid deposition in other organs, but occasionally can be deposited only in lymph nodes
Kimura disease
Inflammatory condition of subcutaneous tissue and lymph nodes of the head and neck
Associated with elevations in serum IG E levels and eosinophilia
on physical exam what are you looking for when looking at lymph nodes!
Location
Localized vs. generalized adenopathy
Size
Greater than 1 cm in diameter (Except for groin)
Consistency
Hard in cancers that induce fibrosis and when previous inflammation has left fibrosis.
Firm, rubbery nodes in lymphomas and chronic leukemia
Fixation
fixed to adjacent tissues by invading cancers or inflammation
Tenderness ***
Suggests recent, rapid enlargement with inflammation, hemorrhage, immunologic stimulation, and malignancy.
what labs do you order for generalized LAD
Complete blood count, Heterophile test, and chest x-ray.
If above normal
PPD- TB
HIV antibody determination
RPR- syphilis
ANA- lupus
what is the best way to diagnose LAD
CT scan first-
open biopsy
find biggest node
Fine needle aspiration for cytology
most useful when searching for recurrence of cancer
substantial false-negative rate due to sampling error
Used in areas where open biopsy is not available or risky
Good in patients with HIV infection for evaluating lymph nodes that are believed to harbor other disease
what are the functions of the spleen
Largest lymph node in the body.
Functions:
Participates in the primary immune response
Acts as a filter for the blood
Responsible for removing from the circulation red blood cells, that are old, sick or if they are coated with immunoglobulins.
what are 6 causes of splenomegaly
congestive infection infiltrative malignancy inflammation hematologic
congestive causes of splenomegaly
Cirrhosis
Heart failure
Thrombosis of portal, hepatic, or splenic veins
malignant causes of splenomegaly
Hematologic malignancies Lymphoma Acute and chronic leukemias Polycythemia vera Multiple myeloma Essential thrombocythemia
Primary splenic tumors
Non-hematologic metastatic solid tumors
infectious causes of splenomegaly
Viral - hepatitis, infectious mononucleosis, cytomegalovirus
Bacterial - salmonella, brucella, tuberculosis
Parasitic -malaria, schistosomiasis,toxoplasmosis, leishmaniasis
Infective endocarditis (embolic)
Fungal
inflammation causes of splenomegaly
sarcoid
serum sickness
SLE
RA- felty syndrome
infiltrative nonmalignant causes of splenomegaly
Gaucher's disease Niemann-Pick disease Amyloid Glycogen storage disease Langerhans cell histiocytosis Hemophagocytic lymphohistiocytosis
hematologic (hypersplenic) causes of splenomegaly
Acute and chronic hemolytic anemias, all etiologies
Sickle cell disease (children)
Following use of recombinant human granulocyte colony-stimulatingfactor
Myelofibrosis
symptoms of splenomegaly
LUQ pain
May be acute or chronic depending on the disease
Acute if splenic infarct or rupture present
Dizziness/hypotension with splenic rupture
Signs of the disease causing splenomegaly
Fever, chills etc with infections
Fatigue, weight loss with cancer
Jaundice, ascitis with cirrhosis
CBC in splenomegaly
CBC:
Neutropenia, anemia, and/or thrombocytopenia may be present without abnormal morphology (hypersplenism)
Absolute neutrophillia with or without Left shift suggest presence of splenic infarction
Atypical lymphocytes
Blasts/young cells
Peripheral smear in splenomegaly
Invading organisms (bartonellosis, babesiosis, and malaria)
Schistocytes
Abnormal cell morphology (spherocytes)
A young adult with fatigue, fever, sore throat, and splenomegaly
infectious mononucleosis or other viral infection
older adult complaining of post-bath pruritus with a ruddy complexion and splenomegaly
polycythemia vera
A patient with chronic alcoholism or hepatitis and ascites
splenomegaly secondary to cirrhosis and portal HTN
what is important in pt history in pt with LAD
Localizing signs or symptoms suggesting infection or malignancy
URI symptoms
Dental pain
Chest pain
Abdominal/pelvic pain
Exposures:
- cat
- undercooked meat
- tick bite
- travel
- high risk behavior
Constitutional symptoms
fever, night sweats, or weight loss (tuberculosis, lymphoma, or other malignancy)
fever (majority of the infectious diseases)
Use of medications that can cause lymphadenopathy
