Lymphatic Pathologies Flashcards
What is Lymphadenopathy?
the palpable enlargement (>1cm) of lymph nodes
How is a lymphadenopathy classified?
Localised: one body part
general: 2 or more areas = underline disease
What leads to splenomegaly?
INFECTIONS
e.g. glandular fever, TB, syphilis , HIV
PORTAL HYPERTENSION
e.g. cirrhosis, cardiac failure
LYMPHOID DISORDERS
e.g. leukaemia, lymphoma, multiple myeloma
RBC DISORDERS
e.g. thalassaemia (haemolytic anaemia)
INFLAMMATORY CONDITIONS
What is glandular fever?
Acute infection of B lymphocytes with Epstein-Barr Virus (EBV)
How is glandular fever transmitted?
Usually through close personal contact - most commonly saliva
Mucosal secretions of the respiratory tract, genital tract, blood
What is the pathophysiology of glandular fever?
EBV initially infects the oropharynx, nasopharynx and salivary epithelial cells
Later extends into lymphoid tissues and B cells
ADAPTIVE IMMUNE RESPONSE
Unaffected B cells produce antibodies against EBV
Cytotoxic T cells attack virus-infected B-cells directly
Enlargement of lymphoid tissue occurs due to:
Proliferation of lymphocytes
Removal of dead and damaged B cells
Clinical features of glandular fever?
Long incubation period: 30-50 days
Classical symptoms: fever, sore throat, cervical lymphadenopathy, fatigue
Progression of disease: generalised lymphadenopathy, splenomegaly, hepatomegaly
Rare complications (~5%): ocular, cardiac, CNS involvement
What is the management for glandular fever?
Rest
analgesics
antipyretics
treatment of secondary bacterial infection
What is leukaemia?
Proliferation of malignant leucocytes in the bone marrow
Overcrowding causes malignant cells to spill into blood
What is lymphoma?
Proliferation of malignant lymphocytes in lymphatic system
Formation of discrete tumours
What is multiple myeloma?
Proliferation of malignant plasma cells in the bone marrow
How is leukaemia classified?
Lymphoid leukaemia
Myeloid leukaemia
Acute leukaemia – rapid growth of immature cells (referred to as ‘blasts’)
Chronic leukaemia : slow growth
What are the 4 types of leukaemia?
Acute lymphoblastic leukaemia (ALL)
Acute myeloid leukaemia (AML)
Chronic lymphocytic leukaemia (CLL)
Chronic myeloid leukaemia (CML)
what is the Aetiology of leukaemia?
combination of genetics
environmental risk factors
What are the clinical features of leukaemia?
rapid onset of symptoms
- Anaemia (↓ RBCs): fatigue, pallor, weakness
- Decreased immunity (↓normal WBCs): fever, mouth ulcers, recurrent infections
- Bleeding tendencies
OTHER:
bone pain
Splenomegaly, hepatomegaly, lymphadenopathy
Non-specific features
Nervous system infiltration
Management for acute Leukaemia?
blood marrow biopsy + combination of chemotherapy.
What are the clinical features of chronic leukaemia?
splenomegaly, extreme fatigue, weight loss, night sweats, fever
Management for chronic Leukaemia?
CLL - observation/ antibodies/ late chemo
CML - tyrosine kinase inhibitors
How is lymphoma classified?
Hodgkin’s lymphoma
Non-Hodgkin’s lymphoma
Risk factors for lymphoma?
Family history
Certain infections
Epstein-Barr Virus, HIV, HCV, HTLV, Herpes Virus-8, H. pylori
Obesity
Iatrogenic immunosuppression
Autoimmune conditions: RA, SLE
Exposure to ionizing radiation or mutagenic chemicals
Clinical features of hotchkins lymphoma?
no spread
Lymphadenopathy
compresive features
B symptoms: fever, sweats, wt loss
Other: fatigue, anorexia, pruitis
Clinical features of non-hotchkins lymphoma?
can spread to other organs
Lymphadenopathy
compresive features
B symptoms: fever, sweats, wt loss
Management of non-hotchkins lymphoma?
Chemotherapy
Radiotherapy
Antibody therapy
Corticosteroids
Stem cell transplant
prognosis 75% cured
Aetiology for multiple myeloma?
Chromosomal mutations play a key role
Exact aetiology unknown
Risk assoc. w/ radiation exposure
Familial predisposition?
Pathophysiology of multiple myeloma?
Myeloma cells: neoplastic plasma cells that produce excessive amounts of abnormal antibodies (M proteins)
Result: decreased immunity, overcrowded marrow
Antibody fragments (light-chains) are also produced and accumulate in tissues and organs
Result: amyloidosis leads to renal failure
Myeloma cells form discrete tumours (plasmacytomas) within bone
Release of osteolytic cytokines destroys overlying cortical bone
Result: radiographic ‘punched-out’ lesions (1-4cm in diameter)
Clinical features of multiple myeloma?
bone destruction
marrow overcrowding
extra-osseous plasmacytomas
What is HIV?
HIV is the pathogen responsible for acquired immunodeficiency syndrome (AIDS)
It is a retrovirus and carries its genetic material as RNA (not DNA)
Modes of transmission of HIV?
- Exchange of body fluids
- Children infected in placenta
- occupational exposures
What is the pathophysiology
behind HIV?
Entry into cell
Conversion of viral RNA
Dormancy
Activation
Host cell death
Stages of HIV
STAGE 1: ACUTE INFECTION
STAGE 2: CHRONIC INFECTION (CLINICAL LATENCY)
STAGE 3: ACQUIRED IMMUNE DEFICIENCY SYNDROME
Management of HIV
MAINTAIN PHYSICAL & MENTAL HEALTH:
POST-EXPOSURE PROPHYLAXIS
PRE-EXPOSURE PROPHYLAXIS
