Lymphoreticular Examination Flashcards
When would you perfrom an examination of the lymphoreticular system?
Examination of the lymphoreticular system is often performed when there is clinical suspicion of haematological malignancy.
What is the following sign and what may it suggest?
Bleeding or bruising/petechiae: may indicate underlying thrombocytopenia.
What is the following sign and what may it suggest?
Pallor: a pale colour of the skin that can suggest underlying anaemia (e.g. leukaemia).
What is the following sign and what may it suggest?
Cachexia: ongoing muscle loss that is not entirely reversed with nutritional supplementation. Cachexia is commonly associated with underlying malignancy (e.g. leukaemia and lymphoma).
Interpret the following findings of examined lymph nodes:
Typically less than 1cm, smooth, rounded, non-tender and mobile.
Typically smooth, rounded, tender, mobile and associated with infective symptoms (e.g. fever).
Widespread enlarged rubbery lymph nodes.
Regional lymphadenopathy in lymph node groups draining the affected organ. Lymph nodes typically feel hard, firm, irregular and are often tethered to local structures.
Interpretation of lymph node findings
Benign lymph nodes: typically less than 1cm, smooth, rounded, non-tender and mobile.
Reactive lymph nodes: typically smooth, rounded, tender, mobile and associated with infective symptoms (e.g. fever).
Lymphadenopathy associated with haematological malignancy: widespread enlarged rubbery lymph nodes.
Lymphadenopathy associated with metastatic cancer: regional lymphadenopathy in lymph node groups draining the affected organ. Lymph nodes typically feel hard, firm, irregular and are often tethered to local structures.
What abdominal signs may you see on inspection in the context of a lymphoreticular exam?
Abdominal distension: can be caused by a wide range of pathology, but in the context of a lymphoreticular examination, gross hepatosplenomegaly should be considered.
Bruising/petechiae: in the context of a lymphoreticular examination, this may suggest low platelets.
Striae (stretch marks): caused by tearing during the rapid growth or overstretching of skin (e.g. gross hepatosplenomegaly, intrabdominal mass).
What further assessments/ investigations would you do in a patient after completing the examination?
Further assessments and investigations
Full blood count, blood film and further imaging (e.g. chest X-ray, ultrasound, CT).
Biopsy of a suspicious lymph node for histological diagnosis.
If there were concerns that lymphadenopathy was due to metastatic spread then an examination of the relevant organs would be indicated. For example, detection of axillary lymphadenopathy in a patient would warrant a breast examination.
