MDT's Lymphatic

Question 1

Overview of Peripheral Lymphadenopathy?

Answer 1

• Enlarged lymph nodes in peripheral

- Peripheral Lymphadenopathy (LAD) has many etiologies

Question 2

Common causes of generalized Peripheral Lymphadenopathy

Answer 2

• HIV
• TB
• Infectious Mono
• Lupus
• Malignancy

Question 3

What do you look for in history regarding Lymphadenopathy?

Answer 3

• Localized signs/symptoms suggesting infection/malignancy
• Exposures to potential infection
• Cat scratches
• Tick bites
• Travel to endemic areas
• High risk behaviors (HIV, drugs)
• Constitutional symptoms
• Medications (Atenolol, cephalosporins, PCN)

Question 4

What do you focus on during exam for lymphadenopathy?

Answer 4

• Location
• Size
• Consistency
• Fixation vs mobile
• Tenderness

Question 5

What are you looking for with consistency on exam regarding lymphadenopathy?

Answer 5

• Hard nodes are found in cancer

- Firm, rubbery nodes found in lymphomas

Question 6

What are you looking for with fixation vs mobility on exam regarding lymphadenopathy?

Answer 6

• Normal lymph nodes are freely moveable in subcutaneous spaces
• Abnormal nodes can become fixed to adjacent spaces

Question 7

What does tenderness suggest on exam regarding lymphadenopathy?

Answer 7

Recent, rapid enlargement that has put pain receptors in the capsule under tension

Question 8

What type of biopsy for lymphadenopathy?

Answer 8

• Fine Needle Aspiration (FNA)

- Open Biopsy

Question 9

What is the treatment for lymphadenopathy?

Answer 9

• Based on specific etiology
• Localized can be observed for 3-4 weeks if screenings don’t suggest malignancy
• Generalized should start with CBC, CXR, HIV testing

Question 10

Essentials of diagnosis for lymphedema?

Answer 10

• Painless, persistent edema of one/both lower extremities (usually younger women)
• Pitting edema w/out ulceration, varicosities, stasis pigmentation
• May be episodes of lymphangitis and cellulitis

Question 11

Primary form of lymphedema is due to?

Answer 11

Congenital developmental abnormalities impairing lymph flow from extremity

Question 12

Secondary form of lymphedema is due to?

Answer 12

Involves inflammatory or mechanical lymphatic obstruction from trauma, regional lymph node resection, irradiation

Question 13

Symptoms/Physical findings of lymphedema?

Answer 13

• Aching discomfort w/ sensation of heaviness or fullness
• Hypertrophy of limb
• Pitting edema

Question 14

Labs/Image findings for lymphedema?

Answer 14

• MRI
• Lymphangiography
• Ultrasound to evaluate DVT

Question 15

Treatment for Lymphedema?

Answer 15

• Referral
• Elevation (esp. during sleep)
• Compression stockings
• Diuretic therapy
• Amputation if complications

Question 16

Diuretic therapy for lymphedema?

Answer 16

• Furosemide 40 mg PO daily

- Bumetanide 1 mg PO daily

Question 17

Disposition for lymphedema?

Answer 17

• No effective cure

- Tx strategies to control problem

Question 18

What is Lymphangitis and Lymphadenitis caused by?

Answer 18

• Commonly occurs secondary to bacterial infection

- Usually caused by Streptococci or Staph Aureus (or both)

Question 19

Symptoms/exam of lymphangitis and lymphadenitis?

Answer 19

• Throbbing pain
• Fever, chills, malaise, anorexia
• Red streaking from wound
• Indurated and painful tissue at site of cellulitis
• Tachycardia

Question 20

Lab findings for lymphangitis and lymphadenitis?

Answer 20

• Leukocytosis with left shift
• Positive cultures of purulent material can guide Tx
• Ultrasound of infected site

Question 21

Treatment for lymphangitis and lymphadenitis?

Answer 21

• General measures
• heat
• elevation
• immobilization
• Analgesia with Tylenol and NSAIDS
• Empiric antibiotics for strep and staph
• Cephalexin
• Bactrim

Question 22

MEDEVAC for lymphangitis and lymphadenitis?

Answer 22

• Yes, emergently if:
• signs of sepsis
• severe lymphangitis requiring IV antibiotics/significant debridement

Question 23

Complications for lymphangitis and lymphadenitis?

Answer 23

• Overwhelming infection

- Septicemia