Mesenteric adenitis (GI) Flashcards
Define mesenteric adenitis.
Inflammation of lymph nodes within the abdominal mesentery
What is the most common cause of mesenteric adenitis?
Recent viral intestinal infection e.g. viral gastroenteritis
Who does mesenteric adenitis mainly affect?
Children and teenagers
What other disease can mesenteric adenitis mimic?
Appendicitis - similar symptoms, difficult to distinguish between the two
What are some known culprits of mesenteric adenitis? (3)
- salmonella
- E. coli
- Streptococci
What is the pathophysiology of mesenteric adenitis?
- bacteria/virus ingested orally –> enters bloodstream via invasion through intestinal epithelium
- organism localises to nodal lymph tissue of body surrounding intestinal mucosa - Peyer’s patches
- organism can then spread regionally through lymphatic pathways to mesenteric lymph nodes –> mesenteric adenitis
What are the clinical features of mesenteric adenitis? (7)
- abdominal pain - usually RLQ (may be widespread)
- general abdominal tenderness
- fever
- mesenteric LN enlargement
- change in bowel habit
- diarrhoea & N/V depending on cause
- Hx recent URTI - sore throat, fever, malaise, nausea, diarrhoea
What might you find on examination in mesenteric adenitis?
- fever
- abdominal tenderness generalised (not localised to RLQ)
- rhinorrhoea
- hyperaemic pharynx and oropharynx - pharyngitis
- associated extramesenteric lymphadenopathy - usually cervica;
- pain on palpation less vs appendicitis
How might you be able to differentiate mesenteric adenitis from appendicitis?
High fever indicates mesenteric adenitis + less pain on palpation
What are some risk factors for mesenteric adenitis? (2)
- children <10y
- recent gastroenteritis or URTI
What are the first-line investigations for mesenteric adenitis? (2)
- abdominal USS / CT abdomen and pelvis
- bloods
What might you find on FBC in mesenteric adenitis?
Elevated WCC and CRP
What might you see on abdominal USS/CTAP in mesenteric adenitis?
Enlarged hypoechoic mesenteric lymph nodes - rule out appendicitis and intussusception
What are some differential diagnoses for mesenteric adenitis? (13)
- constipation
- acute appendicitis
- gastroenteritis
- UTI
- abdominal trauma
- cholelithiasis/cholecystitis
- primary dysmenorrhoea
- pneumonia
- functional abdominal pain
- intussusception
- Meckel’s diverticulum
- Hirschsprung’s disease
- IBD
How do we manage mesenteric adenitis?
- none - often self limiting
- analgesia
- NSAIDs
- drink lots of fluids / IV hydration
- may need Abx if bacterial infection is the cause
