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Heme/Genetics > PhysDi - Heme/Lymph Disorders > Flashcards

PhysDi - Heme/Lymph Disorders Flashcards

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1
Q

Facts about lymphatic system

A
  • 3% of total body weight

- every tissue supplied by blood has lymph vessels except placenta and brain

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2
Q

Role of lymphatics in human body

A
  • movement of lymph fluid
  • production of lymphocytes
  • production of Abs
  • phagocytosis
  • absorption of fat
  • 2nd line manufacturing of blood
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3
Q

lymph fluid

A
  • Clear, sometimes yellow-tinged fluid

- Contains variety of WBCs, rarely RBC

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4
Q

lymph ducts

A
  • intimately related to cardiovascular system
  • closed circuit
  • no built in pumping mechanism, sluggish movement
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5
Q

lymphocytes

A
  • formed by lymph nodes, tonsils, adenoids, spleen, but primarily bone marrow
  • differentiation takes place in thymus
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6
Q

lymph nodes

A
  • occur in groups

- over 600 nodes in body

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7
Q

superficial nodes

A
  • subQ conntective tissues
  • gateway to assessing health
  • readily accessible
  • provide early clues to infection or malignancy
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8
Q

deeper nodes

A

beneath the fascia of muscles and w/i body cavities

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9
Q

Disorders cause what 3 physical signs in the lymphatics?

A
  1. palpable lymph nodes (lymphadenopathy)
  2. red streaks in the skin from superficial lymphangitis
  3. lymphedema
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10
Q

bubos

A

lymphadenopathy caused by the black plague

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11
Q

spleen

A
  • LUQ
  • highly vascular
  • stores RBCs
  • important site for blood filtering w/ macrophages
  • forms blood early in life
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12
Q

What is the spleen made of?

A
  • white pulp: lymph nodules and tissue

- red pulp: venous sinusoids

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13
Q

tonsils

A
  • organized as follicles and crypts covered by mucous membrane
  • small, diamond shaped
  • lie b/w the palatine arches
  • made of lymphoid tissue
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14
Q

adenoids

A
  • “pharyngeal tonsils”
  • located in the nasopharyngeal border
  • can obstruct nasopharyngeal passageway when enlarged
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15
Q

thymus

A
  • located in superior mediastinum
  • vital in early childhood while immune system is developing
  • site for T cell production
  • no function in adulthood
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16
Q

peyer patches

A
  • small, raised areas of lymph tissue on mucosa of the small intestine
  • made of clusters of lymphoid nodules
  • aka GALT: gut associated lymphoid tissue
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17
Q

acute lymphangitis

A
  • inflammation/infection of lymphatic channels or vessels
  • occurs when viruses or bacteria invade the vessels of your lymph system
  • typically through infected cut or wound
  • usually strep or staph
  • rarely non infectious cause like malignancy
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18
Q

sx of acute lymphangitis

A
  • chills
  • moderate lymph nodes swelling and pain
  • +/- fever
  • +/- red streaking from wound to nearest lymph
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19
Q

diagnosis of acute lymphangitis

A
  • physical exam
  • can biopsy wound
  • blood cultures
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20
Q

Tx of acute lymphangitis

A
  • abx (IV or oral)
  • pain meds
  • anit-inflammatories
  • surgery or debridement
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21
Q

complications of acute lymphangitis

A
  • cellulitis
  • bacteremia
  • sepsis
  • abscess
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22
Q

acute suppurative lymphadenitis

A

-bacterial infection of the lymph nodes w/ pus formation

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23
Q

most common causative organism and more rare causes of acute suppurative lymphadenitis

A
  • most common: group A strep

- others: cat scratch disease, TB

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24
Q

Sx of acute suppurative lymphadenitis

A
  • fever
  • moderate lymph node swelling and pain
  • overlying skin erythema and tenderness
  • lymph node feels rubbery if abscess has formed
25
Q

aquired lymphadema

A
  • trauma to ducts of regional nodes OR sometimes infection
  • axillary, inguinal
  • from surgery or metastases
  • does NOT pit
26
Q

congenital lymphadema

A
  • hypoplasia/maldevelopment
  • at birth
  • legs/feet
27
Q

S/S of lymphadema

A
  • Swelling
  • Feeling of heaviness/tightness
  • Restricted ROM
  • Aching or discomfort
  • Recurring infections
  • Hardening or thickening of skin (fibrosis)
28
Q

diagnosis of lymphadema

A

-if not obvious reasons like surgery, may order MRI, CT, or doppler US

29
Q

Tx of lymphadema

A
  • no cure
  • exercises
  • wrapping of limb
  • massage
  • compression garments
30
Q

elephantiasis

A
  • massive accumulation of lymphadema throughout the body

- caused by filarial worm infection that obsructs the lymphatics and prevents drainage

31
Q

hematologic and lymphatic patient history

A
  • all symptoms that a patient could present with overlap with other systems
  • ex: bleeding, fatigue, malaise, fever, blood in stool, etc. etc.
32
Q

heme/lymph PMH

A
  • autoimmune disease
  • transfusions
  • thyroid disease
  • chronic kidney disease
  • celiacs
  • cirrhosis
  • splenomegaly
  • cancer
  • chronic pancreatitis
33
Q

heme/lymph past surgical hx

A
  • gastric bypass
  • gastrectomy
  • mechanical heart valve
  • small bowel resection
34
Q

heme/lymph social hx

A
  • diet restrictions
  • vegan
  • drug use
  • alcohol use
  • exposure to toxic substances
35
Q

heme/lymph family hx

A
  • anemia
  • celiacs
  • pernicious anemia
  • autoimmune disease
  • ethnicity
36
Q

neck ROS

A
  • swelling
  • lumps
  • goiter
  • pain
  • limitation of movement
37
Q

hematologic ROS

A
  • anemia
  • petechiae
  • purpura
  • easy bruising/bleeding
  • epistaxis
  • past transfusions and any reactions
  • lymphadenopathy
38
Q

physical exam for hematologic patient

A
  • skin: pallor
  • HEENOT: smooth tongue, pale conjunctiva
  • Neck/lymph exam
  • musculoskeletal: TTP at sternum, anterior tibia
  • abdomen: hepatosplenomegaly, rectal exam for occult blood
  • neuro: peripheral neuropathy, decreased sensation
39
Q

dematologic exam for hematologic patient

A
  • petechiae
  • purpura
  • pallor: mucous membranes, nail beds, conjunctiva, palmar skin creases
  • jaundice
  • nails - koilonychias
  • mouth: angular chelitis
  • lower extremity ulcers
40
Q

HEENOT exam for hematologic patient

A
  • skin: pale
  • eyes: pallor of conjunctiva
  • Mouth: smooth and beefy red tongue, atrophic tongue, adequate teeth
41
Q

cardio exam for the hematologic patient

A
  • forceful heartbeat
  • strong peripheral pulses
  • tachycardia
  • systolic flow murmur
  • high output heart failure (severe anemia)
  • 4th heart sounds
42
Q

exam of lymph nodes in the extremities

A
  • axillary: feel up, down, front and back (box method)
  • epitrochlear: just above funny bone
  • inguinal: groin
  • popliteal: behind knee
43
Q

general tips for exam of lymph nodes

A
  • can use inspection and palpation
  • use pads of fingers 2, 3, 4
  • dorsum of hand for temp
  • measuring device
  • gloves if needed
  • gown and cover patient
  • room at comfortable temp
44
Q

appearance of normal lymph nodes

A
  • round/oval and smooth

- easily palpable not generally found in healthy adults

45
Q

abnormal lymph nodes indications

A
  • more tender = more likely d/t inflammation
  • cancerous nodes usually NOT tender
  • harder the node and more discreet, more likely a malignancy
  • palpable subraclavicular node on left = BAD
46
Q

What to not if nodes are palpable

A
  • number
  • consistency
  • discrete or matted
  • location
  • mobility
  • tenderness
  • size
  • warmth
  • color of overlying skin
47
Q

Nine S’s of a “lump”

A
  • size
  • shape
  • surface characteristics
  • site
  • symptoms
  • squeezability
  • spread
  • sensations
  • symmetry
48
Q

exam for supraclavicular nodes

A
  • probe deeply in angle formed by clavicle and sternocleidomastoid
  • NEVER a normal finding
  • Virchow’s node
49
Q

anterior (pectoral) group of axillary nodes

A
  • at lower part of pec minor

- receive lymph fluid from breasts and upper abdomen

50
Q

posterior (subscapular) group of axillary nodes

A

-located at lower region of armpits rear wall

51
Q

lateral (brachial) group of axillary nodes

A
  • situated medially and horizontally to the side of the posterior group
  • receive lymph from the arms
52
Q

central group of axillary nodes

A
  • b/w lateral and posterior group

- receives lymph from anterior, posterior, and lateral groups and passes it to the apical group

53
Q

apical group of axillary nodes

A
  • found at upper part of pec minor

- collects lymph from all other axillary nodes

54
Q

general tips for exam of axillary lymph nodes

A
  • more firm deliberate touch (less ticklish)
  • support the patient’s forearm w/ your contralateral arm
  • touch bare skin
  • gown pt
  • warm hands and room
55
Q

how to examine the axillary lymph nodes

A
  • pt is seated
  • palpate w/ contralateral hand
  • support pts wrist and elevate their arm
  • place hand in axilla w/ fingers together and palm toward chest wall
  • firmly rake fingers along thoracic cage to feel for nodes
56
Q

epitrochlear node exam

A

support elbow in one hand as you explore w/ the other

57
Q

inguinal node exam

A
  • have pt lie supine w/ knee slightly flexed
  • palate at and just below inguinal ligament then distally along course of greater saphenous vein
  • drainage from scrotum/penis (not testes) and vulva/lower third of vagina
58
Q

popliteal node exam

A
  • palpate posterior knee

- rare to find abnormalities

Heme/Genetics (15 decks)

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