Spleen and Lymph Nodes Flashcards
Kehr’s sign
aka omalgia.
LUQ TTP and pain medial to top of left shoulder joint
Ballance’s sign
percussion dullness of left flank
suggest intraperitoneal bleeding.
Hypersplenism
Cause: increased sequestration in spleen, increased destruction by spleen, Ab in spleen causing this.
Features: cytopenia (anemia, leukopenia, thrombocytopenia), normal or hyperplastic cellular precursors in bone marrow
Hemolytic anemia
1.membrane structural abnormalities
a. hereditary spherocytosis
2.metabolic abnormalities
a. pyruvate kinase deficiency
b. G6PD deficiency
not cured by splenectomy
3. hemoglobinopathies
a. sickle cell disease
b. thalassemias
Hereditary spherocytosis
AD
Cause: deficiency in membrane proteins for deformability (spectrin, ankyrin, band 3).
Features: abnormally shaped, rigid red cells, may present with symptomatic cholelithiasis (black stones), hemolytic episodes, aplastic crisis
Tx: splenectomy
Sickle Cell Disease
AR
valine substituted for glutamic acid in beta chain of hemoglobin A.
Dx: sickled cells at low O2
Tx: splenectomy early but can autoinfarct
Thalassemias
cause: deficits in one or more component of hemoglobin
Major: homozygous beta-thalassemia
Tx: splenectomy if high risk for OPSI
Acquired Autoimmune Hemolytic Anemia
Coomb’s negative = from drugs, toxins, infectious agents
Tx: steroids, remove agent
Coomb’s pos = autoimmune
Tx: steroids, treat underlying cause
Immune Thrombocytopenic Purpura (ITP)
acute = usually after viral infection, good prognosis
chronic = in young adults F>M
Features: petechia and purpura, antiplatelet Ab
Tx: steroids, gamma globulin or monoclonal antibody, splenectomy
Thrombotic Thrombocytopenic Purpura (TTP)
disease of arteries and capillaries
Features: thrombotic episodes and low platelet counts, fever, purpura, hemolytic anemia, neurologic manifestations, renal disease.
Tx: plasma pheresis with or without antiplatelet therapy, whole blood exchange, steroids. splenectomy as last resort
HIV-associated Thrombocytopenia
Tx: splenectomy
Diseases associated with Hypersplensism
congestive diseases of spleen
portal HTN
splenic vein thrombosis
infiltrative diseases of spleen
Gaucher’s disease, Niemann Pick disease, amyloidosis, extramedullary hematopoiesis
leukemia, lymphoma, Hodgkin’s disease, tumors
Felly’s syndrome (RA, splenomegaly, neutropenia)
Porphyria erythropoietica
sarcoidosis
Tx: splenectomy if platelets <2,000 with or without infection, or need blood transfusion
Infections in Postsplenectomy Patients
Strep pneumo HiB N. meningitidis beta hemolytic strep staph aureus E choli pseudomonas
herpes zoster
babesiosis
malaria
Posterior auricular lymphadenopathy
from rubella
Anterior auricular lymphadenopathy
from conjunctival or eyelid infections
Posterior cervical lymphadenopathy
toxoplasmosis
metastatic cancer
lymphoma
TB
Submental lymphadenopathy
dental infection
Anterior cervical lymphadenopathy
oral cavity/pharyngeal infection
met squamous cell cancer
lymphoma
TB
Axillary lymphadenopathy
cat scratch disease
breast cancer
lymphoma
upper extremity infection
Epitrochlear lymphadenopathy
handinfection
viral disease in kids
sarcoidosis
tularemia
inguinal lymphadenopathy
lower extremity infection lympohgranuloma venereum gonorrhea herpes lymphoma met rectal cancer
Pulmonary hilar lymphadenopathy
met lung cancer sarcoidosis TB histoplasmosis coccidiodomycosis
Mediastinal lymphadenopathy
Hodgkin’s lymphoma
sarcoidosis
met cancer
Generalized lymphadenopathy
infections: influenza, IM, rubella, TB, CMV
systemic disease: HIV, sarcoidosis, Addison’s disease, hyperthyroidism, hypopituitarism, leukemia, lymphoma
drugs: allopurinol, atenolol, captopril, carbamazepine, cephalosporins, gold, hydralazine, penicillin, phenytoin, primidone, pyrimethamine, quinidine, sulfonamides, sulindac
Supraclavicular lymphadenopathy
cancer
Hodgkin’s Lymphoma
ages: late 20’s or mid 70’s
may involve EBV and monocyte macrophage cell line
Features: cervical lymphadenopathy, supradiaphragmatic disease in young, fever, night sweats, weight loss
Dx: CXR, excisional biopsy, bone marrow biopsy, CT
Categories:
1. nodular lymphocyte predominate
2. lymphocyte rich
3. nodular sclerosis
most common
4. mixed cellularity
5. lymphocyte depleted
Histology: have Reed-Sternberg cells = owl’s eye, multinuclear giant cells
also present in IM and with phenytoin use.
stage A = asymptomatic
stage B = sypmtomatic = fever, night sweats, weight loss
Tx: stages 1-2 = radiation therapy
stages 3 and above = chemotherapy with nitrogen mustard, vincristine, procarbazine, prednisione, or doxorubicin, bleomycin, vinblastine, and dacarbazine
Non Hodgkin’s Lymphoma
associated with HIV, organ transplantation
EBV => Burkitt’s lymphoma
human T cell lymphoma virus 1 => Tcell lymphoma in Caribbean Islands
Features: enlarged lymph nodes, N/V, bleeding.
can present with SVC syndrome, acute spinal cord compression, MALT lymphoma, meningeal involvement
Dx: CBC, LFT, CXR, CT chest abd pelvis, bone marrow biopsy
Tx: surgery, radiation, chemotherapy*
