week 4 module 13 lymph system Flashcards
infants
lymph system begins development at 20wks gestation
immature at birth
inc. in childhood especially 6-9y/o
preg.
temporary remission of autoimmune/inflammatory disorders
older adults
nodes dec. size and number with age
HPI enlarged nodes
character: onset, location, duration, number
local s/s: pain, redness, warmth, red streaks
systemic s/s: malaise, fever, wt. loss, night seat, abd. pain
predisposing factors: infection, surgery, trauma
meds: chemo, antibiotics
HPI swelling of extremity
uni/bilateral
intermittent or constant
predisposing factors: CV or renal disorder, surgery, infection, trauma, venous insufficiency.
assoc. s/s: warmth, redness/discoloration, ulceration
PMH
chest imaging
TB
blood transfusions, use of blood products
Chronic illness: cardiac, renal, malignancy, HIV
surgery: trauma, organ transplant, lymph node biopsy
recurrent infections
autoimmune disorders
allergies
FH
malignancy anemia recent infectious disease TB immune disorders hemophilia
personal and social hx
travel: asia, africa, wester pacific, india, philippines
recreational drugs
sexual hx
infants and childrens hx
recurrent infections
- tonsillitis, adenoiditis, bacterial infections, oral candidiasis, chronic diarrhea, chronic severe ecamea
preg patients
weeks of gestation
exposure to infections
pets in household: cat feces
immunization status
older adults
autoimmune disease
recent infection or traume to nodes
delayed healing
immunization status
lymphadenopathy
enlarged lymph nodes
lymphadenitis
inflamed and enlarged lymph nodes
lymphangitis
inflammation of the lymphatics that drain an area of infection; tender erythematous streaks extend proximally from the infected area
- regional nodes may also be tender
lymphedema
edematous swelling due to excess accumulation of lymph fluid in tissues caused by inadequate lymph drainage
lymphangioma
congenital malformation of dilated lymphatics
shotty nodes
small non-tender nodes that feel like BB’s or buckshot under the skin
fluctuant nodes
wavelike motion that is felt when the node is palpated
matted nodes
group of nodes that feel connected and seem to move as a unit
hard, fixed, painless node
suggests malignant process
- usually rapid enlargement
tender node
more likely an inflammatory process
virchow node
palpable supraclavicular node on left
- clue to thoracic or abdominal malignancy
slow nodal enlargement suggests
benign process
acute lymphangitis patho
inflammation of one or more lymphatic vessels
acute lymphangitis subjective
enlarged lymphnode pain malaise possible fever minor trauma to skin distal to the area of infection
acute lymphangitis objective
red streaks after the course of the lymphatic collecting duct
tracing of fine lines streaking up the extremity
indurated and palpable to gentle touch sometimes
look distal for sites of infection, esp. between digits
acute suppurative lymphadenitis patho
infection and inflammation of a lymph node, single or group
acute suppurative lymphadenitis subjective
enlarged nodes
pain
acute suppurative lymphadenitis objective
involved node usually firm and tender
overlying tissue edematous, erythematous, within 72hr
abscess formation extensive; nodes fluctuant
mycobacterial adenitis characterized by
inflammation without warmth that may or may not be tender
lymphedema patho
edematous swelling due to excess accumulation of lymph fluid in tissues caused by inadequate lymph drainage
lymphedema subjective
painless swelling of limb; uni/bilateral onset usually gradual hx of trauma, surgery, or radiation to area travel where filariasis is common family hx leg swelling
lymphedema objective
swelling and often distortion of extremities
may or may not pit
overlying skin thickens and feels tougher than usual
primary lymphedema
apparent at birth and most often involves the legs
degree varies with the severity and distribution of the abnormality
may not appear till young adulthood
Stage 0 lymphedema
latent or subclinical
swelling is not evident despite impaired lymph transport
Stage 1 lymphedema
pitting may occur
early accumulation of fluid relatively high in protein content
- subsides with elevation
Stage 2 lymphedema
tissue fibrosis is present
limb elevation alone rarely reduces swelling
pitting may be present, as fibrosis worsens pitting decreases
Stage 3 lymphedema
pitting is absent
trophic skin changes are present
lymphangioma/cystic hygroma patho
congenital malformation of dilated lymphatics
lymphangioma subjective
painless cystic masses
usually manifest during 1st year of life
- often enlarged after an URI
asymptomatic when in posterior triangle of neck
- found anteriorly may cause airway/swallowing issues
lymphangioma/ cystic hygroma objective
soft, nontender, and easily compressible spongy fluid-containing mass without discrete margins.
most present at birth
- neck, axilla, less common: chest, extremities
lymphatic filariasis (elephantiasis) patho
massive accumulation of lymphedema throughout the body
- widespread inflammation and obstruction of the lymphatics by the filarial worms transmitted by mosquitos
lymphatic filariasis (elephantiasis) subjective
swelling of limb or body area
travel: asia, africa, western pacific, india, philippines
many w/out s/s
fever, chronic pulmonary infection
non-hodgkin lymphoma patho
malignant neoplasm of the lymphatic system and the reticuloendothelial tissues
non-hodgkin’s subjective
painless enlarged lymph nodes fever wt. loss night sweats abd. pain/fullness family hx
non-hodgkin’s objective
- nodes may be localized in the posterior cervical triangle or may become matted, crossing into the anterior triangle
- nodes well defined and solid
Hodgkin’s lymphoma patho
malignant lymphoma
starts in single node and spreads to contiguous lymph nodes, spleen, liver, and bone marrow.
neoplastic giant cells release factors that induce accumulation of lymphocytes, macrophages, and granulocytes
hodgkin lymphoma subjective
painless enlarged lymph nodes
may have abd. pain
sometimes fever
possible hx of mononucleosis
hodgkin lymphoma objective
most common:
- painless enlargement of cervical lymph nodes
- - generally asymmetric and progressive
Nodes sometimes matted and firm, almost rubbery
Epstein-Barr virus Mononucleosis patho
infectious mono
oral epithelial cells
incubation period 30-50 days
epstein-barr virus mononucleosis subjective
malaise fatigue acute or prolonged fever HA ST nausea abd pain myalgia
epstein-barr virus mononucleosis objective
- generalized lymphadenopathy, most common in cervical nodes and submandibular
- epitrochlear lymphadenopathy
- hepatomegaly
- splenomegaly
- moderate to severe pharyngitis with tonsillar enlargement, occasional exudates
- petechiae at the junction of the hard and soft palate
toxoplasmosis patho
zoonosis, caused by the parasite toxoplasma gondii
- ingestion of oocysts in soil undercooked meat, raw eggs, cat feces or litter
- infection persists for life without s/s
- immunosuppresion: neurologic disease and organ manifestations
- preg: serous congenital infection, particularly in 1st trimester
toxoplasmosis subjective
no s/s
hx of eating raw or rare meat, undercooked eggs
hx contact with cat feces
toxoplasmosis objective
single node, chronically enlarged and nontender
- usually in the posterior cervical chain
roseola infantum patho
infection by human herpes virus 6
- common in infancy peak age 2 years
- present in the saliva of most adults transmitted by oral secretions
roseola infantum subjective
fever- high grade and persistant over 3-4 days
may have mild resp. illness and lymphadenopathy
roseola infantum objective
- adeopathy, discrete and not tender, involves the occipital and postauricular chains, may last for some time.
- when fever diminishes, morbillifrom fine maculopapular rash occurs, spreads from trunk to extremities, then child begins to feel better
