008 Lymph Nodes - Introduction to Clinical Surgery Lectures

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Lecture on lymph nodes from a series of lectures on an introduction to clinical surgery. It has been devised with medical students in mind.

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008 Lymph Nodes - Introduction to Clinical Surgery Lectures

  1. 1. Lymph Nodes Nick Harvey
  2. 2. Lymph Nodes: Causes of Lyphadenopathy <ul><li>Generalised </li></ul><ul><ul><li>Systemic infections </li></ul></ul><ul><ul><li>Leukaemia </li></ul></ul><ul><ul><li>Autoimmune diseases </li></ul></ul><ul><li>Localised </li></ul><ul><ul><li>Local infection </li></ul></ul><ul><ul><li>Metastases </li></ul></ul><ul><ul><li>Lymphoma </li></ul></ul>
  3. 3. Lymph Nodes: History <ul><li>Onset, Course, Duration </li></ul><ul><li>Painful or painless </li></ul><ul><li>Other lumps </li></ul><ul><ul><li>Present or past? </li></ul></ul><ul><ul><li>Same type or effect </li></ul></ul><ul><li>Cause </li></ul><ul><ul><li>Symptoms suggestive of primary tumour in the catchment area </li></ul></ul><ul><li>Effect on General Condition </li></ul><ul><ul><li>Fever, weight loss, appetite, bleeding tendency, recurrent infections </li></ul></ul>
  4. 4. Lymph Nodes: Lymphatic Drainage of the Body Head & Neck <ul><li>Superficial Cervical Lymph Nodes </li></ul><ul><ul><li>Submental (tongue, mouth, lips) </li></ul></ul><ul><ul><li>Submandibular (tongue, mouth) </li></ul></ul><ul><ul><li>Jugulodigastric (tonsils) </li></ul></ul><ul><ul><li>Pre-auricular (scalp) </li></ul></ul><ul><ul><li>Post-auricular (scalp) </li></ul></ul><ul><ul><li>Occipital (scalp) </li></ul></ul><ul><li>Deep Cervical Lymph Nodes </li></ul><ul><ul><li>Upper deep cervical </li></ul></ul><ul><ul><li>Lower deep cervical </li></ul></ul><ul><ul><ul><li>Thyroid, upper oesophagus, naso- and oropharynx </li></ul></ul></ul>
  5. 5. Lymph Nodes: Lymphatic Drainage of the Body Head & Neck
  6. 6. Lymph Nodes: Examination Cervical Lymph Nodes <ul><li>Start behind the patient </li></ul><ul><li>Tilt the head to the same side you’re examining </li></ul><ul><li>Relationship to sternocleidomastoid </li></ul>
  7. 7. Lymph Nodes: Lymphatic Drainage of the Body Head & Neck Lymph Nodes <ul><li>Plan for Examination of Cervical Lymphadenopathy </li></ul><ul><ul><li>Skin of scalp, ears & neck </li></ul></ul><ul><ul><li>Nose </li></ul></ul><ul><ul><li>Mouth: floor, tongue, gums, tonsils </li></ul></ul><ul><ul><li>Parotid, submandibular & thyroid </li></ul></ul><ul><ul><li>Arms, chest wall (breasts) </li></ul></ul><ul><ul><li>Indirect laryngoscopy </li></ul></ul>
  8. 8. Lymph Nodes: Lymphatic Drainage of the Body Supraclavicular Lymph Nodes <ul><li>Upper & Lower Deep Cervical </li></ul><ul><li>Right </li></ul><ul><ul><li>Upper limb, both sides of the chest & breast </li></ul></ul><ul><li>Left </li></ul><ul><ul><li>Upper limb, both sides of the chest & breast </li></ul></ul><ul><ul><li>Lungs & abdominal viscera including testes </li></ul></ul>
  9. 9. Lymph Nodes: Lymphatic Drainage of the Body Axillary Lymph Nodes <ul><li>Anterior group </li></ul><ul><li>Posterior group </li></ul><ul><li>Central group </li></ul><ul><li>Apical group </li></ul><ul><li>Lateral group </li></ul><ul><ul><li>Upper limb & trunk above the level of umbilicus </li></ul></ul>
  10. 10. Lymph Nodes: Lymphatic Drainage of the Body Axillary Lymph Nodes
  11. 11. Lymph Nodes: Lymphatic Drainage of the Body Inguinal Lymph Nodes <ul><li>Trunk below the umbilicus </li></ul><ul><li>Lower limb </li></ul><ul><li>External genitalia skin </li></ul><ul><li>Lower half of anal canal </li></ul>
  12. 12. Lymph Nodes: Lymphatic Drainage of the Body Thoracic Duct <ul><li>Starts at L2 on right side - cisterna chyli </li></ul><ul><li>Crosses to the left side at T4 </li></ul><ul><li>Terminates in the left subclavian vein </li></ul>
  13. 13. Lymph Nodes: Examination <ul><li>General </li></ul><ul><ul><li>Temperature </li></ul></ul><ul><ul><li>Cachexia/weight loss </li></ul></ul><ul><ul><li>Anaemia </li></ul></ul><ul><ul><li>Jaundice </li></ul></ul><ul><ul><li>Petechial haemorrhage/ecchymoses </li></ul></ul><ul><li>Local </li></ul><ul><ul><li>Presenting lymph node (as a swelling) </li></ul></ul><ul><ul><li>Other lymph nodes </li></ul></ul><ul><ul><li>Lymphatics </li></ul></ul><ul><ul><li>Catchment area </li></ul></ul><ul><ul><li>Liver & spleen </li></ul></ul>
  14. 14. Lymph Nodes: Investigations <ul><li>FBC, U&Es, LFTs, Clotting </li></ul><ul><li>CXR, Abdo USS, CT </li></ul><ul><li>Appropriate investigation to find a primary </li></ul><ul><li>FNA cytology </li></ul><ul><li>Biopsy?? </li></ul>

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