Lymphatic/Hematopoetic System IPM 2

Сентябрь 11, 2022

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Lymphatic/Hematopoetic System IPM 2

Содержание

2. Objectives Student should be able to … describe location, size, consistency, and other attributes of lymphadenopathy
3. Overview This is a short lecture! A major goal is to synthesize the lymphatic system as
4. Lymphatic System
5. Lymph Node Examination Head/neck Axillary Inguinal/femoral
6. Head and Neck Nodes Preauricular Posterior auricular Occipital Tonsillar Submandibular Submental Superficial cervical Posterior cervical Deep
7. Axillary A pectoral (anterior) L lateral P posterior C central Ap apical
8. Inguinal/ Femoral Horizontal group Vertical group
9. Descriptors of Lymphadenopathy Location…obvious Mobility Size Texture Shape Tender/non-tender Associated erythema or warmth…signs of inflammation
10. Spleen Left upper quadrant Palpation most specific for detecting enlarged spleen (89-99% specificity) Spleen palpable to
11. Case 28 yo man presents with c/o fevers, night sweats and 30 pound weight loss. He
12. Case painless lymphadenopathy in anterior axilla and anterior cervical as well as supraclavicular areas bilaterally. Lymph
13. Differential Diagnosis Lymphoma Infection Cancer—metastatic Granulomatous disease
14. Anemia- Signs/Symptoms Dyspnea on exertion Palpitations Angina pectoris Intermittent claudication Headache Syncope anorexia Dizziness/vertigo Nausea Cold
15. Anemia Blood loss Hemolysis/sequestration Deficiencies Decreased production
16. Symptoms Symptoms based on acuity of HgB drop Acute blood loss usually creates rapid onset of
17. Anemia of Acute Blood Loss Trauma or GI tract loss most common Menstrual/vaginal loss Urinary tract
18. Hemolysis and Sequestration Causes for hemolytic anemias include: Autoimmune Drug induced Cell membrane disorders Hereditary Splenomegaly
19. Scleral Icterus Yellow sclera Can be seen in hemolysis
20. Deficiencies Iron deficiency anemia is most common worldwide and in US-spoon nails and pica Megaloblastic anemias
21. Koilonychia (spoon nails)
22. Smooth Tongue/Glossitis
23. Signs and Symptoms of Coagulation Disorders Bleeding Ecchymoses Petechiae Hemarthroses Hematomas
24. Platelets versus Coags Petechiae—platelets low or dysfunctional Ecchymoses, hematomas, hemarthroses—seen more frequently with low clotting factors
25. Petechiae
26. Purpura
27. Hemarthrosis
28. Hematoma
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Objectives
Student should be able to …
describe location, size, consistency, and other

attributes of lymphadenopathy
identify common clinical scenarios involving lymphadenopathy
identify the signs and symptoms of anemia
define the signs and symptoms of bleeding and coagulation disorders

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Overview
This is a short lecture!
A major goal is to synthesize the

lymphatic system as a whole…lymph node regions have been discussed individually by specific site…i.e., head, neck, and abdomen, but not put together for systemic illness such as lymphoma.
We will also discuss the signs and symptoms of anemias, leukemias, bleeding disorders, and coagulation disorders

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Lymphatic System

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Lymph Node Examination
Head/neck
Axillary
Inguinal/femoral

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Head and Neck Nodes
Preauricular
Posterior auricular
Occipital
Tonsillar
Submandibular
Submental
Superficial cervical
Posterior cervical
Deep cervical
Supraclavicular

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Axillary
A pectoral (anterior)
L lateral
P posterior
C central
Ap apical

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Inguinal/ Femoral
Horizontal group
Vertical group

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Descriptors of Lymphadenopathy
Location…obvious
Mobility
Size
Texture
Shape
Tender/non-tender
Associated erythema or warmth…signs of inflammation

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Spleen
Left upper quadrant
Palpation most specific for detecting enlarged spleen (89-99% specificity)
Spleen

palpable to umbilicus is suggestive of hematologic pathology
Percussion is non-sensitive (dullness in Traube’s space) but can be specific in non-obese patients

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Case
28 yo man presents with c/o fevers, night sweats and 30

pound weight loss. He develops pruritis when he showers. He also has noted some enlarged “glands” in his neck and armpits. On lymphatic exam he has the following:

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Case
painless lymphadenopathy in anterior axilla and anterior cervical as well as

supraclavicular areas bilaterally.
Lymph nodes are not tender, freely mobile and no associated inflammation. They are ovoid (grape-shaped) and measure 2 x 3 cm. There is no splenomegaly by palpation or percussion.

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Differential Diagnosis
Lymphoma
Infection
Cancer—metastatic
Granulomatous disease

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Anemia- Signs/Symptoms
Dyspnea on exertion
Palpitations
Angina pectoris
Intermittent claudication
Headache
Syncope
anorexia
Dizziness/vertigo
Nausea
Cold intolerance
Amenorrhea
Decrease libido/impotence

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Anemia
Blood loss
Hemolysis/sequestration
Deficiencies
Decreased production

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Symptoms
Symptoms based on acuity of HgB drop
Acute blood loss usually

creates rapid onset of symptoms
Slow drop in HgB may lead to fewer symptoms

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Anemia of Acute Blood Loss
Trauma or GI tract loss most common
Menstrual/vaginal

loss
Urinary tract
Nosebleeds leading to anemia, but not because of it!
Tachycardia and hypotension are common findings
History helps the most for these

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Hemolysis and Sequestration
Causes for hemolytic anemias include:
Autoimmune
Drug induced
Cell membrane disorders
Hereditary
Splenomegaly can

lead to sequestration of blood cells

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Scleral Icterus
Yellow sclera
Can be seen in hemolysis

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Deficiencies
Iron deficiency anemia is most common worldwide and in US-spoon nails

and pica
Megaloblastic anemias caused by B12 or folate deficiencies-paresthesias and diarrhea
Smooth tongue/glossitis

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Koilonychia (spoon nails)

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Smooth Tongue/Glossitis

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Signs and Symptoms of Coagulation Disorders
Bleeding
Ecchymoses
Petechiae
Hemarthroses
Hematomas

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Platelets versus Coags
Petechiae—platelets low or dysfunctional
Ecchymoses, hematomas, hemarthroses—seen more frequently with

low clotting factors or dysfunction
Bleeding can be seen with either

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Petechiae

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Purpura

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Hemarthrosis

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Lymphatic/Hematopoetic System IPM 2

Содержание

ObjectivesStudent should be able to …describe location, size, consistency, and other

OverviewThis is a short lecture!A major goal is to synthesize the

Lymphatic System

Lymph Node ExaminationHead/neckAxillaryInguinal/femoral

Head and Neck NodesPreauricularPosterior auricularOccipitalTonsillarSubmandibularSubmentalSuperficial cervicalPosterior cervicalDeep cervicalSupraclavicular

AxillaryA pectoral (anterior) L lateral P posterior C central Ap apical

Inguinal/ FemoralHorizontal groupVertical group

Descriptors of LymphadenopathyLocation…obviousMobilitySizeTextureShapeTender/non-tenderAssociated erythema or warmth…signs of inflammation

SpleenLeft upper quadrantPalpation most specific for detecting enlarged spleen (89-99% specificity)Spleen

Case28 yo man presents with c/o fevers, night sweats and 30

Casepainless lymphadenopathy in anterior axilla and anterior cervical as well as

Differential DiagnosisLymphomaInfectionCancer—metastaticGranulomatous disease

Anemia- Signs/SymptomsDyspnea on exertionPalpitationsAngina pectorisIntermittent claudicationHeadacheSyncopeanorexiaDizziness/vertigoNauseaCold intoleranceAmenorrheaDecrease libido/impotence

AnemiaBlood lossHemolysis/sequestrationDeficienciesDecreased production

Symptoms Symptoms based on acuity of HgB dropAcute blood loss usually

Anemia of Acute Blood LossTrauma or GI tract loss most commonMenstrual/vaginal

Hemolysis and SequestrationCauses for hemolytic anemias include:AutoimmuneDrug inducedCell membrane disordersHereditarySplenomegaly can

Scleral IcterusYellow scleraCan be seen in hemolysis

DeficienciesIron deficiency anemia is most common worldwide and in US-spoon nails