STUDY - Technical - New Dacian's Medicine
Lymphadenopathy
(Classical / Allopathic Medicine)
Lymphadenopathy -
enlargement of one or more lymph nodes - may result from
increased production of lymphocytes or reticuloendothelial
cells or from infiltration of cells that aren't normally
present. This sign may be generalized (involving three or more
node groups) or localized. Generalized lymphadenopathy may be
caused by an inflammatory process, such as bacterial or viral
infection; connective tissue disease; endocrine disorder; or
neoplasm. Localized lymphadenopathy usually results from
infection or trauma affecting the drained area. (See Causes of
localized lymphadenopathy.)
Normally, lymph
nodes range from ¼″ to 1″ (0.5 to 2.5 cm) in diameter and are
discrete, mobile, nontender and, except in children,
nonpalpable. (However, palpable nodes may be normal in
adults.) Nodes that exceed 11/8″ (3 cm) in diameter are cause
for concern. They may be tender, and the skin overlying the
lymph node may be erythematous, suggesting a draining lesion.
Or they may be hard and fixed, tender or nontender, suggesting
a malignant tumor. Assess the patient for unilateral versus
bilateral areas of lymphadenopathy.
Causes of
localized lymphadenopathy
Various disorders can cause localized lymphadenopathy, but this sign usually results from infection or trauma affecting the drained area. Here you'll find some common causes of lymphadenopathy listed according to the areas affected.
Various disorders can cause localized lymphadenopathy, but this sign usually results from infection or trauma affecting the drained area. Here you'll find some common causes of lymphadenopathy listed according to the areas affected.
Auricular:
Erysipelas; Herpes zoster ophthalmicus; Infection; Rubella;
Squamous cell carcinoma; Styes or chalazion; Tularemia
Axillary: Breast
cancer; Lymphoma; Mastitis
Cervical:
Cat-scratch fever; Facial or oral cancer; Infection;
Mononucleosis; Mucocutaneous lymph node syndrome; Rubella;
Rubeola; Thyrotoxicosis; Tonsillitis; Tuberculosis; Varicella
Inguinal and
femoral: Carcinoma; Chancroid; Lymphogranuloma venereum;
Syphilis
Occipital:
Roseola; Scalp infection; Seborrheic dermatitis; Tick bite;
Tinea capitis
Popliteal:
Infection
Submaxillary and
submental: Cystic fibrosis; Dental infection; Gingivitis;
Glossitis
Supraclavicular:
Neoplastic disease
HISTORY:
Ask the patient when he first noticed the swelling and if it's located on one side of his body or both.
Review the patient's medical history for recent infection and other health problems. If a biopsy has ever been performed on one of the patient's lymph nodes, check to see if it revealed previously diagnosed cancer. Also, ask the patient if there's a family history of cancer.
Ask the patient when he first noticed the swelling and if it's located on one side of his body or both.
Review the patient's medical history for recent infection and other health problems. If a biopsy has ever been performed on one of the patient's lymph nodes, check to see if it revealed previously diagnosed cancer. Also, ask the patient if there's a family history of cancer.
PHYSICAL
ASSESSMENT:
Palpate the entire lymph node system to determine the extent of lymphadenopathy and to detect other areas of local enlargement. Use the pads of your index and middle fingers to move the skin over underlying tissues at the nodal area.
If you detect enlarged nodes, note their size in centimeters and whether they're fixed or mobile, tender or nontender, erythematous or nonerythematous, and tender or rough. Is the node discrete or does the area feel matted?
If you detect tender, erythematous lymph nodes, check the area drained by that part of the lymph system for signs of infection, such as erythema and swelling. Also, palpate for and percuss the spleen.
Palpate the entire lymph node system to determine the extent of lymphadenopathy and to detect other areas of local enlargement. Use the pads of your index and middle fingers to move the skin over underlying tissues at the nodal area.
If you detect enlarged nodes, note their size in centimeters and whether they're fixed or mobile, tender or nontender, erythematous or nonerythematous, and tender or rough. Is the node discrete or does the area feel matted?
If you detect tender, erythematous lymph nodes, check the area drained by that part of the lymph system for signs of infection, such as erythema and swelling. Also, palpate for and percuss the spleen.
SPECIAL
CONSIDERATIONS:
Expect to obtain blood for routine blood work, platelet count, and liver and renal function studies. If tests reveal infection, check your facility's policy regarding infection control.
Expect to obtain blood for routine blood work, platelet count, and liver and renal function studies. If tests reveal infection, check your facility's policy regarding infection control.
PEDIATRIC
POINTERS:
Infection is the most common cause of lymphadenopathy in children. The condition is commonly associated with otitis media and pharyngitis.
Infection is the most common cause of lymphadenopathy in children. The condition is commonly associated with otitis media and pharyngitis.
PATIENT
COUNSELING:
Tell the patient that a fever under 101° F (38.3° C) may assist recovery and shouldn't be treated with an antipyretic, unless he's very uncomfortable. Advise him to try and soothe the fever with tepid baths.
Tell the patient that a fever under 101° F (38.3° C) may assist recovery and shouldn't be treated with an antipyretic, unless he's very uncomfortable. Advise him to try and soothe the fever with tepid baths.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common symptoms,
Edition V, McGraw - Hill, 2002.