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Surgery: Vascular > 3) Lymphatic > Flashcards

3) Lymphatic Flashcards

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1
Q

What is the definition of the lymphatic system’s role in fluid management?

A

Uptake, transportation, & return of fluid, foreign substances & macromolecules from the interstitial space to the systemic circulation.

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2
Q

What is the protective function of the lymphatic system?

A

Protection of the host by a filtration system that resists infection & impedes the spread of neoplasm.

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3
Q

What is lymphadenopathy?

A

Lymph node enlargement.

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4
Q

What do T cells, B cells, cytokines, and vascular endothelial growth factor stimulate?

A

Lymphangiogenesis.

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5
Q

What are the types of inflammatory disorders in the lymphatic system?

A
  • Acute: Non-specific
  • Specific: Infectious mononucleosis
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6
Q

What are the types of lymphomas?

A
  • Hodgkin’s lymphoma
  • Non-Hodgkin’s lymphoma
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7
Q

What blood diseases are associated with the lymphatic system?

A
  • Acute leukemia
  • Chronic myeloid leukemia
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8
Q

What are some types of lipidosis related to the lymphatic system?

A
  • Gaucher’s disease
  • Niemann-Pick’s disease
  • Chronic lymphatic leukemia
  • Hand-Schuler-Christian’s disease
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9
Q

What is the definition of acute lymphangitis?

A

Inflammation of lymphatic vessels.

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10
Q

What are the characteristics of acute lymphangitis?

A
  • Non-specific
  • Specific: T.B. & syphilis
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11
Q

What is the commonest organism involved in etiology?

A

Streptococci

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12
Q

What are the general clinical manifestations of lymphadenitis?

A

Fever, rigors & general constitutional disturbances

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13
Q

What are the local signs of lymphadenitis?

A

Pain, edema & red tender streaks

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14
Q

What happens to regional lymph nodes in lymphadenitis?

A

They become enlarged & tender

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15
Q

What is a major complication of lymphadenitis?

A

Complete obliteration of the affected lymphatics leading to permanent edema or elephantiasis

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16
Q

What is the first step in the treatment of lymphadenitis?A)

A

Treatment of the cause

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17
Q

Which antibiotics are commonly used in treating lymphadenitis?

A

Penicillin & broad-spectrum antibiotics

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18
Q

What local treatments are recommended for lymphadenitis?

A

Local rest of the affected part & local heat to help resolution

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19
Q

What should be done if suppuration occurs in lymphadenitis?

A

An incision is needed

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20
Q

Define lymphadenitis.

A

Inflammation of lymph nodes

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21
Q

Where does lymphadenitis typically occur?

A

Along the lymphatics from inflamed focus

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22
Q

What is the pathology of acute septic lymphadenitis?

A

Lymph nodes are enlarged, congested and edematous; cut section shows leucocytic infiltration

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23
Q

What may occur in the pathology of lymphadenitis?

A

Periadenitis

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24
Q

What are the complications of lymphadenitis?

A
  1. Spread to proximal LNs
  2. Spread to nearby tissue
  3. Suppuration leading to abscess
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25
What are the characteristics of lymph nodes in acute septic lymphadenitis?
Enlarged, red, hot, tender, firm or soft; if suppuration occurs, fluctuation
26
What is the first step in the treatment of lymphadenitis?
TTT of the causative focus ## Footnote TTT refers to targeted treatment of the underlying cause of lymphadenitis.
27
What are the general treatments for lymphadenitis?
General rest & antibiotics ## Footnote Antibiotics are used to address any bacterial infection contributing to lymphadenitis.
28
What should be done if an abscess forms in lymphadenitis?
Incision & drainage ## Footnote This procedure is necessary to relieve pressure and clear the infection.
29
Is chronic nonspecific lymphadenitis clinically important?
It is very common BUT clinically non important ## Footnote Despite its prevalence, it often does not lead to significant health issues.
30
What are common sites for chronic nonspecific lymphadenitis?
Chronic nonspecific deep cervical LNs in patients with chronic tonsillitis or sinusitis, chronic nonspecific inguinal LNs in people walking barefooted ## Footnote These sites are indicative of ongoing infections in nearby regions.
31
What is a common cause of chronic nonspecific lymphadenitis?
Chronic infection of nearby focus, incomplete resolution of acute lymphadenitis ## Footnote These factors lead to persistent lymph node enlargement.
32
What is the clinical picture of chronic lymphadenitis?
Nodes are slightly enlarged, mobile, tender & firm in consistency ## Footnote These characteristics help differentiate it from other conditions.
33
What must be excluded if lymphadenitis persists for more than 3 or 4 months?
TB must be excluded ## Footnote Tuberculosis can present similarly and requires different management.
34
What are the two types of TB lymphadenitis?
1. Lymph borne (common in young) 2. Blood borne (in elderly) ## Footnote The mode of transmission affects the demographic most at risk.
35
What are the common sites for lymph-borne TB lymphadenitis?
1. Cervical LN groups (commonest) 2. Mediastinal & axillary groups (especially in children) 3. Abdominal LNs (children & adolescents) 4. Tabes mesenterica (>50y) ## Footnote Each site corresponds to the pathway of TB infection and its effects.
36
What is a common finding in x-ray for tabes mesenterica?
Multiple mottled calcific shadows of mesenteric LNs ## Footnote This indicates old TB nodes that have healed through fibrosis and calcification.
37
How do organisms reach the lymph nodes?
Through afferent lymphatics.
38
What is the first area affected in T.B. periadenitis?
The capsule.
39
What follows the capsule in the progression of T.B. infection?
The cortex.
40
What is the final area affected in T.B. infection?
The medulla.
41
What forms when multiple tubercles coalesce?
A cold abscess that may rupture.
42
What can result from a ruptured cold abscess?
T.B. sinus or ulcer.
43
What is a common local sign of lymph borne type T.B.?
Localized lymphadenopathy affecting upper deep cervical LNs.
44
How does the consistency of lymph nodes change in T.B.?
* Early: Firm * Caseation: Cystic * Calcification: Hard
45
What happens to lymph nodes in lymph borne type T.B.?
They become matted together.
46
What is the arrangement of lymph nodes in advanced lymph borne T.B.?
Beaded cords due to thickening of connecting lymphatics.
47
What is the incidence of blood borne type T.B.?
Rare.
48
What age group is usually affected by blood borne type T.B.?
Usually elderly.
49
What is a characteristic sign of blood borne type T.B.?
Generalized lymphadenopathy.
50
What is the consistency of lymph nodes in blood borne type T.B.?
Rubbery, resembling Hodgkin's lymphoma.
51
How are lymph nodes described in blood borne type T.B.?
Discrete.
52
What is caseation in the context of T.B.?
May burrow through deep fascia or muscle, causing bilocular abscess.
53
What is a cold abscess in T.B.?
Neither cold nor abscess; contains caseating material.
54
What characterizes a T.B. sinus?
Thin cyanotic undermined edges with thin serous discharge.
55
What happens if T.B. is left untreated?
It can spread to other groups of lymph nodes.
56
57
What is the purpose of a chest x-ray in the investigation of tuberculous lymphadenitis?
To identify abnormalities associated with the condition ## Footnote Chest x-ray helps visualize potential lung involvement or lymph node enlargement.
58
What does a good tuberculin test indicate?
A negative indicator for tuberculosis ## Footnote A negative tuberculin test suggests the absence of an active TB infection.
59
What is the role of biopsy in the diagnosis of tuberculous lymphadenitis?
To establish the diagnosis by examining lymph nodes ## Footnote Biopsy provides histological evidence of tuberculosis.
60
What is aspirated from a cold abscess for examination?
Microscopical pus for acid fast bacilli and PCR ## Footnote This helps confirm the presence of Mycobacterium tuberculosis.
61
What are the components of the treatment for tuberculous lymphadenitis before caseation?
Good diet & vitamins, at least 2 antituberculous drugs, surgical excision if no response ## Footnote Commonly used drugs include Rifampicin and INH.
62
What is the recommended duration for antituberculous drug therapy?
At least 9 months ## Footnote This duration is crucial for effective treatment of tuberculosis.
63
What is the purpose of aspiration and injection of streptomycin solution in treating a cold abscess?
To prevent sinus formation ## Footnote Streptomycin helps to manage the abscess and reduce the risk of complications.
64
When is surgical incision indicated in the treatment of a cold abscess?
In cases of secondary infection ## Footnote Incision may be necessary to drain infected fluid.
65
What should be done if a tuberculous sinus is resistant to conservative measures?
Excise with underlying nodes ## Footnote Surgical intervention may be required if medical treatment fails.
66
What is the definition of chronic lymphatic obstruction (lymphedema)?
Hypertrophic skin & SC tissues caused by chronic lymphatic obstruction ## Footnote Lymphedema results from impaired lymphatic drainage.
67
What are the common and rare anatomical sites affected by lymphedema?
**Common sites**: - **Lower limbs (most frequent)**, particularly post-mastectomy upper limb lymphedema. **Rare sites**: - Scrotum, external genitalia, and rarely breasts.
68
Compare the three types of primary lymphedema in terms of incidence, age of onset, sex predilection, and site involvement.
69

Surgery: Vascular (3 decks)

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