Flashcards in Lecture 3 - Cervical Lymph Nodes And Neck Lumps Deck (57)
An enlarged lymph node may signal what?
Disease in the area it drains
Lymph nodes can be organised into two groups. What are they?
Lymph nodes can be organised into regional (or superficial) and terminal (or deep) groups.
Give some examples of regional/superficial lymph nodes in the head and neck.
In the area of the head and neck there are several regional groups, such as the occipital, post auricular (also called retroauricular or mastoid nodes), and submandibular nodes.
What do regional lymph nodes do?
Regional lymph nodes drain specific areas and, in the head and neck region, lie superficially within the superficial cervical fascia. So they can be readily palpated when enlarged.
What do the terminal/deep lymph nodes do?
Terminal lymph nodes lie within the neck, deep to the investing layer of cervical fascia. They are collectively called the deep cervical nodes, and they receive all the lymph from the head and neck, including lymph drained first via the regional groups.
Which structures drain into the deep cervical lymph nodes?
Deep tissues of the neck (e.g. larynx, thyroid gland) will drain directly to deep cervical lymph nodes.
Pathology in these structures may first present as an enlarged deep cervical node (e.g. laryngeal cancer).
What are the deep revival lymph nodes closely related to?
The carotid sheath and in particular to the IJV.
Give some examples of deep cervical lymph nodes.
Where is the jugulo-digastric lymph node and what does it drain? When might it become enlarged?
The jugulo- digatric node (also called the tonsillar node) is located just below and behind the angle of the mandible and is concerned with lymph drainage of the palatine tonsil, oral cavity and the tongue.
It is often swollen and tender in tonsillitis and can also become enlarged in cancers affecting the structures it drains.
What does the jugulo-omohyoid lymph node drain? When might it become enlarged?
The jugulo-omohyoid node is mainly associated with the lymph drainage of the tongue, oral cavity, trachea, oesophagus and the thyroid gland.
Infection or disease affecting these structures may therefore present with an enlarged jugulo-omohyoid lymph node.
Where are the supraclavicular cervical lymph nodes and what do they drain? When may they become enlarged?
Found in the root of the neck on either side.
They drain lymph from the abdomen and thorax and drain via the thoracic duct into the venous circulation.
These lymph nodes can enlarge in the late stages of malignancies of the abdomen and thorax.
What is a lymphadenopathy?
A collection of enlarged lymph nodes
What are the roles of the lymphatic system?
1) remove excess fluid from the interstitial space (remember form Body Logistics - begin with 20L, left with 17- need to recover 3L lost to interstitium)
2) returns small proteins (including pathogens) and fluid that leaked from capillaries
3) key role in immune defence and surveillance
- Physical and phagocytic barrier - phagocytes mount an immune response against pathogens and prevent them from travelling further, entering the blood
- Source of lymphocytes
What are the clinical manifestations of disease involving the lymphatic system?
2) Lymphadenopathy: swollen lymph node(s) due to infection or malignancy (primary and secondary)
What are the features of a lymph node?
- Physical filter
- Phagocytic filter
- Full of lymphocytes (T & B) cells): Activate and proliferate in response to antigens
Then swell and enlarge
Lymph nodes have how many afferent vessels compare to efferent vessels?
A number of afferent vessels whereas only a singe efferent vessel.
Why does fluid slow down as it enters a lymph node and what happens in the lymph node if there are pathogens present?
All substances transported in lymph pass through ≥ 1 lymph node
• Fluid slows down as it goes through lymph node because it allows for time to filter particular connective tissues
• Phagocytes can then phagocytose and lymphocytes can be activated
• Activation and proliferation of lymphocytes - causes lymph nodes to swell
Pathogens include: bacteria, viruses, malignant cells...
What are the specific regions in body where collections of lymph nodes may be palpable?
Where are most of the body’s lymph nodes found?
Nearly ½ of all the body’s lymph nodes are found in the neck
What are the main causes of enlarged lymph nodes?
Infection (most common - particularly in children)
What are the features of an enlarged lymph node caused by infection and what is usually revealed in the history?
- doesn’t feel fixed to tissues
- recent history of cold/cough
What are the features of an enlarged lymph node caused by malignancy and what is usually revealed in the history, including red flag symptoms?
- hard, matted (stuck to something), non-tender
— tethered as if it has invaded the subcutaneous tissue
- rubbery, mobile, fast-growing
— lymphoma can commonly present as enlarged lymph nodes in the front or lateral aspect of the neck
• short history of enlargement - growth of the lymph node was rapid
• weight loss (not seen in infective lymph nodes, unless it’s associated with candida/TB/any other HIV associated infection)
• night sweats
If a lymph node is found to be enlarged, what should you do?
• take a comprehensive history
• Examine the area of tissue it drains
• If systemic disease/malignancy suspected examine other lymph nodes and body systems
Where are the superficial and deep cervical lymph nodes found?
Superficial cervical lymph nodes are found in the superficial fascia beneath the skin
Deep cervical lymph nodes are found within the investing layer of the deep cervical fascia
Many deep cervical lymph nodes are associated with the route of the IJV in the carotid sheath in the neck
Superficial lymph nodes eventually drain into the deep lymph nodes
Which cervical lymph nodes are more readily palpable?
The superficial ones although sometimes the deep ones can be palpated too.
However, a palpable lymph node may be normal for some people so history of it is important
What are the 8 important superficial lymph nodes draining the face, scalp and neck?
- posterior cervical
- anterior cervical
The superficial nodes in the neck,
are associated with route of EJV or AJV
They are found in the subcutaneous fascia underneath the skin
The superficial lymph nodes can be readily palpable, sometimes even in health (!) but especially if become even slightly enlarged. What structure do the superficial lymph nodes form around the base of the head?
Which structures do the superficial lymph nodes drain?
• Occipital drains back of scalp
• Post-auricular - drains behind ear and lateral scalp
• Pre-auricular - also drains eye - conjunctivitis/any other infection of the eye - would have palpable preauricular lymph node
• Submandibular - drains rest of face
— Swelling under chin (enlarged submental or submandibular lymph nodes), look inside px’s mouth - on tongue and under tongue
If a patient has enlarged pre- or postauricular lymph nodes but nothing seems to be wrong it’s their face, scalp or eyes, then where should you look?
Should examine/look inside their ears