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Heme/Genetics > PhysDi - Heme/Lymph Disorders > Flashcards

PhysDi - Heme/Lymph Disorders Flashcards

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1
Q

Facts about lymphatic system

A
  • 3% of total body weight

- every tissue supplied by blood has lymph vessels except placenta and brain

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2
Q

Role of lymphatics in human body

A
  • movement of lymph fluid
  • production of lymphocytes
  • production of Abs
  • phagocytosis
  • absorption of fat
  • 2nd line manufacturing of blood
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3
Q

lymph fluid

A
  • Clear, sometimes yellow-tinged fluid

- Contains variety of WBCs, rarely RBC

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4
Q

lymph ducts

A
  • intimately related to cardiovascular system
  • closed circuit
  • no built in pumping mechanism, sluggish movement
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5
Q

lymphocytes

A
  • formed by lymph nodes, tonsils, adenoids, spleen, but primarily bone marrow
  • differentiation takes place in thymus
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6
Q

lymph nodes

A
  • occur in groups

- over 600 nodes in body

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7
Q

superficial nodes

A
  • subQ conntective tissues
  • gateway to assessing health
  • readily accessible
  • provide early clues to infection or malignancy
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8
Q

deeper nodes

A

beneath the fascia of muscles and w/i body cavities

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9
Q

Disorders cause what 3 physical signs in the lymphatics?

A
  1. palpable lymph nodes (lymphadenopathy)
  2. red streaks in the skin from superficial lymphangitis
  3. lymphedema
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10
Q

bubos

A

lymphadenopathy caused by the black plague

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11
Q

spleen

A
  • LUQ
  • highly vascular
  • stores RBCs
  • important site for blood filtering w/ macrophages
  • forms blood early in life
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12
Q

What is the spleen made of?

A
  • white pulp: lymph nodules and tissue

- red pulp: venous sinusoids

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13
Q

tonsils

A
  • organized as follicles and crypts covered by mucous membrane
  • small, diamond shaped
  • lie b/w the palatine arches
  • made of lymphoid tissue
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14
Q

adenoids

A
  • “pharyngeal tonsils”
  • located in the nasopharyngeal border
  • can obstruct nasopharyngeal passageway when enlarged
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15
Q

thymus

A
  • located in superior mediastinum
  • vital in early childhood while immune system is developing
  • site for T cell production
  • no function in adulthood
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16
Q

peyer patches

A
  • small, raised areas of lymph tissue on mucosa of the small intestine
  • made of clusters of lymphoid nodules
  • aka GALT: gut associated lymphoid tissue
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17
Q

acute lymphangitis

A
  • inflammation/infection of lymphatic channels or vessels
  • occurs when viruses or bacteria invade the vessels of your lymph system
  • typically through infected cut or wound
  • usually strep or staph
  • rarely non infectious cause like malignancy
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18
Q

sx of acute lymphangitis

A
  • chills
  • moderate lymph nodes swelling and pain
  • +/- fever
  • +/- red streaking from wound to nearest lymph
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19
Q

diagnosis of acute lymphangitis

A
  • physical exam
  • can biopsy wound
  • blood cultures
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20
Q

Tx of acute lymphangitis

A
  • abx (IV or oral)
  • pain meds
  • anit-inflammatories
  • surgery or debridement
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21
Q

complications of acute lymphangitis

A
  • cellulitis
  • bacteremia
  • sepsis
  • abscess
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22
Q

acute suppurative lymphadenitis

A

-bacterial infection of the lymph nodes w/ pus formation

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23
Q

most common causative organism and more rare causes of acute suppurative lymphadenitis

A
  • most common: group A strep

- others: cat scratch disease, TB

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24
Q

Sx of acute suppurative lymphadenitis

Study These Flashcards
A
  • fever
  • moderate lymph node swelling and pain
  • overlying skin erythema and tenderness
  • lymph node feels rubbery if abscess has formed
25
aquired lymphadema
- trauma to ducts of regional nodes OR sometimes infection - axillary, inguinal - from surgery or metastases - does NOT pit
26
congenital lymphadema
- hypoplasia/maldevelopment - at birth - legs/feet
27
S/S of lymphadema
- Swelling - Feeling of heaviness/tightness - Restricted ROM - Aching or discomfort - Recurring infections - Hardening or thickening of skin (fibrosis)
28
diagnosis of lymphadema
-if not obvious reasons like surgery, may order MRI, CT, or doppler US
29
Tx of lymphadema
- no cure - exercises - wrapping of limb - massage - compression garments
30
elephantiasis
- massive accumulation of lymphadema throughout the body | - caused by filarial worm infection that obsructs the lymphatics and prevents drainage
31
hematologic and lymphatic patient history
- all symptoms that a patient could present with overlap with other systems - ex: bleeding, fatigue, malaise, fever, blood in stool, etc. etc.
32
heme/lymph PMH
- autoimmune disease - transfusions - thyroid disease - chronic kidney disease - celiacs - cirrhosis - splenomegaly - cancer - chronic pancreatitis
33
heme/lymph past surgical hx
- gastric bypass - gastrectomy - mechanical heart valve - small bowel resection
34
heme/lymph social hx
- diet restrictions - vegan - drug use - alcohol use - exposure to toxic substances
35
heme/lymph family hx
- anemia - celiacs - pernicious anemia - autoimmune disease - ethnicity
36
neck ROS
- swelling - lumps - goiter - pain - limitation of movement
37
hematologic ROS
- anemia - petechiae - purpura - easy bruising/bleeding - epistaxis - past transfusions and any reactions - lymphadenopathy
38
physical exam for hematologic patient
- skin: pallor - HEENOT: smooth tongue, pale conjunctiva - Neck/lymph exam - musculoskeletal: TTP at sternum, anterior tibia - abdomen: hepatosplenomegaly, rectal exam for occult blood - neuro: peripheral neuropathy, decreased sensation
39
dematologic exam for hematologic patient
- petechiae - purpura - pallor: mucous membranes, nail beds, conjunctiva, palmar skin creases - jaundice - nails - koilonychias - mouth: angular chelitis - lower extremity ulcers
40
HEENOT exam for hematologic patient
- skin: pale - eyes: pallor of conjunctiva - Mouth: smooth and beefy red tongue, atrophic tongue, adequate teeth
41
cardio exam for the hematologic patient
- forceful heartbeat - strong peripheral pulses - tachycardia - systolic flow murmur - high output heart failure (severe anemia) - 4th heart sounds
42
exam of lymph nodes in the extremities
- axillary: feel up, down, front and back (box method) - epitrochlear: just above funny bone - inguinal: groin - popliteal: behind knee
43
general tips for exam of lymph nodes
- can use inspection and palpation - use pads of fingers 2, 3, 4 - dorsum of hand for temp - measuring device - gloves if needed - gown and cover patient - room at comfortable temp
44
appearance of normal lymph nodes
- round/oval and smooth | - easily palpable not generally found in healthy adults
45
abnormal lymph nodes indications
- more tender = more likely d/t inflammation - cancerous nodes usually NOT tender - harder the node and more discreet, more likely a malignancy - palpable subraclavicular node on left = BAD
46
What to not if nodes are palpable
- number - consistency - discrete or matted - location - mobility - tenderness - size - warmth - color of overlying skin
47
Nine S's of a "lump"
- size - shape - surface characteristics - site - symptoms - squeezability - spread - sensations - symmetry
48
exam for supraclavicular nodes
- probe deeply in angle formed by clavicle and sternocleidomastoid - NEVER a normal finding - Virchow's node
49
anterior (pectoral) group of axillary nodes
- at lower part of pec minor | - receive lymph fluid from breasts and upper abdomen
50
posterior (subscapular) group of axillary nodes
-located at lower region of armpits rear wall
51
lateral (brachial) group of axillary nodes
- situated medially and horizontally to the side of the posterior group - receive lymph from the arms
52
central group of axillary nodes
- b/w lateral and posterior group | - receives lymph from anterior, posterior, and lateral groups and passes it to the apical group
53
apical group of axillary nodes
- found at upper part of pec minor | - collects lymph from all other axillary nodes
54
general tips for exam of axillary lymph nodes
- more firm deliberate touch (less ticklish) - support the patient's forearm w/ your contralateral arm - touch bare skin - gown pt - warm hands and room
55
how to examine the axillary lymph nodes
- pt is seated - palpate w/ contralateral hand - support pts wrist and elevate their arm - place hand in axilla w/ fingers together and palm toward chest wall - firmly rake fingers along thoracic cage to feel for nodes
56
epitrochlear node exam
support elbow in one hand as you explore w/ the other
57
inguinal node exam
- have pt lie supine w/ knee slightly flexed - palate at and just below inguinal ligament then distally along course of greater saphenous vein - drainage from scrotum/penis (not testes) and vulva/lower third of vagina
58
popliteal node exam
- palpate posterior knee | - rare to find abnormalities

Heme/Genetics (15 decks)

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