LYMPH NODES

Peripheral lymph nodes - round or oval formation of various sizes, usually located at the
confluence of lymphatic vessels. Lymph nodes - part of the lymphatic system, which is
carried out through the drainage of certain anatomical zones. Lymph nodes serve barrier
and immune function.

Anatomic and physiologic features LYMPH NODES

Final formation of the lymph nodes occurs in the postnatal period. Newborn capsule of
lymph nodes is very thin and delicate, trabeculae and underdeveloped. Lymph nodes are
small, soft consistency, so they palpation is difficult. The size and number of lymph nodes
are increased by the end of the first six months of life. In newborns and children during the
first years of life, lymph nodes have a characteristic pattern chetkoobrazny due to
constrictions in the area are not fully formed valves.

By 1 year of life, lymph nodes can already be palpated in most children. Along with a
gradual increase in the volume they undergo further differentiation.

By 3 years of life thin connective tissue capsule is well defined, has slowly sprawling
reticular cells. By 7.8 years in the lymph node with marked reticular stroma gradually
begin to form trabeculae which grow in certain directions, forming the skeleton of the
site. By 12-13 years of lymph node has a complete structure: well-developed connective
tissue capsule, trabeculae, follicles, narrower sinuses and less abundant reticulum, mature
valve apparatus. In children, the lymph nodes, adjacent, interconnected by numerous
lymphatic vessels.

During puberty, the growth of lymph nodes stops, they partially regress. Maximum number
of lymph nodes numbered in 10 years. In the adult human total more than 400 lymph
nodes, their mass is about 1% of body weight (500-1000 g).

The reaction of the lymph nodes at various (mostly infectious) agents identify children
from the 3rd month of life. In 1-2 years the barrier function of lymph nodes is low, which
explains the frequent in this age of generalization of infection.
3-3029

In the preschool period, lymph nodes may already serve as a mechanical barrier and
respond to the presence of pathogens of infectious diseases inflammatory
reaction. Children this age often appear lymphadenitis, including abscesses and kazeoz-
WIDE (tuberculosis).
For 7.8 years it is possible to suppress infection within the lymph node. At this age and in
older children, the pathogens enter the lymph nodes, but not fester or other specific
changes.

The following groups are available palpation of peripheral lymph nodes (the first 7 groups
listed below the union -

Fig. 2-9. Cervical lymph nodes: 1 - over- P A common name clavicular 2 - zadnesheynye 3 -
occipital; "cervical lymph 4 - mastoid 5 - genial, 6 - sub-assemblies, Fig. 2-9). Mandibular; 7 -
front surface i. occipital, located-Shein. zhennye on the hills zaty -

bone alkaline; collect lymph from the scalp and back of the neck.

2. Mastoid, located behind the ears in the mastoid process, and parotid localized in front of
the ear of the parotid salivary gland, lymph collected from the middle ear, the skin
surrounding the ear, ears and ear canal.

3. Wharton, located under the branches of the lower jaw; collect lymph from the skin and
mucous membrane of the gums.

4. Chin (usually one on each side) collect lymph from the skin of the lower lip, gums and
mucosa of the lower incisors.

5. Anterior, located anterior to t. stemocleidomastoideus, mainly in the upper cervical

triangle; collect lymph from the skin of the person from the parotid gland, the mucous
membranes of the nose, throat and mouth.

6. Zadnesheynye, located on the trailing edge so sternocleidomastoideus and before the

trapezius muscle, mainly in the lower cervical triangle; collect lymph from the skin of the
neck and part of the larynx.

7. Supraclavicular, located in the supraclavicular pits; collect lymph from the skin of the
upper part of the breast, esophagus, and the tops of the lungs.

8. Subclavian, located in the subclavian areas; collect lymph from the skin of the chest and
pleura.

9. Underarm, located in the axillary pits; collect lymph from the skin of the upper
extremities, except for III, IV, V fingers and the inner surface of the brush.

10. Thoracic located medially on lin. axillaris anterior under the bottom edge so
pectoralis major, collect lymph from the skin of the chest, the parietal pleura, partly from
the lungs and breast.
11. Elbow, or kubitalnye located in the sulcus bicipitalis (groove of the biceps muscle);
collect lymph from the skin III, IV, V fingers and the inner surface of the brush.

12. Inguinal, situated along the inguinal ligament; collect lymph from the skin of the lower
extremities, lower abdomen, buttocks, perineum, from the genitals and anus.

13. Popliteal, located in the popliteal fossa; collect lymph from the skin of the foot.

Knowing the location of lymph nodes and the direction of lymphatic vessels, and the
resulting efferent lymph, helps to define the entrance gate and the source of infection focal
lesions, as well as on-site implementation of the pathological agent, sometimes do not
detect any changes, while the regional lymph nodes are enlarged and painful.

MATERIALS AND METHODS

Inquiries and examination

A child or his parents can express themselves to notice swollen lymph nodes, with
lymphadenitis may complain of pain, the appearance of swelling or redness in the location
of lymph nodes.

On examination can detect only a considerably enlarged, superficial lymph nodes. When
lymphadenitis reveal flushing skin and subcutaneous adipose tissue swelling over the
inflamed lymph node.

Palpation

On palpation of lymph nodes draw attention to the following parameters.

* The quantity (normally the diameter of the lymph nodes does not exceed 0.5 cm, ie larger
than a pea). Distinguish the following amounts of lymph nodes: a millet grain (I degree),
lentils (II degree), pea (III degree), Bob (IV degree), hazelnut (V degree), a pigeon's egg

(VI degree). Swollen lymph nodes may be symmetrical, widespread or isolated and reach
such a degree that they become visible during the inspection.

Number (no more than three palpable nodes in the group - single lymph node, more than
three - plural).

Consistency (soft, elastic, thick), largely depending on the pathology of old, with chronic
course of the process nodes are dense, in the acute phase - soft.

Mobility (normal nodes are mobile).

 Relation to the skin, subcutaneous fat and with each other (in the norm are not soldered).

The sensitivity and tenderness to palpation (normal sensitive and painless), indicating an
acute inflammatory process. Palpation of symmetric groups of lymph nodes (except

elbow) produced simultaneously with both hands. Normally healthy children can be
palpated no more than three groups of lymph nodes (cervical, axillary, inguinal). Normally,
no palpable chin, over-and subclavian, thoracic, kubitalnye and popliteal lymph
nodes. Status of lymph nodes are normal if they are smaller than a pea, single, soft-elastic
consistency, mobile, not soldered to the skin and between themselves, painless.

In a clinical study of lymph nodes, if necessary, more accurate diagnosis of the nature of
their defeat perform puncture, biopsy and lymphography.

TERMINOLOGY and semiotics LYMPH NODES

Poliadeniya - increasing the number of lymph nodes.

Lymphadenopathy - enlargement of lymph nodes observed in infectious, inflammatory

and neoplastic processes. It is possible to increase both due to reactive hyperplasia as a
result of the immune response to infection, and as a result of the involvement of lymph
nodes directly into the tumor or inflammatory process.

Lymphadenitis - inflammation of the lymph node, manifesting tenderness to palpation,

swelling of surrounding tissues (periadenitom) and reddening of the skin over it. Nodes
themselves are thick, and when purulent fusion fluctuating. In engaging in the process of
surrounding subcutaneous tissue develops phlegmonous adenitis. Lymphadenitis may be
either acute or chronic, local or diffuse, caused by general disease or local infection. If
regional lymphadenitis developed due to the inflammatory focus in the underlying
Department of limbs, then on her skin is sometimes possible to find a narrow strip of
hyperemia (lymphangitis), coming from the site of inflammation to the site.

Violation displaceability lymph node occurs when inflammation and its cohesion with the
underlying tissues, as well as during germination in his tumor.

Local (Regionarnoe) enlarged lymph nodes noted in purulent skin processes: folliculitis,
pyoderma, furunculosis, multiple miliary abscesses, infected wound, hydradenitis etc.

When angina, diphtheria and scarlet fever reveal an increase in morbidity and anterior
lymph nodes.

For rubella is characterized by a significant increase in morbidity and occipital lymph

nodes.

"When mumps in the first place increasing prootic lymph nodes.

 Cat scratch disease (felinoz) is accompanied by long-continued reaction kubitalnyh or
axillary lymph nodes.

Tuberculosis peripheral lymph nodes most likely to occur in the cervical group. In this
case, the nodes represent a significant size, dense, smooth package with a tendency to
caseous disintegration and the formation of fistulas, after which the remains uneven
sunken scars. Nodes are welded together, with the skin and subcutaneous tissue. Similar
changes were observed when aktinomikoznom lymphadenitis.

Noncommunicable diseases, such as lymphosarcoma, clinically can manifest increase of

one group of lymph nodes (cervical or supraclavicular). In this case nodes are usually very
dense, painless, without local inflammatory changes.

Generalized lymphadenopathy occurs in many infectious and noncommunicable

diseases, but some of them have certain diagnostically important features.

Generalized lymphadenopathy - a typical and early signs of HIV infection. Lymph nodes
with moderate density, sensitive or slightly painful to palpation, not soldered to each other
and with surrounding tissues, have smooth contours.

With infectious mononucleosis increases all groups of lymph nodes, but most significantly
- zadnesheynye. They are often seen during the inspection, especially when turning the
head to the side. Lymphostasis possible development and the appearance of puffiness face.

When measles occurs generalized lymphadenopathy, relate more to the neck, occipital
and axillary lymph nodes.

For adenoviral infection, and parainfluenza moderately increased zadnesheynye, anterior

and occipital lymph nodes.

In chronic tuberculous intoxication palpable almost all groups of lymph nodes, they are
multiple, small and dense ( "pebbles").

In toxoplasmosis lymph nodes (usually cervical, axillary and inguinal) increased to the
size of a hazelnut, sometimes form packs, but they can be palpated each lymph node. The
nodes in this disease painless and not suppurate.

When plague and tularemia is significant increase in the lymph nodes in the form of large
conglomerates - bubo, soldered with a bright hyper-peremirovannoy and hot skin.

Lymphogranulomatosis usually begins with the increase in individual groups of

peripheral lymph nodes, most cervical and submandibular. Gradually, lymph nodes
increase and merge into large conglomerates. Their elastic consistency, the number
increased, there is no pain, to touch, they resemble "a sack of potatoes. Decisive importance
in the differential diagnosis is a histological study of biopsies of enlarged lymph nodes and
detection of them Berezovsky-Sternberg cells.

In acute lymphoblastic leukemia lymph nodes in all groups are increasing rapidly in size,
are juicy and painless.