LYMPHADENOPATY

&
LYMPHADENITIS

Umar Zein
FK UISU
Medan
 LYMPHATIC SYSTEMS

consists of:

1) lymphatic vessels

2) lymphoid tissues and

lymphoid organs
 The Lymphatic System
The body has approximately 600 lymph nodes, but
only those in the submandibular, axillary or inguinal
regions may normally be palpable in healthy people.
Lymphadenopathy refers to nodes that are abnormal
in either size, consistency or number. There are
various classifications of lymphadenopathy, but a
simple and clinically useful system is to classify
lymphadenopathy as "generalized" if lymph nodes are
enlarged in two or more noncontiguous areas or
"localized" if only one area is involved.
 Distinguishing between localized and
generalized lymphadenopathy is important
in formulating a differential diagnosis.
In primary care patients with unexplained
lymphadenopathy, approximately 3/4 of
patients will present with localized
lymphadenopathy and 1/4 with generalized
lymphadenopathy.
travel along with blood
vessels.

1) lymphatic vessels
 Lymphatic vessels start
with lymphatic capillaries

lymphatic ducts

lymphatic trunks

lymphatic collecting vessels

lymphatic capillary
- blind ended vessels

- permeable to proteins even cells

The main function
- collect excess large particles and tissue fluid

lymph
Special lymph capillaries --- Lacteals

- collect digested fats ( in chylomicrons)

Valves are present to
Lymphbackflow.
prevent driven by
rhythmic contractions
Valves are present to
prevent backflow.
connection to the veins
blockage of lymph
drainage

Lymphedema

- swelling in tissues

- due to tumor pressure,

parasites, or surgery
Elephantiasis

blockage by
parasitic worms
Role of Lymph Vessels in Metastasis
 LYMPHATIC SYSTEMS

consists of:

1) lymphatic vessels

2) lymphoid tissues and

lymphoid organs
 LYMPHOID TISSUE

- diffusely located throughout body in all

organs

- contains germinal centers with dense

population of B lymphocytes

- houses macrophages

- Function: host defense

 LYMPHATIC SYSTEMS

consists of:

1) lymphatic vessels

2) lymphoid tissues and

lymphoid organs
lymphoid organs
Include: Lymph Nodes
Spleen
Thymus
Tonsils
Function:

host defense
eliminates abnormal (sick, aged, or cancerous)
cells and pathogens
lymphoid organs
Lymph Nodes

Swollen lymph nodes is caused by

expansion in theand
- Macrophages number of
lymphocytes
lymphocytes
attack microorganisms
lymphoid organs
Lymph Nodes
Spleen

- site for immune

surveillance and response
- removes debris, foreign
matter, toxins, bacteria,
viruses, old blood cells
- readily subject to rupture
from mechanical trauma
 - site of maturation of T
lymphoid organs
lymphocytes
Lymph Nodes - secretes hormones
(thymopoietin and
Spleen
thymosins)
Thymus - critical role in
childhood
lymphoid organs
Lymph Nodes
Spleen
Thymus
Tonsils

- trap and destroy bacteria

 Defenses Against Pathogens

1) Nonspecific defenses - broadly effective, no prior

exposure
1) external barriers
2) inflammation
3) fever

2) Specific defense - results from prior exposure,

protects against only a particular pathogen
immune system
 1) External Barriers

Subepithelial
Skin areolar tissue

toughness of keratin
tissue gel: viscous
barrier
dry andof nutrient-poor
hyaluronic acid

defenses: peptides
neutrophils attack microbes
hyaluronidase: enzyme
used byacid
lactic pathogens (snake
(acid mantle) is
a component
bites of toxins
and bacterial
perspiration
 1) External Barriers

Mucous membranes

stickiness of
mucus

lysozyme:
enzyme destroys
bacterial cell walls
 2) Non Specific Immunity -
Inflammation
Defensive response to
tissue injury

limits spread of pathogens,

then destroys them; removes
debris, initiates tissue repair

suffix -itis denotes

inflammation of specific
organs
 2) Inflammation

Cardinal signs
redness (erythema) caused
by hyperemia ( blood flow)
swelling (edema) caused by
capillary permeability and
filtration
heat caused by hyperemia
pain caused by inflammatory
chemicals and pressure on
nerves
 2) Inflammation

Inflammatory chemicals

- bradykinin, histamine, and

leukotrienes
- secreted by damaged cells,
mast cells, basophils,
lymphocytes, macrophages and
platelets
- stimulates vasodilation,
increases capillary permeability,
and induces pain.
 Pain
Causes
Direct injury to nerve endings
Inflammatory chemicals
Tissue swelling

Brandykinin, Prostaglandins, and bacterial toxins can

induce pain.
Brandykinin, produced from a plasma protien, is
released from basophils and mast cells

Pain is an important signal to tissue repair, as it

signals the body to rest and not further injury itself.
 3) Fever

Defense mechanism: can do more good than harm

promotes interferon activity
accelerating metabolic rate and tissue repair
inhibiting pathogen reproduction

Pyrogen (fever-producing agent):

- secreted by macrophages (endogenous) and
microorganisms (exogenous)
- stimulates anterior hypothalamus to secrete
prostaglandin E which resets body thermostat higher
 Introduction

Lymphadenopathy is defined as an
abnormality in size and consistency of
lymph nodes,while the term lymphadenitis
refers to lymphadenopathy that occurs from
infectious and other inflammatory
processes.
 Although infections are the most common
cause of lymph node enlargement,
clinicians must be aware of a broad range of
other disease processes that lead to lymph
node enlargement.
 Physical Examination
Size.
Pain/Tenderness :The presence or absence of
tenderness does not reliably differentiate benign from
malignant nodes.
Consistency: Stony-hard nodes are typically a sign of
cancer, usually metastatic. Very firm, rubbery nodes
suggest lymphoma. Softer nodes are the result of
infections or inflammatory conditions. Suppurant nodes
may be fluctuant. The term "shotty" refers to small
nodes that feel like buckshot under the skin, as found in
the cervical nodes of children with viral illnesses.
 Physical Examination
Matting : can be either benign (e.g.,
tuberculosis, sarcoidosis) or malignant (e.g.,
metastatic carcinoma or lymphomas
Location : infectious mononucleosis causes
cervical adenopathy and a number of
sexually transmitted diseases are associated
with inguinal adenopathy
 Physical Examination
Supraclavicular lymphadenopathy has the highest risk of
malignancy, estimated as 90 percent in patients older
than 40 years and 25 percent in those younger than age.
Lymphadenopathy of the right supraclavicular node is
associated with cancer in the mediastinum, lungs or
esophagus.
The left supraclavicular (Virchow's) node receives
lymphatic flow from the thorax and abdomen, and may
signal pathology in the testes, ovaries, kidneys,
pancreas, prostate, stomach or gallbladder. Although
rarely present
Lymphadenitis is the inflammation of
a lymph node.
 Lymphoid system of maxillofacial area:
1 glandula parotis; 2 nodi lymphatici occtpitales; 3 nodi lymphatici auriculares poster. 4 nodi
lymphatici cervicales profundi superiores; 5 v. jugutaris dextra; 6 nodi lymphatici : cales superficiales; 7
nodi lymphatici cervicales profundi inferiores; 8 nodi lymphatici auricu anteriorea; 9 nodi lymphatici
submaxillares; 10 nodulus lymphaticus submentalis; 11 a. ca communis dextra; 12 truncus
lymphaticus jugularis dexter.
THE MAINS WAYS OF FLOWING LYMPH
FROM LOWER AND APPER LIPS
 Lymphadenitis is often a complication of a bacterial
infection of a wound, although it can also be caused
by viruses or other disease agents. Lymphadenitis
may be either generalized, involving a number of
lymph nodes; or limited to a few nodes in the area of
a localized infection. Lymphadenitis is sometimes
accompanied by lymphangitis, which is the
inflammation of the lymphatic vessels that connect
the lymph nodes.
 Causes
Streptococcal and staphylococcal bacteria are the most
common causes of lymphadenitis, although viruses, protozoa,
rickettsiae, fungi, and the tuberculosis bacillus can also infect
the lymph nodes. Diseases or disorders that involve lymph
nodes in specific areas of the body include rabbit fever
(tularemia), cat-scratch disease, lymphogranuloma venereum,
chancroid, genital herpes, infected acne, dental abscesses, and
bubonic plague. In children, tonsillitis or bacterial sore throats
are the most common causes of lymphadenitis in the neck
area. Diseases that involve lymph nodes throughout the body
include mononucleosis, cytomegalovirus infection,
toxoplasmosis, and brucellosis.
 Physical examination
The diagnosis of lymphadenitis is usually based on a
combination of the patient's history, the external
symptoms, and laboratory cultures. The doctor will
press (palpate) the affected lymph nodes to see if
they are sore or tender. Swollen nodes without
soreness are often caused by cat-scratch disease. In
children, the doctor will need to rule out mumps,
tumors in the neck region, and congenital cysts that
resemble swollen lymph nodes.
PALPATION OF SUBMANDIBLE
LYMPH NODES
PALPATION OF SUBMENTAL
LYMPH NODES
PALPATION OF RETROMANDIBLE
LYMPH NODES
 CLINICAL CLASSIFICATION
OF LYMPHADENITIS

-Acute: serous, purulent.

-Chronic: hyperplastic, purulent.

 Symptoms
Lymphadenitis is marked by swollen
lymph nodes that are painful, in most
cases, when the doctor touches them. If
the lymphadenitis is related to an
infected wound, the skin over the
nodes may be red and warm to the
touch.
Acute lymphadenitis
Chronic lymhadenitis
Operation of removed lymph nodes attached
chronical inflammation
Operation of removed lymph nodes attached
chronical inflammation
Removed lymph nodes
 Treatment
The medications given for lymphadenitis vary according to the
bacterium or virus that is causing it. If the patient also has
lymphangitis, he or she will be treated with antibiotics, usually
penicillin G or cephalosporins. Erythromycin is given to
patients who are allergic to penicillin.
Supportive care of lymphadenitis includes resting the affected
limb and treating the area with hot moist compresses.
Cellulitis associated with lymphadenitis should be treated
surgically because of the risk of spreading the infection.
Pus is drained only if there is an abscess and usually after the
patient has been started on antibiotic treatment. In some cases,
a biopsy of an inflamed lymph node is necessary if no
diagnosis has been made and no response to treatment has
occurred.
 Prognosis
The prognosis for recovery is good if the
patient is treated promptly with antibiotics.
In most cases, the infection can be brought
under control in three or four days. Patients
with untreated lymphadenitis may develop
blood poisoning (septicemia), which is
sometimes fatal.