Saturday, July 7, 2012

enlarged lymph nodes

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Lymph nodes found in several places in our bodies. Often bumps arise in areas where lymph nodes are and often it is also causing anxiety in both patients, elderly patients or whether this enlargement is a normal thing, a dangerous disease or a symptom of the malignancy. It is necessary to recognize the possibilities the causes of enlarged lymph nodes and the clinical picture so knowing the procedural path that will be done. Enlarged lymph nodes 55% in head and neck region because of the discussion takes precedence in the enlarged lymph nodes in head and neck region.

Lymph nodes (KGB)
Lymph nodes are part of our body's defense system. Our body has approximately 600 lymph nodes, but only the submandibular area (bottom of the lower jaw; sub: bottom; mandible: the lower jaw), armpit or groin are normal in healthy people is palpable.

Wrapped in a fibrous capsule that contains a collection of cells forming the body's defenses and is a screening antigen (foreign protein) of the lymph vessels to pass through. Lymph vessels will flow to the KGB that the KGB would know the location of lymph vessels that flow through it.

Therefore bypassed by the flow of lymph vessels which can carry antigens (microbes, foreign substances) and has the body's defense cells then if there is an antigen that infect the lymph nodes can produce immune cells that more to address these antigens so that the lymph nodes enlarged. Enlarged lymph nodes can be derived from the addition of immune cells derived from the BEC itself as lymphocytes, plasma cells, monocytes and histiocytes, or because the arrival of inflammatory cells (neutrophils) to overcome the infection in the lymph nodes (lymphadenitis), infiltration (influx) of malignant cells or a pile of metabolites disease macrophages (Gaucher disease)

By knowing the location of enlarged lymph nodes, we can deploy to the location of the possibility of infection or cause enlargement of the KGB.

Lymphadenopathy refers to the abnormal lymph nodes in size, consistency or number. In the neck region (cervikal), enlarged lymph nodes are defined when the glands are larger than the diameter of one centimeter. Enlarged lymph glands in the neck often occurs in children. Approximately 38% to 45% in normal children have lymph nodes are palpable neck region. From studies in the Netherlands there are 2556 cases of unexplained limadenopati and 10% referred to subspesialis, 3.2% require biopsy and 1.1% had malignancy. The study of family medicine in the United States, none of 80 patients with unexplained lymphadenopathy who had malignancies and three of 238 patients with malignancies of limadenopati unexplained.

Patients aged> 40tahun with unexplained lymphadenopathy risk keanasan 4% compared to 0.4% risk of malignancy when found in patients <40tahun.Figure 1. lymph nodes neck area, flow direction and possible causes. images taken from aafpFigure 2. lymph nodes groin area, flow direction and possible causes. Gambat taken from aafpFigure 3. lymph nodes arm area, flow direction and possible causes. Picture taken from aafpEtiology (cause)Enlarged lymph nodes can be divided into local or generalized (generalized). Enlarged lymph nodes generally defined as enlarged lymph nodes in two or more regions. Areas the presence of lymph nodes are:Picture taken from www.aafp.orgThe most common cause is the result of the process of infection and infections that usually occur is infection by viruses in the upper respiratory tract (rinovirus, parainfluenza virus, influenza, respiratory syncytial virus (RSV), coronavirus, adenovirus, or reovirus). Other viruses ebstein barr virus, cytomegalovirus, rubella, rubeola, varicella-zooster virus, herpes simplex virus, coxsackievirus, human immunodeficiency virus. Bacteria in inflammatory lymph nodes (lymphadenitis) can be due to beta-hemolytic Streptococcus Group A or staphylococcus aureus. Anaerobic bacteria when associated with Dental caries (tooth decay) and gum disease. Diphtheria, haemophilus influenza type b rarely cause this. Bartonella henselae, mikrobakterium atypical and tuberculosis and Toxoplasma.Malignancies such as leukemia, neuroblastoma, rhabdomyosarkoma and lymphoma can also cause lymphadenopathy. Other diseases are one of the symptoms are lymphadenopathy is kawasaki, collagen disease, lupus. The drugs also cause a general lymphadenopathy. Lymphadenopathy dairy neck region were reported after immunization (DPT, polio or typhoid).Each cause can not be determined just from the enlarged lymph nodes only, but of other symptoms that accompany enlargement of the lymph nodes.Clinical symptomsDiagnosis of lymphadenopathy requires anamnesis (interview), physical examination, and investigations when necessary. In the history can be obtained:anamnesis DescriptionLocation of enlarged lymph nodes Enlarged lymph nodes on both sides of the neck of a sudden is usually caused by a viral infection of the upper respiratory tract. In Kawasaki disease infection by enlargement of lymph nodes generally only one side. If long lasting (chronic) can be attributed to infection by mycobacteria, Toxoplasma, or citomegalovirus ebstein barr virus.Accompanying symptoms (symptoms) Fever, sore throat and cough directed to cause upper respiratory tract infections. Fever, night sweats and weight loss leading to tuberculosis infection or malignancy. Cause unexplained fever, fatigue and joint pain increases the likelihood of disease by collagen disease or serum (serum sickness-plus history of drugs or blood products).History of present illness and past presence of inflammation of the tonsils (tonsillectomy) previously directed to infection by streptococcus; abrasions on the face or neck or signs of infection Staphylococcal infection causes direct; and the presence of tooth and gum infections can also lead to anaerobic bacterial infection. Previous blood transfusions can lead to citomegalovirus, Epstein Barr virus or HIV.The use of drugs Lymphadenopathy may occur after the use of drugs such as phenytoin and isoniazid. Other drugs such as allupurinol, atenolol, captopril, carbamazepine, cefalosporin, gold, hidralazine, penicillin, pirimetamine, quinidine, sulfonamides, sulindac). Enlargement because the drug is generally the whole body (generalized)Exposure to infections Exposure / previous contact to people with upper respiratory tract infection, pharyngitis streptococcal, or tuberculosis helped direct cause of lymphadenopathy.History of travel or work trip to areas of Africa could result in exposed tripanosomiasis, people working in the forest can be exposed to tularemiaPhysical examinationPhysical examinationIn general malnutrition or stunted growth that leads to chronic (long running) such as tuberculosis, malignancy or immune system disordersCharacteristics of lymph nodes and surrounding area must be considered. Lymph nodes should be measured for subsequent comparison. It should be noted the presence or absence tenderness, redness, warmth at the touch, can be freely moved or can not be moved, if there are fluctuations, whether hard or chewy consistency.• Size: normal when the diameter of 0.5 cm and groin> 1.5 cm, said to be abnormal)
• Tenderness: the process is generally caused by inflammation or bleeding
• Consistency: hard as a rock lead to malignancies, solid rubber-like leads to lymphoma; software directs the process of infection; fluctuating directs the occurrence of abscesses / pernanahan
• Annealing / clustered: some nodes that attach to and move together when actuated. Can be caused by tuberculosis, sarcoidosis, malignancy.
Enlarged lymph nodes of the neck posterior (back) are in rubella infection and mononucleosis. Supraclavicular neck or the back of the KGB has a risk of malignancy is greater than the enlargement of the anterior part of the KGB.
Enlarged neck lymph nodes accompanied by other regions are also often caused by viral infection.
Malignancy, drugs, collagen diseases generally associated Degnan generalized enlargement of lymph nodes.
On the enlargement of the KGB by a viral infection, the KGB is generally bilateral (two sisi-kiri/kiri and right), soft and movable. If there is infection by bacteria, usually glandular pain in emphasis, either one side or two sides and can be volatile and can be driven. The existence of the redness and the temperature is hotter than the surrounding directing bacterial infection and the presence of volatile indicate the occurrence of an abscess. When lymphadenopathy due to malignancy signs of inflammation did not exist, the KGB hard and can not be driven (Degnan bound tissue underneath)
In infekswi by mycobacteria enlarged lymph-month run weekly, although it can be sudden, the KGB became volatile and above the skin becomes thinner, and can rupture and form bridges of the overlying skin.
Signs of an accompanying
(Signed) The existence of a red throat, white patches on the tonsils, red spots on the ceiling directs infection by streptococcus bacteria. The existence of membrane on the walls of the throat, tonsils, hard palate is removed and when removed bleeding, swelling of the soft tissues of the neck (bull neck) leading to infection by the diphtheria bacteria. Pharyngitis, rash and enlargement of the spleen lead to Epstein Barr virus infection. An inflammation of the lining of the eyes and Koplik spots leads to measles. Presence of pale, bleeding spots (red spots are not lost Degnan emphasis), bruises that do not clear the cause, and an enlarged liver and spleen leads to leukomia. Long fever that does not respond to fever medicine; redness of the eye; inflammation of the throat, "strawberry tongue"; changes on the hands and feet (swelling, redness on the palms of the hands and feet); lymphadenopathy one side (unilateral) leads to Kawasaki disease.
Flow Diagnosis
taken from the RCH
Differential diagnosis:
Lump in the throat that is often misinterpreted as an enlarged neck lymph nodes:
• • Mumps: parotits gland enlargement due to viral infection, the angle of mandible may disappear because of swelling
Thyroglossal duct cyst • •: in the midline and moves with swallowing
• • Dermoid cyst: a lump in the midline can be solid or filled with fluid
• • Hemangioma: abnormalities of the blood vessels so that the resulting tangle of blood vessels contain lumps, red or bluish.
Management of cervical lymph nodes enlargement are based on the cause. Many cases of enlarged lymph nodes neck heal by itself and does not require any treatment other than observation. Failure to shrink after 4-6 weeks can be an indication for lymph node biopsy performed. Biopsy was done when there are signs and symptoms that lead to keganasa, KGB persist or increase in size with the right treatment, or diagnosis can not be enforced.

Pembesarab KGB in children is usually caused by viruses and heal itself, although the KGB enlargement can take place weekly. Treatment of the KGB by a bacterial infection (lymphadenitis) is a 10-day oral antibiotic in the first 2 days of monitoring flucloxacillin 25mg/kgBB four times a day. If there is an allergic reaction to penicillin group antibiotic cephalexin can be given 25mg/kg (up to 500mg) three times daily or erythromycin 15mg/kg (up to 500mg) three times a day.

If the cause is a mycobacteria tuberculosis lymphadenopathy then given anti-tuberculosis drugs for 9-12 months. When caused by mycobacteria other than tuberculosis will require removal of lymph nodes are infected or when surgery is impossible or not optimal given class of macrolide antibiotics and antimikobakterium. Investigations are not necessary if acute lymphadenopathy, but if it lasts> 2minggu be examined blood serology for Epstein Barr virus, citomegalovirus, hiv, toxoplasma; Mantoux test, chest X-rays, biopsies, are all adapted to the existing signs and symptoms and the most direct diagnosis.
Enlarged lymph nodes neck area are common and generally harmless. Observation is the main thing. The diagnosis obtained from the interview physical examination and investigations if necessary. If the diagnosis could not be determined and not get the signs and symptoms toward malignancy can doibservasi daulu for 3-4 weeks.

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