1. Reticuloendothelial and Immune System History and Examination
Dr. Lanice Jones
Vientiane 2008

2. Definition
Phagocytic cells of the body, including the lymphatic system, spleen and bone marrow, tonsils, and thymus gland
Responsible for immune defence in the body

3. History Localized symptoms Generalized symptoms:
Pain from swelling, pressure (swollen lymph nodes or ‘glands’
Fullness (abdominal fullness ie enlarged spleen)
Generalized symptoms:
Fatigue, tiredness, lack of energy
Weight loss
Night sweats
Associated symptoms: ie joint pain, rash,

4. Lymphatic System Function:
Defence System: Filtration and phagocytosis, production of antibodies
Hematopoiesis: lymph nodes are the site of final stages of maturation for some lymphocytes and monocytes that have migrated from the bone marrow
Fluid Balance: return fluid filtered out of capillaries back to the venous circulation system

5. Lymph Node Examination
Lymph node Groups
Head: occipital, preauricular, ostauricular, subental, subandibular
Cervical: anterior, posterior, deep
Clavicular: supraclavicular, infraclavicular
Axillary: anterior, lateral, posterior, apical, medial
Epitroclear
Inguinal

6. Lymph nodes of the Head Submental lymph nodes Submandibular Parotid
Preauricular
Postauricular
Occipital
Anterior cervical
Supracalvicular
Posterior cervical

7. Examination of Lymph Nodes
Often not palpable
Enlarge with infection, or inflammation
(enlarged submandibular node, which drains the tonsils, in acute tonsillitis

8. Axillary Lymph Nodes
Lateral
Medial
Apical
Anterior
Posterior Nodes

9. Lymph Node distribution

10. Examination of the Lymphatic System
Inspection:
Lymphedema
Surgical scars
Obvious masses
Palpation:
Move fingers in a circular motion over the area of lymph node distribution
Small nodes are common

11. Lymphatic System Palpation: Note Location of nodes Size of nodes
Discrete or matted node
Mobile or fixed
Consistency (soft, firm, hard)
Tenderness

12. Matted lymph nodes – stuck together

13. Spleen
Function:
To remove material from the blood stream, such as removing old and deformed red blood cells
Control quality and function of red blood cells
Supplies 25% of the mass of lymphoid tissue
Can react and enlarge quickly to fight infection and inflammation

14. History Pain or discomfortLeft Upper Quadrant
Feeling of fullness in the abdomen
Pain in left shoulder area (irritation to diaphragm and phrenic nerve)
Early saity (fullness after eating a small amount, from pressure on the abdomen)

15. Examination Inspection:
Pallor or erythema, conjunctiva, mucous membranes, palms
Percussion: Traube’s space
Palpation:

16. Percussion of Traube’s Space
Location:
Draw line through 6th rib midclavicular line
Draw line through 9th rib midaxillary line
Draw a line curving upwards from 9th to sixth rib
Draw line along costal margin
The space between costal margin and curving upwards between 9th to 6th rib is Traube’s Space

17. Traube’s Space Percussion
Air in the stomach produces a tympanic sound with percussion over Traube’s space
Dullness over Traube’s space on inspiration suggests possible Splenomegly

18. Splenic Palpation
Reach over and around the patient to support and press forward the lower rib cage and adjacent tissue
Palpate below the left costal margin with your right hand
Ask the patient to take a deep breath, and try to feel the edge of the spleen as it comes down on deep inspiration.
A normal sized spleen can be palpated with a low flat diaphragm ie COPD or with very deep inspiration

19. Examination of the Tonsils
History: pain, swelling, difficulty swallowing, vocal change, bad breath
Physical Exam: inspection: symmetry, color, size, coating, pus,
Palpation: lymph nodes