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

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

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,

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

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

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

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

Axillary Lymph Nodes Lateral Medial Apical Anterior Posterior Nodes

Lymph Node distribution

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

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

Matted lymph nodes – stuck together

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

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)

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

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

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

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

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