Lymphatic/Hematopoetic System IPM 2

Содержание

1. Lymphatic/Hematopoetic System IPM 2
2. ObjectivesStudent should be able to …describe location,
3. OverviewThis is a short lecture!A major goal
4. Lymphatic System
5. Lymph Node ExaminationHead/neckAxillaryInguinal/femoral
6. Head and Neck NodesPreauricularPosterior auricularOccipitalTonsillarSubmandibularSubmentalSuperficial cervicalPosterior cervicalDeep cervicalSupraclavicular
7. AxillaryA pectoral (anterior) L lateral P posterior C central Ap apical
8. Inguinal/ FemoralHorizontal groupVertical group
9. Descriptors of LymphadenopathyLocation…obviousMobilitySizeTextureShapeTender/non-tenderAssociated erythema or warmth…signs of inflammation
10. SpleenLeft upper quadrantPalpation most specific for detecting
11. Case28 yo man presents with c/o fevers,
12. Casepainless lymphadenopathy in anterior axilla and anterior
13. Differential DiagnosisLymphomaInfectionCancer—metastaticGranulomatous disease
14. Anemia- Signs/SymptomsDyspnea on exertionPalpitationsAngina pectorisIntermittent claudicationHeadacheSyncopeanorexiaDizziness/vertigoNauseaCold intoleranceAmenorrheaDecrease libido/impotence
15. AnemiaBlood lossHemolysis/sequestrationDeficienciesDecreased production
16. Symptoms Symptoms based on acuity of HgB
17. Anemia of Acute Blood LossTrauma or GI
18. Hemolysis and SequestrationCauses for hemolytic anemias include:AutoimmuneDrug
19. Scleral IcterusYellow scleraCan be seen in hemolysis
20. DeficienciesIron deficiency anemia is most common worldwide
21. Koilonychia (spoon nails)
22. Smooth Tongue/Glossitis
23. Signs and Symptoms of Coagulation DisordersBleedingEcchymosesPetechiaeHemarthrosesHematomas
24. Platelets versus CoagsPetechiae—platelets low or dysfunctionalEcchymoses, hematomas,
25. Petechiae
26. Purpura
27. Hemarthrosis
28. Hematoma
29. Ecchymosis
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ObjectivesStudent should be able to …describe location, size, consistency, and other attributes of lymphadenopathyidentify common clinical scenarios involving lymphadenopathyidentify the signs and symptoms of anemiadefine the signs and symptoms of bleeding

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Слайд 1Lymphatic/Hematopoetic System IPM 2
Scott E. Smith M.D., Ph.D.
12-10-02

Слайд 2Objectives
Student should be able to …
describe location, size, consistency, and

other attributes of lymphadenopathy
identify common clinical scenarios involving lymphadenopathy
identify the

signs and symptoms of anemia
define the signs and symptoms of bleeding and coagulation disorders

ObjectivesStudent should be able to …describe location, size, consistency, and other attributes of lymphadenopathyidentify common clinical scenarios

Слайд 3Overview
This is a short lecture!
A major goal is to synthesize

the lymphatic system as a whole…lymph node regions have been

discussed individually by specific site…i.e., head, neck, and abdomen, but not put together for systemic illness such as lymphoma.
We will also discuss the signs and symptoms of anemias, leukemias, bleeding disorders, and coagulation disorders

OverviewThis is a short lecture!A major goal is to synthesize the lymphatic system as a whole…lymph node

Слайд 4Lymphatic System

Слайд 5Lymph Node Examination
Head/neck
Axillary
Inguinal/femoral

Слайд 6Head and Neck Nodes
Preauricular
Posterior auricular
Occipital
Tonsillar
Submandibular
Submental
Superficial cervical
Posterior cervical
Deep cervical
Supraclavicular

Head and Neck NodesPreauricularPosterior auricularOccipitalTonsillarSubmandibularSubmentalSuperficial cervicalPosterior cervicalDeep cervicalSupraclavicular

Слайд 7Axillary
A pectoral (anterior)
L lateral
P posterior
C central
Ap

apical

Слайд 8Inguinal/ Femoral
Horizontal group

Vertical group

Слайд 9Descriptors of Lymphadenopathy
Location…obvious
Mobility
Size
Texture
Shape
Tender/non-tender
Associated erythema or warmth…signs of inflammation

Descriptors of LymphadenopathyLocation…obviousMobilitySizeTextureShapeTender/non-tenderAssociated erythema or warmth…signs of inflammation

Слайд 10Spleen
Left upper quadrant
Palpation most specific for detecting enlarged spleen (89-99%

specificity)
Spleen palpable to umbilicus is suggestive of hematologic pathology
Percussion is

non-sensitive (dullness in Traube’s space) but can be specific in non-obese patients

SpleenLeft upper quadrantPalpation most specific for detecting enlarged spleen (89-99% specificity)Spleen palpable to umbilicus is suggestive of

Слайд 11Case
28 yo man presents with c/o fevers, night sweats and

30 pound weight loss. He develops pruritis when he showers.

He also has noted some enlarged “glands” in his neck and armpits. On lymphatic exam he has the following:

Case28 yo man presents with c/o fevers, night sweats and 30 pound weight loss. He develops pruritis

Слайд 12Case
painless lymphadenopathy in anterior axilla and anterior cervical as well

as supraclavicular areas bilaterally.
Lymph nodes are not tender, freely

mobile and no associated inflammation. They are ovoid (grape-shaped) and measure 2 x 3 cm. There is no splenomegaly by palpation or percussion.

Casepainless lymphadenopathy in anterior axilla and anterior cervical as well as supraclavicular areas bilaterally. Lymph nodes are

Слайд 13Differential Diagnosis
Lymphoma
Infection
Cancer—metastatic
Granulomatous disease

Слайд 14Anemia- Signs/Symptoms

Dyspnea on exertion
Palpitations
Angina pectoris
Intermittent claudication
Headache

Syncope
anorexia
Dizziness/vertigo
Nausea
Cold intolerance
Amenorrhea
Decrease libido/impotence

Anemia- Signs/SymptomsDyspnea on exertionPalpitationsAngina pectorisIntermittent claudicationHeadacheSyncopeanorexiaDizziness/vertigoNauseaCold intoleranceAmenorrheaDecrease libido/impotence

Слайд 15Anemia
Blood loss
Hemolysis/sequestration
Deficiencies
Decreased production

Слайд 16Symptoms
Symptoms based on acuity of HgB drop
Acute blood loss

usually creates rapid onset of symptoms
Slow drop in HgB may

lead to fewer symptoms

Symptoms Symptoms based on acuity of HgB dropAcute blood loss usually creates rapid onset of symptomsSlow drop

Слайд 17Anemia of Acute Blood Loss
Trauma or GI tract loss most

common
Menstrual/vaginal loss
Urinary tract
Nosebleeds leading to anemia, but not because of

it!
Tachycardia and hypotension are common findings
History helps the most for these

Anemia of Acute Blood LossTrauma or GI tract loss most commonMenstrual/vaginal lossUrinary tractNosebleeds leading to anemia, but

Слайд 18Hemolysis and Sequestration
Causes for hemolytic anemias include:
Autoimmune
Drug induced
Cell membrane disorders
Hereditary
Splenomegaly

can lead to sequestration of blood cells

Hemolysis and SequestrationCauses for hemolytic anemias include:AutoimmuneDrug inducedCell membrane disordersHereditarySplenomegaly can lead to sequestration of blood cells

Слайд 19Scleral Icterus
Yellow sclera

Can be seen in hemolysis

Слайд 20Deficiencies
Iron deficiency anemia is most common worldwide and in US-spoon

nails and pica
Megaloblastic anemias caused by B12 or folate deficiencies-paresthesias

and diarrhea
Smooth tongue/glossitis

DeficienciesIron deficiency anemia is most common worldwide and in US-spoon nails and picaMegaloblastic anemias caused by B12

Слайд 21Koilonychia (spoon nails)

Слайд 22Smooth Tongue/Glossitis

Слайд 23Signs and Symptoms of Coagulation Disorders
Bleeding
Ecchymoses
Petechiae
Hemarthroses
Hematomas

Слайд 24Platelets versus Coags
Petechiae—platelets low or dysfunctional
Ecchymoses, hematomas, hemarthroses—seen more frequently

with low clotting factors or dysfunction
Bleeding can be seen with

either

Platelets versus CoagsPetechiae—platelets low or dysfunctionalEcchymoses, hematomas, hemarthroses—seen more frequently with low clotting factors or dysfunctionBleeding can

Слайд 25Petechiae

Слайд 26Purpura

Слайд 27Hemarthrosis

Слайд 28Hematoma

Слайд 29Ecchymosis

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Lymphatic/Hematopoetic System IPM 2

Содержание

Слайды и текст этой презентации

Слайд 1Lymphatic/Hematopoetic System IPM 2Scott E. Smith M.D., Ph.D.12-10-02

Слайд 2ObjectivesStudent should be able to …describe location, size, consistency, and

other attributes of lymphadenopathyidentify common clinical scenarios involving lymphadenopathyidentify the

Слайд 3OverviewThis is a short lecture!A major goal is to synthesize

the lymphatic system as a whole…lymph node regions have been

Слайд 4Lymphatic System

Слайд 5Lymph Node ExaminationHead/neckAxillaryInguinal/femoral

Слайд 6Head and Neck NodesPreauricularPosterior auricularOccipitalTonsillarSubmandibularSubmentalSuperficial cervicalPosterior cervicalDeep cervicalSupraclavicular

Слайд 7AxillaryA pectoral (anterior) L lateral P posterior C central Ap

apical

Слайд 8Inguinal/ FemoralHorizontal groupVertical group

Слайд 9Descriptors of LymphadenopathyLocation…obviousMobilitySizeTextureShapeTender/non-tenderAssociated erythema or warmth…signs of inflammation

Слайд 10SpleenLeft upper quadrantPalpation most specific for detecting enlarged spleen (89-99%

specificity)Spleen palpable to umbilicus is suggestive of hematologic pathologyPercussion is

Слайд 11Case28 yo man presents with c/o fevers, night sweats and

30 pound weight loss. He develops pruritis when he showers.

Слайд 12Casepainless lymphadenopathy in anterior axilla and anterior cervical as well

as supraclavicular areas bilaterally. Lymph nodes are not tender, freely

Слайд 13Differential DiagnosisLymphomaInfectionCancer—metastaticGranulomatous disease

Слайд 14Anemia- Signs/SymptomsDyspnea on exertionPalpitationsAngina pectorisIntermittent claudicationHeadacheSyncopeanorexiaDizziness/vertigoNauseaCold intoleranceAmenorrheaDecrease libido/impotence

Слайд 15AnemiaBlood lossHemolysis/sequestrationDeficienciesDecreased production

Слайд 16Symptoms Symptoms based on acuity of HgB dropAcute blood loss

usually creates rapid onset of symptomsSlow drop in HgB may

Слайд 17Anemia of Acute Blood LossTrauma or GI tract loss most

commonMenstrual/vaginal lossUrinary tractNosebleeds leading to anemia, but not because of

Слайд 18Hemolysis and SequestrationCauses for hemolytic anemias include:AutoimmuneDrug inducedCell membrane disordersHereditarySplenomegaly