Reticuloendothelial and Immune System History and Examination

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 • 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 LymphaticSystem • 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