Examination of the Lymph Nodes - Clinical Examination

Summary

This video script outlines the clinical examination of lymph nodes, focusing on key regions including the head and neck, axilla, and inguinal areas. It emphasizes the importance of systematic inspection and palpation of various lymph node stations such as the sub-occipital, submandibular, axillary groups, and inguinal regions. The script also covers techniques for assessing lymph node enlargement, consistency, tenderness, and mobility, with a particular focus on identifying abnormalities like conglomerates, which may indicate malignancy. Additionally, it highlights the role of spleen palpation in detecting systemic conditions like splenomegaly.

Takeaways

• 😀 A thorough clinical examination of lymph nodes involves inspection and palpation, covering head and neck, axilla, and inguinal areas.
• 😀 One-third of all lymph nodes are located in the head and neck area, making them easily palpable.
• 😀 Key lymph nodes to palpate in the head and neck include sub-occipital, retro- and pre-auricular, submandibular, sub-mental, and those near the internal jugular vein.
• 😀 Supraclavicular lymph nodes are critical to examine as their enlargement can indicate malignancies, particularly from abdominal tumors.
• 😀 Palpating the lymph nodes involves assessing their consistency, tenderness, mobility, and any erythema or fusion, which may indicate malignancy.
• 😀 Axillary lymph nodes are grouped into pectoral, subscapular, brachial, central, and apical groups, with each draining specific areas of the chest, arms, and upper body.
• 😀 The pectoral lymph nodes are found behind the pectoralis major muscle, while the brachial nodes are located near the proximal humerus.
• 😀 Palpating the axillary nodes requires ensuring the arm is relaxed to differentiate lymph nodes from surrounding muscles.
• 😀 Inguinal lymph nodes are divided into horizontal and vertical groups, which drain the lower extremities, trunk, and external genitalia.
• 😀 Examination of the spleen is crucial as splenomegaly can indicate systemic inflammatory or malignant conditions, and it is palpated below the left costal margin during inspiration.

Q & A

Why is a thorough clinical examination of the lymph nodes important?

A thorough examination helps detect signs of infections, inflammation, or malignancies. It also provides valuable information about systemic diseases, as enlarged lymph nodes can be associated with various medical conditions.

What are the main lymph node stations to examine during a clinical check-up?

The primary lymph node stations to examine include the head and neck area, axilla (armpit), and inguinal area. These are the areas most commonly involved in pathological changes.

Which lymph nodes are typically palpable in the head and neck area?

The lymph nodes that should be palpated in the head and neck area include the sub-occipital, retro-auricular, pre-auricular, submandibular, sub-mental, posterior triangle, and those near the internal jugular vein.

What is the significance of palpating the supraclavicular lymph nodes?

Enlargement of the supraclavicular lymph nodes is often associated with malignancies, especially those originating from abdominal tumors like gastric cancer. An enlarged Virchow node, found in the left supraclavicular fossa, may be a sign of metastatic disease.

How should palpation of lymph nodes be performed to differentiate them from muscles?

Palpation should be performed on a relaxed area to distinguish between lymph nodes and muscles. Tension in the muscles can make it difficult to feel lymph nodes clearly.

What does it mean if lymph nodes are described as conglomerates?

Conglomerates refer to multiple fused lymph nodes. The presence of conglomerate lymph nodes is highly suspicious for malignancy, as they may indicate the spread of cancerous cells.

How are axillary lymph nodes grouped and what do they drain?

Axillary lymph nodes are divided into several groups: the pectoral group (anterior axillary fold), subscapular group (posterior axillary fold), brachial group (upper arm), and central group (base of the axilla). These groups drain the chest, arms, and parts of the chest wall.

What is the purpose of examining the inguinal lymph nodes?

The inguinal lymph nodes are examined to assess lymphatic drainage from the lower extremities, external genitalia, trunk, and lower back. They are divided into horizontal and vertical groups, each responsible for draining specific areas.

Why is splenomegaly important to consider during a lymph node examination?

Splenomegaly, or an enlarged spleen, can indicate systemic inflammatory or malignant conditions. Since the spleen is part of the lymphatic system, its enlargement may provide important diagnostic clues.

How is a pathologically enlarged spleen palpated during a clinical examination?

A pathologically enlarged spleen is typically palpated under the left costal margin during inspiration, as the inferior edge of the spleen descends to the examiner's fingertips. The examiner may also lift the patient's left flank to facilitate the examination.