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 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: 1. Defence System: Filtration and phagocytosis,

production of antibodies

2. Hematopoiesis: lymph nodes are the site of final stages of maturation for some lymphocytes and monocytes that have migrated from the bone marrow

3. Fluid Balance: return fluid filtered out of capillaries back to the venous circulation system

Lymph Node Examination

Lymph node Groups1. Head: occipital, preauricular, ostauricular,

subental, subandibular2. Cervical: anterior, posterior, deep3. Clavicular: supraclavicular, infraclavicular4. Axillary: anterior, lateral, posterior, apical,

medial5. Epitroclear6. Inguinal

Lymph nodes of the Head

1. Submental lymph nodes

2. Submandibular

3. Parotid

4. Preauricular

5. Postauricular

6. Occipital

7. Anterior cervical

8. Supracalvicular

9. 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 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

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