tailieunhanh - Chapter 060. Enlargement of Lymph Nodes and Spleen

This chapter is intended to serve as a guide to the evaluation of patients who present with enlargement of the lymph nodes (lymphadenopathy) or the spleen (splenomegaly). Lymphadenopathy is a rather common clinical finding in primary care settings, whereas palpable splenomegaly is less so. Lymphadenopathy Lymphadenopathy may be an incidental finding in patients being examined for various reasons, or it may be a presenting sign or symptom of the patient's illness. The physician must eventually decide whether the lymphadenopathy is a normal finding or one that requires further study, up to and including biopsy. . | Chapter 060. Enlargement of Lymph Nodes and Spleen This chapter is intended to serve as a guide to the evaluation of patients who present with enlargement of the lymph nodes lymphadenopathy or the spleen splenomegaly . Lymphadenopathy is a rather common clinical finding in primary care settings whereas palpable splenomegaly is less so. Lymphadenopathy Lymphadenopathy may be an incidental finding in patients being examined for various reasons or it may be a presenting sign or symptom of the patient s illness. The physician must eventually decide whether the lymphadenopathy is a normal finding or one that requires further study up to and including biopsy. Soft flat submandibular nodes 1 cm are often palpable in healthy children and young adults and healthy adults may have palpable inguinal nodes of up to 2 cm which are considered normal. Further evaluation of these normal nodes is not warranted. In contrast if the physician believes the node s to be abnormal then pursuit of a more precise diagnosis is needed. Approach to the Patient Lymphadenopathy Lymphadenopathy may be a primary or secondary manifestation of numerous disorders as shown in Table 60-1. Many of these disorders are infrequent causes of lymphadenopathy. In primary care practice more than two-thirds of patients with lymphadenopathy have nonspecific causes or upper respiratory illnesses viral or bacterial and 1 have a malignancy. In one study 84 of patients referred for evaluation of lymphadenopathy had a quot benign quot diagnosis. The remaining 16 had a malignancy lymphoma or metastatic adenocarcinoma . Of the patients with benign lymphadenopathy 63 had a nonspecific or reactive etiology no causative agent found and the remainder had a specific cause demonstrated most commonly infectious mononucleosis toxoplasmosis or tuberculosis. Thus the vast majority of patients with lymphadenopathy will have a nonspecific etiology requiring few diagnostic tests. Table 60-1 Diseases Associated with Lymphadenopathy .