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Gastro Exam
 
 
Gastro Exam
The gastrointestinal exam is used to assess patients for pathology affecting the gastrointestinal tract, hepatobiliary system or other abdominal organs.
The Patient
The Hands
The Arms
The Face
The Neck
The Chest
The Abdomen – Inspection
The Abdomen – Auscultation
The Abdomen - Palpation
The Groin
Digital Rectal Examination
 

Lymph Nodes

 
 

Overview

  • Examination of the supraclavicular lymph nodes is of particular importance in the gastrointestinal exam, as enlargement of Virchow's node (the left supraclavicular node) may occur due to embolisation of a GI tumour.

    • How to Assess

      • Using the pulps of the fingers, gently palpate each of the lymph node groups within the cervical and axillary regions.

    • Feel For

    • Size - normally <10mm
    • Tenderness
    • Consistency - hard (metastasis), rubbery (lymphoma), soft (reactive)
    • Mobility - mobile or tethered to underlying structures

    • Causes of Lymphadenopathy

    • Infection - bacterial, viral, fungal, protozoal
    • Inflammatory disorders - lupus, rheumatoid arthritis
    • Malignancy - leukaemia, lymphoma, metastasis
    • Medications - allopurinol, atenolol, cephalosporins, penicillin, phenytoin
    • Benign idiopathic lymphadenopathy

Cervical Lymph Nodes

  • Submental nodes - immediately below chinTeeth, oral mucosa, tongue
  • Submandibular nodes - Along angle of mandibleFloor of mouth
  • Anterior cervical nodes - over sternocleidomastoidPosterior pharynx, tonsils, parotid
  • Posterior cervical nodes - posterior to sternocleidomastoidsScalp, posterior neck
  • Suboccipital nodes - below occiputInferior scalp
  • Preauricular nodes - Anterior to pinnaEyelids, conjunctivae
  • Postauricular nodes - posterior to pinnaExternal auditory meatus, pinna, scalp
  • Right supraclavicular node - in right supraclavicular fossaMediastinum, lungs, oesophagus
  • Left supraclavicular node (Virchow's node) - in left supraclavicular fossaChest, abdomen

Axillary Lymph Nodes

  • Pectoral nodes - anteriorly, behind pectoralis major muscleAnterolateral chest wall, central / lateral breast
  • Subscapular nodes - posteriorly, in front of subscapularis musclePosterior neck and chest wall
  • Lateral nodes - lateral aspect of armpitMedial hand, forearm and arm
  • Central nodes - within centre of axillaDrainage from pectoral, subscapular and lateral nodes
  • Infraclavicular nodes - below distal aspect of clavicleLateral hand, forearm and arm
  • Apical nodes - medially, at lateral border of 1st ribDrainage from all axillary lymph nodes
Last updated on November 26th, 2019
 
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