Gastro Exam
 
 

Lymph Nodes

 
 
 
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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
 
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