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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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