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Gastro Exam

Lymph Nodes

November 26th, 2019


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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