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Lymphadenitis is an inflammation of lymph nodes. It is an illness of secondary type, it is shown after the arisen inflammation in a certain area of a body. In rather exceptional cases primary purulent inflammation of lymph nodes is diagnosed. Causative agents of this disease are streptococci, and also some other pathogenic microbes. However the mixed flora most often takes place. The illness arises after microorganisms, toxins, and also decomposition products of fabrics get with a lymph to lymph nodes. Penetration can happen through damages on skin, mucous membranes, and also a hematogenous way.
Lymphadenitis can be divided into a purulent, serous, productive inflammation. If process of an inflammation extends to other fabrics, then the periadenitis as a result can develop. For this state a characteristic symptom is the immovability of nodes in which there passes the inflammation, for example, if cervical lymphadenitis is diagnosed for the person, then the similar phenomena are noted in a neck. Lymphadenitis can proceed in an acute or chronic form. The course of acute lymphadenitis occurs differently. If to liquidate a suppurative focus as soon as possible, then the hyperemia will disappear after that, there will be an exudate rassasyvaniye, and after reduction of lymph nodes their morbidity will stop.
At the beginning of purulent lymphadenitis displays of catarral and hyperplastic lymphadenitis are observed, the purulent infiltration of a node is formed later and several centers appear. After their merge the lymph node melts. If its capsule and surrounding fabrics is involved in purulent process, then the adenoflegmona as a result develops. At development of putrefactive lymphadenitis lymph nodes are surprised a sphacelism.
Also there is a classification based on division on the center of inflammatory process (pakhovy lymphadenitis, cervical lymphadenitis). One of the most often found types of this disease is pakhovy lymphadenitis.
The patient with lymphadenitis feels the following symptoms of lymphadenitis: severe pain because of which it keeps extremities in forced situation. Temperature increases, hypostasis develops. If lymphadenitis is located superficially, then the hyperemia and temperature increase locally can be observed. At a late stage of a disease the fever, fluctuation, a leukocytosis is shown. At the same time primary center of an infection does not matter any more.
Lymphadenitis happens both acute, and chronic, distinguish also specific and nonspecific lymphadenitis. Lymphadenitis nonspecific, as a rule, is provoked staphylococcus, more seldom streptococci and other pyogenic microbes become activators. The purulent wound, an anthrax, a furuncle, an erysipelatous inflammation, osteomyelitis, a trophic ulcer and other educations can become the centers of distribution of an illness. Also microbes can get into a lymph node during its wound. In such situation lymphadenitis is primary disease.
The inflammation in lymph nodes is shown and develops on the general type. If purulent lymphadenitis progresses, inflammatory processes can provoke destructive forms of a disease — abscessing and a necrosis, and the putrefactive infection can cause ichorization of lymph nodes. Simple lymphadenitis is a form of a disease at which the inflammation, as a rule, does not leave further a lymph node. If the destructive form of lymphadenitis takes place, then the inflammation can extend to fabrics, nearby. Owing to changes in serous fabric there can be a serous inflammation or a purulent inflammation with the subsequent formation of an adenoflegmona. Especially serious symptoms of lymphadenitis are shown at an ichorous form of an illness.
At an acute nonspecific form of an illness the following symptoms of lymphadenitis are shown. Lymph nodes increase and morbidity is shown, periodically there is a headache, weakness, feeling of an indisposition, body temperature can increase. Rather often at acute lymphadenitis the inflammation of absorbent vessels is shown. Symptoms of acute lymphadenitis depend on a form of a disease and character of an inflammation. Generally general condition of the patient at catarral lymphadenitis especially is not broken. As symptoms pains in a zone of regional lymph nodes can be shown. At the same time increase in lymph nodes, their morbidity is noted during a palpation.
If process of a disease progresses and the periadenitis develops, then the described signs can be aggravated. Painful feelings gain sharpness, to skin over lymph nodes to become hyperemic, and at a palpation of nodes of the patient feels pain. Lymph nodes which could be palpated very accurately earlier merge among themselves and with the fabrics surrounding them now, besides they become motionless.
Inflammatory processes in lymph nodes differ in productive character. They pass into a purulent form in rather exceptional cases. The following symptoms are distinguished from displays of chronic nonspecific lymphadenitis: lymph nodes increase and condensed, morbidity in them is felt weak, they among themselves are not accustomed to drinking. In such state lymph nodes stay rather long span, later connecting fabric expands inside and they decrease.
At tubercular lymphadenitis as the general disease tuberculosis is shown. Lymphadenitis at children can just be shown in the period of primary tuberculosis. Microbacteria of tuberculosis can cause tuberculosis of peripheral lymph nodes. The infection can extend in the different ways. So, it can get through almonds. Most often the infection gets in the limfogematogenny way, extending from the struck lymph nodes.
If the disease begins sharply, then at the patient sharp rise in temperature is observed, there are symptoms of tubercular intoxication, lymph nodes become more, in them inflammatory and necrotic changes are shown. As a special symptom of tubercular lymphadenitis which distinguishes it from other forms, note existence of a periadenitis. Very seldom there are fistulas. Most often defeats are shown on cervical, submaxillary and axillary nodes. Chronic lymphadenitis at children sometimes develops in parallel with infectious diseases — antritis, tonsillitis, rhinitis, periodontitis. At the very beginning of development lymphadenitis at children is shown by a tumor in the locations of lymph nodes. When pressing on it the child can feel pain. And in several days the inflammation passes on the located fabrics nearby. The lymph node to become hard probed, fabrics are condensed. In the presence of similar symptoms it is necessary to address the pediatrician at once.
Diagnosis of lymphadenitis
To make the corresponding diagnosis, the doctor is guided by a clinical picture, considering anamnestic data. The doctor defines superficial lymphadenitis (pakhovy, cervical lymphadenitis) rather easily. It is more difficult to diagnose lymphadenitis which complication is the periadenitis, and fatty tissue between muscles, kletchatochny spaces of a mediastinum and retroperitoneal space is involved in inflammatory process.
To establish the differential diagnosis, it is important to know where primary pyoinflammatory center is located. It is important to differentiate chronic nonspecific lymphadenitis with a hyperadenosis at other infectious and other diseases. In the course of recognition of lymphadenitis of chronic type the doctor estimates the whole complex of symptoms of a disease. If statement of the diagnosis is complicated, then it is necessary to carry out a biopsy of a lymph node or to remove it for the subsequent histologic research. Such studying of material means much in the course of differential diagnosis of chronic lymphadenitis and identification of metastasises of malignancies.
The diagnosis "specific lymphadenitis" is established by results of complex inspection of the patient. At the same time contact of the patient with TB patients, his reaction to tuberculine, existence or lack of tubercular defeat in easy and other bodies is considered.
Also it is possible to establish the correct diagnosis by means of a puncture of the struck lymph node. It is possible to define education in nodes of kaltsinat which on a x-ray film are visible in the form of dense shadows on cervical soft tissues, under a jaw, in a zone of armpits and a groin by a X-ray. Differentiation of tubercular lymphadenitis with nonspecific purulent lymphadenitis, metastasises of malignancies, a lymphogranulomatosis is important.
At suspicion on pakhovy lymphadenitis it is necessary to conduct careful examination of rectal area and generative organs, to determine what the condition of pelvic bones and hips is. It is important to establish the correct diagnosis, in certain cases pakhovy lymphadenitis is defined as the restrained hernia.
Treatment of lymphadenitis
Treatment of lymphadenitis of an acute nonspecific form is appointed depending on at what stage it begins. If available only initial forms of an illness, then treatment of lymphadenitis it is made by means of conservative methods. So, the struck body has to stay at rest, as treatment UVCh-therapy, therapy of the center of an infection is applied (that is opening of abscesses, opening of purulent zatek), also an antibioticotherapia is carried out.
At purulent lymphadenites the operational method of treatment is applied: abscesses are opened, from them pus is removed, the drainage of wounds is carried out. All subsequent events are held same, as well as in the course of treatment of purulent wounds.
At treatment of lymphadenitis of a chronic nonspecific form it is necessary to liquidate first of all the main illness which became a source of this form of lymphadenitis. Treatment of lymphadenitis specific is carried out depending on nature of defeat of lymph nodes, and also existence in other bodies of tubercular changes. If process active, drugs of the first row are used: Tubazidum, streptomycin in a complex with PASK or Etioniamidum, Pyrazinamidum, Prothionamidum, Ethambutolum. Process of treatment to last from 8 to 15 months.
Also streptomycin is entered into a node with defeat, bandages by tubazidovy, tibonovy ointment and streptomycin are applied it. If purulent process is pronounced, then for treatment use antibiotics with a broad spectrum of activity.
Complications of lymphadenitis
This disease can provoke a number of complications. At the patient thrombophlebitis can be shown, purulent process can extend to kletchatochny spaces, also at the patient emergence of the metastatic centers of a purulent infection is possible.
Prevention of lymphadenitis
For prevention of lymphadenitis it is necessary to avoid injuries and wounds, it is rational to treat treatment of pyoinflammatory diseases. At patients with axillary lymphadenitis sepsis, subpektoralny phlegmon can be shown.