Lymphangitis, lymphadenitis, giant cell arteritis and polymyalgia rheumatica
Clin Med-CV test 2
Terms in this set (41)
What is lymphangitis?
inflammation of the lymph channels
What is the cause of lymphangitis?
wound infected w/ strep or staph
If the infection progresses what can result?
A red streak that extends from the wound or area of cellulitis towards a regional lymph node is a clinical finding in what disease process?
What are the characteristics of the regional lymph nodes in lymphangitis?
enlarged, tender and soft
What are sxs of lymphangitis?
throbbing pain, malaise, anorexia, sweating, chills and high fever
What will the CBC show in a pt w/ lymphangitis?
leukocytosis w/ a left shift
What other lab testing should be performed in a pt who you suspect lymphangitis in?
staph or strep
How can you distinguish thrombophlebitis from lymphangitis?
in thrombophlebitis, the induration is hardened
How can you distinguish cat scratch fever from lymphangitis?
in cat scratch fever the nodes will be non-tender
What is the treatment for lymphangitis?
hot compress, elevation of infected area, analgesia, and abx
What antibiotics should be considered for tx of lymphangitis?
cephalosporins, extended spectrum PCNS or trimeth sulfa
What is important in wound care?
debridement of any necrotic tissue
When should a pt w/ lymphangitis be hospitalized?
hospitalize any pt w/ streaking and start on iv abc
What is 2˚ lymphedema caused by?
trauma, lymph node resection, radiation or extensive involvement of lymph nodes by a malignant disease or filariasis
What is primary lymphedema caused by
caused by congenital abnormalities
What does lymphedema cause?
2˚ dilation of lymphatic channels which leads to incompetence of the valves which disrupts the normal flow of the vessels. This causes stasis of protein rich fluid and secondary fibrosis
What is the main clinical finding in lymph edema?
painless edema of the lower extremity
What the 1st sign that lymphedema is progressing?
pitting edema w/o ulceration, varicosities or stasis pigmentation
What happens as lymph edema progresses?
it will become non-pitting and in advanced stages there will be hypertrophy of the lymph
What tests are available for lymphedema diagnosis?
-lymphangiography and radioactive isotope studies (find focal defects in lymph flow)
-T2-weighted MRI (to identify obstruction masses)
What is the treatment for lymphedema?
supportive therapy: elevation, compression stockings, massage toward the trunk, prevent cellulitis through hygiene
Are diuretics helpful in lymphedema?
they can be used but rarely helpful
Complications of lymphedema?
amputation if lymphangiosarcoma develops
What age groups are Giant cell arteritis and polymyalgia rheumatica seen in?
pts >50 yrs
what are the main differences between giant cell arteritis and polymyalgia rheumatica?
giant cell arteritis causes blindness and needs HIGH dose steroids while polymyalgia rheumatica does NOT cause blindness and needs LOW dose steroids
What is the hallmark of diagnosis in polymyalgia rheumatica?
pain and stiffness in the shoulder and hips, lasting for weeks w/o explanation.
What is the difference btwn polymyalgia rheumatica and normal aging?
there is NO muscular weakness
What fraction of cases of polymyalgia rheumatica occur in isolation?
A pt presents w/ fever, malaise and weight loss. The pt complains of being unable to comb their hair. Upon physical exam you find joint swelling but no muscular weakness. What might these sxs suggest?
How will you treat the above pt?
prednisone 10-20mg (low dose)
What are some lab tests for polymyalgia rheumatica?
CBC, ESR, CRP
What is the treatment for Giant cell arteritis?
pred 60 mg
What do you prescribe to a pt that has giant cell arteritis and vision loss?
IV pulse methylpredinisolone
What are sxs of giant cell arteritis?
HA, scalp tenderness, jaw claudication, polymyalgia rheumatica, visual abnormalities (amaurosis fugax), increased ESR
A pt w/ giant cell arteritis presents w/ a cherry red stye....
they are likely to go blind
giant cell arteritis involved w/ the temporal artery
What are some complications of giant cell arteritis?
blindness, aneurysm of thoracic aorta,stenosis of subclavian, carotid and basilar arteries, subclinical large artery disease
In pts w/ giant cell arteritis, what is unusual about their high fever?
they have a normal WBC count
What do lab tests show in giant cell arteritis?
CBC-mild normochromic anemia, increased ESR, ALK P elevated
What should be performed if temporal arteritis is suspected?
biopsy of at least 2 cm long and unilateral. If positive do MR angiography or CT