Lymphatic System



Lymphatic System



Equipment



• Centimeter ruler


• Skin-marking pencil



Examination


The lymphatic system is examined by inspection and palpation, region by region, during the examination of other body systems, and by palpating the spleen. If enlarged nodes are found, inspect regions drained by nodes for infection or malignancy and examine other regions for enlargement.



Lymph Nodes Most Accessible to Inspection and Palpation


The more superficial the node, the more accessible it is to your palpation.














































































Technique Findings
Head and Neck
Inspect for visible nodes
Ask if patient is aware of any lumps. UNEXPECTED: Edema, erythema, red streaks, or lesions.
image
Palpate superficial nodes; note size, consistency, mobility, tenderness, warmth
Bend patient’s head slightly forward or to side. Palpate gently with pads of second, third, fourth fingers.
 EXPECTED: Nodes not palpable.
UNEXPECTED: Enlarged, tender, red or discolored, fixed, matted, inflamed, or warm nodes; increased vascularity.
image
Neck

 EXPECTED: Nodes not palpable.
UNEXPECTED: Enlarged, tender, red or discolored, fixed, matted, inflamed, or warm nodes; increased vascularity.

 UNEXPECTED: Detection of Virchow nodes.
Note: A palpable supraclavicular node should always make you suspect the probability of a malignancy.
Axillae
Inspect for visible nodes
Ask if patient is aware of any lumps. UNEXPECTED: Edema, erythema, red streaks, or lesions.
Palpate superficial nodes for size, consistency, mobility, tenderness, warmth
Using firm, deliberate, gentle touch, rotate fingertips and palm.  
Attempt to glide fingers beneath nodes.  
Axillary nodes
Support patient’s forearm and bring palm of examining hand flat into axilla. With palmar surface of fingers, reach deep into hollow, pushing firmly upward, then bring fingers down, rotating your fingers and gently rolling soft tissue against chest wall and axilla. Explore apex, medial, lateral aspects along rib cage; lateral aspects along upper surface of arm; and anterior and posterior walls of axilla. Repeat mirror image of this maneuver for the other axilla.
image		 EXPECTED: Nodes not palpable.
UNEXPECTED: Enlarged, tender, red or discolored, fixed, matted, inflamed, or warm nodes; increased vascularity.
Other Lymph Nodes
Inspect visible nodes
Ask if patient is aware of any lumps. UNEXPECTED: Edema, erythema, red streaks, or lesions.
Palpate superficial nodes for size, consistency, mobility, tenderness, warmth
Systematically palpate other areas, moving hand in circular fashion, probing without pressing hard. EXPECTED: Nodes not palpable.
UNEXPECTED: Enlarged, tender, red or discolored, fixed, matted, inflamed, or warm nodes; increased vascularity.

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