Acute mesenteric lymphadenitis.pptx

Lecture notes for medical students

1. Tips on using my ppt. You can freely download, edit, modify and put your name etc. Don’t be concerned about number of slides. Half the slides are blanks except for the title. First show the blank slides (eg. Aetiology ) > Ask students what they already know about ethology of today's topic. > Then show next slide which enumerates aetiologies. At the end rerun the show – show blank> ask questions > show next slide. This will be an ACTIVE LEARNING SESSION x three revisions. Good for self study also. See notes for bibliography.

2. Learning Objectives

3. Learning Objectives Introduction & History Relevant Anatomy, Physiology Aetiology Pathophysiology Pathology Classification Clinical Features Investigations Management Prevention Guidelines Take home messages

4. Introduction & History.

5. Introduction Mesenteric lymphadenitis refers to inflammation of the mesenteric lymph nodes. This process may be acute or chronic, depending on the causative agent. It causes a clinical presentation that is often difficult to differentiate from acute appendicitis

6. Aetiology

7. Aetiology Idiopathic Congenital/ Genetic Nutritional Deficiency/excess Traumatic Infections /Infestation Autoimmune Neoplastic (Benign/Malignant) Degenerative / lifestyle Iatrogenic Psychosomatic Poisoning/ Toxins/ Drug induced

8. Aetiology

9. Etiology Infections beta- hemolytic streptococcus Staphylococcus species Escherichia coli Streptococcus viridans Yersinia  species Mycobacterium tuberculosis Giardia lamblia ,  and non–  Salmonella  typhoid.

10. Etiology Infections :Virus Viruses, such as coxsackieviruses (A and B), rubeola virus, and adenovirus serotypes 1, 2, 3, 5, and 7, have been implicated. Epstein-Barr virus (EBV), acute human immunodeficiency virus (HIV) infection, and catscratch disease (CSD).

11. Pathophysiology

12. Pathophysiology The frequent association of this condition, especially in children with upper respiratory tract infection, has popularized a theory that swallowed pathogen-laden sputum may be the primary source of infection. Fecal -oral transmission occurs in  Y enterocolitica  infection and may present as a common source outbreak. This infection has also been associated with meat, milk, and water contamination. Rarely, person-to-person or zoonotic contacts with fecal carriers can lead to infection.

13. Pathophysiology Microbial agents are thought to gain access to the lymph nodes via the intestinal lymphatics . Grossly, the lymph nodes are enlarged and often soft. The adjourning mesentery may be edematous , with or without exudates Microscopically, the lymph nodes show nonspecific hyperplasia and, in suppurative infection, necrosis with numerous pus cells.

14. Clinical Features

15. Clinical Features Demography Symptoms Signs Prognosis Complications

16. Clinical Features Demography Up to 20% of patients undergoing appendectomy have been found to have nonspecific mesenteric adenitis. The condition affects males and females equally.  Yersinia  infection is more common in boys than in girls. ore common in children and adolescents younger than 15 years, and this condition during childhood or adolescence is linked to a significantly reduced risk of ulcerative colitis in adulthood.

17. Clinical Features Symptoms Abdominal pain - Often right lower quadrant (RLQ) but may be more diffuse Fever, Malaise,Anorexia Diarrhea Concomitant or antecedent upper respiratory tract infection Nausea and vomiting (which generally precedes abdominal pain, as compared to the sequence in appendicitis)

18. Clinical Features Signs Fever (38-38.5°C) Flushed appearance RLQ tenderness - Mild, with or without rebound tenderness Voluntary guarding rather than abdominal rigidity Rectal tenderness Rhinorrhea

19. Clinical Features Signs Hyperemic pharynx Toxic appearance Associated peripheral lymphadenopathy (usually cervical) in 20% of cases

20. Diagnostic Studies

21. Diagnostic Studies Imaging Studies X-Ray USG CT Angiography MRI Endoscopy Nuclear scan

22. Diagnostic Studies Laboratory Studies CBC count: Leucocytosis Serology can be supportive Urinalysis stool cultures Blood culture:

23. Diagnostic Studies Imaging Studies USG CT MRI Laparoscopy

24. Diagnostic Studies Histopathology Lymph node specimen: In patients subjected to laparotomy, lymph nodes may show evidence of inflammation or suppuration, and culture may yield a causative organism.

25. Differential Diagnosis

26. Differential Diagnosis Acute Pyelonephritis Appendicitis Benign Neoplasm of the Small Intestine Cholecystitis Chronic Mesenteric Ischemia Cystitis in Females Ectopic Pregnancy Inflammatory Bowel Disease Pelvic Inflammatory Disease Urinary Tract Infection in Males

27. Management

28. Management . Patients with mild, uncomplicated presentations do not require antibiotics, and supportive care generally suffices. General supportive care includes hydration and pain medication after excluding acute surgical abdomen. Empiric, broad-spectrum antibiotics

29. Operative Therapy

30. Operative Therapy Surgery is usually indicated in suppuration and/or abscess, with signs of peritonitis, or if acute appendicitis cannot be excluded with certainty. At laparotomy, the diagnosis is generally clear. An appendectomy should be performed in view of the tendency for recurrence of lymphadenitis and the difficulty in differentiating adenitis from appendicitis.

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