mesenteric lymphadenitis
Introduction
Introduction to mesenteric lymphadenitis Mesenteric lymphadenitis is generally thought to be caused by a blood stasis infection of streptococcus, and is also thought to be related to intestinal inflammation and parasitic diseases. More common in the end of the ileum. The lymph nodes showed multiple congestion and swelling. There may be a small amount of inflammatory exudate in the abdominal cavity. Under the microscope, the lymphatic sinus is dilated. The neutrophils enter the lymphatic sinus from small blood vessels and phagocytose bacteria. Some white blood cells can thus undergo degeneration and collapse, forming cell debris or denatured substances. The blood vessels in the lymph nodes also expand and congest, the germinal center hyperplasia, and the sinus cells and immunoblasts proliferate. The disease is more common in children under 7 years of age. The pathogenic microorganisms causing non-specific mesenteric lymphadenitis may be Staphylococcus (S. aureus), hemolytic streptococcus, Rhodococcus, pseudotuberculosis, Penicillium, virus, schistosomiasis, amoeba, and the like. The exact cause of the disease is unclear. Common in children or adolescents, and more common in the ileocecal lymph nodes. There are many lymph nodes in this area, especially children. Intestinal contents stay longer in the distal part of the ileum, and toxins and bacterial products are easily absorbed there to cause an acute inflammatory reaction of the lymph nodes. basic knowledge Sickness ratio: 0.05% Susceptible people: no specific people Mode of infection: non-infectious Complications: Intussusception Intestinal obstruction
Cause
Cause of mesenteric lymphadenitis
Cause:
The pathogenic microorganisms causing non-specific mesenteric lymphadenitis may be Staphylococcus (S. aureus), hemolytic streptococcus, Rhodococcus, pseudotuberculosis, Penicillium, virus, schistosomiasis, amoeba, and the like. The exact cause of the disease is unclear. Common in children or adolescents, and more common in the ileocecal lymph nodes. There are many lymph nodes in this area, especially children. Intestinal contents stay longer in the distal part of the ileum, and toxins and bacterial products are easily absorbed there to cause an acute inflammatory reaction of the lymph nodes.
In addition, some people think that the patient often feels tired, discomfort and symptoms of upper respiratory tract inflammation 1 to 2 days before the onset of the disease, so it is thought to be caused by the infection of streptococcus. Some authors believe that toxemia is the key to the pathogenesis of mesenteric lymphadenitis, but there is no bacterial growth in lymph node culture. Acute mesenteric lymphadenitis is more common in children under 7 years of age. Before the onset, there are often forehead symptoms such as sore throat, fever, fatigue and discomfort, and then umbilical and right lower quadrant pain, nausea, vomiting, and sometimes diarrhea or constipation. Such an onset process is exactly the opposite of fever after acute appendicitis, and the body temperature rises sharply in the early stage of the disease. At the time of physical examination, there may be tenderness in the umbilicus and the right lower abdomen. The range is wider and the tender point is not fixed. Because the abdominal muscles are not developed, the abdominal muscle tension may not be obvious. Sometimes a small nodular mass can be found. The white blood cell count is increased or normal. If it is caused by streptococci, the abdominal cavity puncture can draw a thin grass green liquid, and the smear can find Gram-positive cocci. Epidemiology This disease is rare in clinical practice and can occur at any age, but it is mainly found in children and adolescents. It is one of the important causes of acute abdominal pain in children.
Prevention
Mesenteric lymphadenitis prevention
1, mesenteric lymphadenitis is mostly a viral infection, often in the course of acute upper respiratory tract infection, or secondary to intestinal inflammation. Therefore, usually pay attention to prevent colds and fever and pay attention to diet.
2, prognosis: the disease has a good prognosis, often naturally relieved within 3 to 4 days.
3. Prevention: For patients with fever, especially children and young adults, if there are prodromal symptoms of upper respiratory tract infection, antiviral and anti-infective treatment should be carried out immediately to prevent acute non-specific mesenteric lymphadenitis.
Complication
Mesenteric lymphadenitis complications Complications, intussusception, intestinal obstruction
complication:
Often the complications of upper respiratory tract infection, because children have more vomiting, eating less, so water, electrolyte disorders are common; some patients may have intussusception, intestinal obstruction.
Symptom
Mesenteric lymphadenitis symptoms Common symptoms Abdominal tenderness Unexplained fever Fever accompanied by abdominal pain,... Sore throat constipation
Symptoms and signs:
1. There is sore throat, burnout discomfort after upper respiratory tract infection, followed by fever, abdominal pain, vomiting, sometimes accompanied by diarrhea or constipation. About 22% of sick children have cervical lymphadenopathy.
2, abdominal pain is the earliest symptoms of this disease, can be in any part, but because the lesion mainly invades a group of lymph nodes in the terminal ileum, it is common in the right lower abdomen, the nature of abdominal pain is not fixed, can be expressed as pain or spastic pain, in Children with two pain intervals felt better. The most sensitive tender parts may be different from each physical examination. The tenderness is close to the midline or high. It is not fixed like acute appendicitis, and the degree is milder than acute appendicitis. There is little rebound tenderness and abdominal muscle tension. Occasionally, a small nodular mass with tenderness can be found in the right lower abdomen, which is a swollen mesenteric lymph node. Some patients may have intestinal obstruction and should be observed.
3, younger children with clinical symptoms similar to appendicitis, but the condition is mild, and without abdominal muscle tension, acute mesenteric lymphadenitis should be considered, usually after fasting, intravenous infusion, antibiotics, etc. Significantly improved, no need for surgery. However, it is sometimes difficult to identify with appendicitis. It is advisable to perform surgical exploration if the symptoms are not improved.
4, before the onset of sore throat, fever, burnout discomfort and other forequarters symptoms will appear umbilical and right lower quadrant pain, nausea, vomiting, sometimes diarrhea or constipation. Such an onset process is exactly the opposite of fever after acute appendicitis, and the body temperature rises sharply in the early stage of the disease. At the time of physical examination, there may be tenderness in the umbilicus and the right lower abdomen. The range is wider and the tender point is not fixed. Because the abdominal muscles are not developed, the abdominal muscle tension may not be obvious. Sometimes a small nodular mass can be found. The white blood cell count is increased or normal. If it is caused by streptococcus, abdominal puncture can draw a thin grass green liquid, smear can find Gram-positive cocci.
5, often 1 to 2 days before the onset of symptoms of general malaise, sore throat, fever and other symptoms of upper respiratory tract infection. Then there is abdominal pain, the lower abdomen and the umbilicus, often paroxysmal, such as twisted. Suffering from pain after eating can vomit food. Physical examination revealed flushing of the face, pale lips, congestion of the pharynx, and abdominal tenderness from the lower right to the upper left, but obliquely in the right lower abdomen, with no muscle tension and rebound tenderness. Children with thin skin can sometimes reach enlarged lymph nodes. Clinically, it must be differentiated from acute appendicitis. The former is generally abdominal pain after fever, metastatic abdominal pain is not obvious, abdominal pain is often not limited, white blood cell count is not obvious; the latter mostly metastatic right lower abdominal pain, persistent, nausea, vomiting is more obvious, right lower abdomen tenderness limitation, Often accompanied by abdominal muscle tension and rebound tenderness, white blood cell counts are significantly increased. Typical cases are generally not difficult to identify. However, identification may be difficult when young children are not very cooperative or unable to describe the condition.
Examine
Examination of mesenteric lymphadenitis
1, the history of the disease often precedes the upper respiratory tract infection, intestinal infection, cervical lymphadenitis and other medical history.
2. Symptoms are similar to acute appendicitis. Mainly manifested as abdominal pain, can occur in any part, more common in the lower right abdomen, mesenteric lymphadenitis B ultrasound picture occasionally showed metastatic right lower abdominal pain, the nature of pain or spastic pain, to a lesser extent, more tolerable. During the onset of pain, the patient may have no other discomfort, and some patients may be accompanied by nausea, vomiting, diarrhea or constipation. There is fever at the beginning of the disease, and the body temperature usually does not exceed 39 °C. The disease can be recurrent, but mostly self-limiting.
Diagnosis
Diagnosis and differentiation of mesenteric lymphadenitis
First, the basis of diagnosis
1, mostly in the upper respiratory tract infection or intestinal infection with fever, abdominal pain, vomiting and other performance.
2, abdominal pain is common in the right lower quadrant pain, paroxysmal, spastic pain, rebound tenderness and abdominal muscle tension are rare.
3, abdominal tenderness is not fixed, can change with body position changes.
4, ultrasound examination showed mesenteric lymphadenopathy.
Second, diseases that are easily misdiagnosed:
Excessive peristalsis, intestinal ascariasis, and other causes of abdominal pain should be excluded.
1, acute appendicitis: the two symptoms are similar, but acute mesenteric lymphadenitis is milder, the onset is slower. Typical appendicitis patients have metastatic right lower abdominal pain, fixed tenderness and rebound tenderness in the right lower abdomen, and abdominal muscle tension. The total number of white blood cells and neutrophils increased.
2, tuberculous mesenteric lymphadenitis: slow onset, in addition to abdominal pain, fever, often have night sweats, weight loss, loss of appetite and other symptoms of tuberculosis, accompanied by other parts of tuberculosis infection, tuberculin test or tuberculosis antibodies, etc. For identification.
3, infectious mononucleosis: mesenteric lymphadenopathy may also occur, but often accompanied by cervical lymphadenopathy, splenomegaly, examination of atypical lymphocytes, cold agglutinin, Epstein-Barr virus titer, etc. is conducive to diagnosis.
4, the disease is easy to be confused with acute appendicitis. Patients generally have genital mesenteric lymphadenitis after fever, metastatic abdominal pain is not obvious, abdominal pain is often not limited, white blood cell count is not obvious; the latter mostly metastatic right lower abdominal pain, persistent. Nausea and vomiting are more obvious, and the lower right abdomen is limited by tenderness, often accompanied by abdominal muscle tension and rebound tenderness. The white blood cell count was significantly increased. In addition, the disease should be differentiated from intestinal tumors, ovarian tumors, tuberculous lymphadenitis, Crohn's disease, Yersinia enteritis and Yersinia lymphadenitis. Children with acute mesenteric lymphadenitis and acute appendicitis have many similarities, can be expressed as lower right abdominal pain, fever, etc., easily misdiagnosed, but each has its own characteristics.
