Steps of improvement of lymph universities of the classification. Causes of pathological changes. Methods of morphological education of lymphatic universities.

lymphadenopathy shiny lymph nodesє a pathological camp, as a result of the development of how people grow up, in this particular way.

Lymphatic system - the price of a part of sukupnostі sudin, scho vikonuє kilka important functions from the regulation of speech exchange, cleansing the cells and tissues of the body from all kinds of bacteria, as it will also prevent normal cell circulation of lymphocytes (specific cells, from which the immune system of humans is stored). To the warehouse lymphatic systems enter blood vessels, capillaries, lymph nodes and ducts.

The development of lymphadenopathy is seen as a result of the presence of people who are ill, as they may think about the nature of their walk. In addition, such a pathology in the course of its progress can be tolerated by an ill-fated interruption. Because of the fact that lymphadenopathy is established on the development of diseaseless pathological processes in the body of people, then the patient with such ailments is guilty of undergoing medical treatment in children. They are referred to hematologists, infectious diseases, oncologists and others.

Khvoroba, provoking the development of universities in the lymphatic system, may not only be hostile to those who are lymph nodes, but they have been rooted in some people.

With a lot of lymphadenopathy, the internal organs.

Providing the diagnosis of pathology and form

Pathological camp, in the process of development of how to develop lymphatic universities I will call it that, yak hyperplasia. Similar to the kind of reaction to the body, it is nonspecific and may appear as a result of all kinds of officials who pour it on. Most often the improvement of lymph nodes takes the offensive reasons:

1. frankness young people viral and autoimmune walking.
2. Trivial reception of any medical supplies and drugs. Overwhelmingly the consumption of medications is not often provoking the development of syrovatkovy ailments, tobto pathology, which leads to the development of malignant diseases.
3. Osvita ignition processes in the universities of lymphatic systems as a result of infection with all kinds of infectious microorganisms.
4. Cutting lymphoid tissues to organisms with fungal agents.
5. Evidence of pathological infectious nature, which negatively infuses into the mill immune system people. To such ailments it is possible to bring the state of respiratory viral infections.

Krim tsyogo, lymphadenopathy shi can mother yak gostre, so i chronic overrun... At the same time state form The development of the pathological process of the symptomatology in the main good is rotated, at that time it is practical not to supervise any kind of critical signs.

Lymphadenopathy in children

In the main, it can develop in any kind of independent state of belonging to the people, however, the most often also become ill with the enemies of children. It’s tied with that, but in a child’s life, and more precisely up to 12 years, the child’s system is lymphatic because it’s immature, it’s like it’s shaped like a baby during the period of the internal uterine development of the fetus. To this, through the impermanence of lymphodenopathy, children are the most powerful until lymphodenopathy is diagnosed.

When 1 fate of life is reached, the baby is more likely to develop regional growth of lymph nodes, groin, and lymph nodes. At the same time, such a period becomes the most insecure for the health of the child, since its organism is still weak in order to stand up against infectious pathologies. For older children, the norm is 2 or 3 groups of universities of the lymphatic system.

Ale, tim not mensh, the child wants a single lymph node, you can talk about the manifestation of various systemic pathologies in your body, which is impossible without respect!

diagnostics

On the verge of lymphodenopathy, he is guilty of taking care of only one doctor in the course of taking a second look at the sick person. At the same time, if in the process of the patient's treatment the doctor will see the growth of the lymph universities, then for the purpose of the factor, which provoking the diagnosis of such a pathological camp, the ailing one will need to destroy zagalny analiz and blood. Krym, the patient will be given additional blood donation for detection in new HIV infection and hepatitis. At the same time, in order to diagnose and identify the cause of the increase in lymphatic universities, people will need to go through a number of instrumental procedures, before which are applied:

1. Computer tomography (CT), radiography abo ultrasound dosage(SPL) shyny viddilu... For the addition of carrying out one of such diagnostic techniques, it is possible to establish what the same (glib or surface) university of the lymphatic system of attacks, and the importance of its size characteristics.
2. Biopsy of a fiery university. Such a procedure is a puncture of a lymphatic university with the help of a special syringe, in order to get rid of the tissue. To be careful in order to get rid of it in laboratory minds and find out the cause of the diagnosis of lymphadenopathy by ourselves.

Not less important is the role in the diagnosis of such a sick child. For example, children have inflamed lymphoid fabrics and are most often seen as a result of getting into the system of any infections. In such a rank, vikhodit, scho ailment in the main is infectious in nature. As soon as the patient changes 35 years old, then it is more for all the reason, which provoked the diagnosis of lymphodenopathy, if the people of old fungal, bacterial or viral pathologies are evident. When someone is older than a sick person, it’s a matter of fact that, as well as sickness in a new chronic interruption, it is significant to move. The development of lymphadenopathy in people, for which there are 40 types of changes, in most cases are attributed to the progress of any pathologies of an oncological nature.

Krim tsyogo, when staging a diagnosis, it is especially respectful to turn to rupture, consistency and size ignited limfovuzla... For example, if the damage to the lymphatic universities is changed in their sizes of 2 cm, then in such a way the patient needs to fix it.

Symptoms of pathological development of lymphatic universities

The main clinical familiarity with the prevention of lymphodenopathy in the shia є the development of universities in the lymphatic system, as with the whole supervising of the offensive:

• when carrying out palpation, the university may have a strong soreness;
• there is a strong swelling from the side of the burnt lymph fabric;
• shkirnі pokrivi in ​​mіstyakh nabrya will melt a red vidtinka.

Symptoms and symptoms appear to lie because the reasons provoked the diagnosis of the main ailment, and in the area of ​​localization of the pathological process. Prior to the broadest sign of lymphadenopathy, the following should be applied:

1. Viniknennya shkirnykh visipan from the side of fired universities, poyava children... Such symptoms are encouraged to indicate the presence of sick children with infectious pathologies.
2. Diseases seen in the slopes and destructions. Even with protracted lymphadenopathy in humans, there is a tendency to swell pain, then there can be indications of the development of any ailments from other tissues, for example, such as rheumatoid arthritis I.
3. Hepatosplenomegaly (pathological increase in the size of the spleen and liver). Most often, the diagnosis of such a symptom is tied to the virulent nature of the appearance of lymphadenopathy. Up to one z vyrusnyh zhvoryuvan, I can provoke inflammation of lymph nodes, blood cancer and mononucleosis can be carried.
4. Indigestion and attack-like cough. In addition, the ignition process is not rapidly expanding to the intrathoracic lymph nodes. This is also the phenomenon of vinikє in times, as the main reason for the destruction of lymphoid tissue in the body was the manifestation of a person suffering from tuberculosis, for some malignant neoplasms in the breast.
5. The appearance of sore eyes in the throat, vuha, as well as nasal congestion. Provoking the approval of such key signs of lymphadenopathy can develop in people of all ENT-ailments, including tonsillitis, sinusitis, otitis media and other pathologies.

Methods for the treatment of lymphatic disease

Lymphadenopathy treatment exact reason, Yaka provoked the diagnosis of a pathological process, і її povne usunennya. The tactics, vicariously, was used to reduce the main ailment, if the skin patient wakes up and becomes more likely to become lymphoma from nature. For example, if there is such a disease of the disease on the patient's obvious ailments, then the sick person will be recognized as a standard medication scheme for drug use, as transferring the stagnation of older anti-Russian and antibacterial diseases. When you reach an important interruption of lymphadenopathy, patients can be hospitalized, de you will be shown a victorian of internal dots.

Yakscho w patologіchne zbіlshennya Shiin lіmfatichnih vuzlіv steel vnaslіdok rozvitku in organіzmі Lyudin rіznih systemically patologіy, vrazhayuchih spoluchnu tkaninu, in such vipadku in yakostі їh lіkuvannya dotsіlno vikoristovuvati gormonosoderzhaschіh drugs i cytostatics (grupa medikamentіv, mainly zavdannya yakih polyagaє in galmuvannі patologіchnogo rozrostannya spoluchnoї tkanini) ... However, storing such problems can provoke the patient's accusations of important side reactions and acceleration. To that, self-treatment with cytostatic drugs cannot be carried out in any case. Coristinating with such medicines can only be done because the drug itself has designated it to the ailment.

Calling the treatment scheme is necessary to be victorious, as lymphadenopathy is due to the manifestation of the patient's puffy new foods. The main methodology for usuning the evil process is the victorious treatment of chemotherapy procedures and the surgical vision of plump education. If you want to go to the place of the effective treatment the patient is guilty of maintaining a permanent medical control with the help of an increase in the possible relapse of the pathological process.

The limit of drug treatment for lymphadenopathy is clear and in ways folk medicine, Scho allow zmenshiti to show ailments. However, in order to achieve a positive result, it is necessary to be victorious at the same time with the main treatment and only with the permission of the doctor!

Lymph nodes function as a filter, which will eliminate pathogenic microorganisms and reproduce. The stink of the snail mill is absolutely painless, visually not visible, the size is not bigger than a pea. Firing lymph nodes under the slit (submandibular lymphadenopathy) mouthwash and larynx. Deprived organ zhooply zbudnikіv ailments and zapobіgє їх widening in all organism.

Reasons for the development of lymphadenopathy

The main reasons for burning lymph nodes:

• Infectious diseases: Rubella, flu, stomatitis, tonsilitis;
• Vich infection;
• weakening immunity;
• oncological illness;
• mechanical injuries;
• herpes simplex virus;
• sharpened teeth with caries;
• chronic illness of ENT organs.

At the stage of broadening, the pathology is localized, generalized or regionalized. With a localized type, one lymph node is defeated, the form of an organisation is generalized in a gap, in the country, in the area of ​​the head. Regional lymphadenopathy is characterized by symmetric lesions of universities.

For example, in case of angina fired up the gap between lymph nodes from both sides. And in case of pulpitis or alveolitis, there will be only one organ, but there will be only one organ in the presence of infection. With parotitis or toxoplasmosis, a few groups of universities are involved in the process.

The main symptoms of pediatric lymphadenopathy

Most often, pathology is diagnosed in young children and in the elderly, if the immune system is most weakened and inflamed. On the first plan, there are signs of the main ailment, like a firing process in a lymph fabric.

Clinical symptoms of lymphadenopathy:

• low-grade fever;
• improvement of lymph nodes under the lower slot;
• vuzli sore on palpation;
• uncomfortable seeing before the hour of prokovtuvannya їzhі, іdkrivannya company.

Such symptoms do not cause great discomfort and are a little like the main disease. Alle, all the central universities will be asked to accept the approval of the masses, and show their best. Shkirni twist the chervonyut, get hot on the dot, grow temporal temperature tila. Vuzol is soft, ruddy, it hurts a lot, especially before the hour, growling. Symptoms of intoxication to the body will be accepted.

sick teeth

The caries of the tooth wicker into special microorganisms, which make the dull ball of the emerald, and then penetrate into the larger ball of the dentine. As a result of the life of the bacteria, toxins are violated, which can cause the tooth to burn. If the caries grows into pulp, the inflammation of the nerve fibers, glibous tissues of the periodontium appears. The embryo is clear, individuals that grow more and more lymph nodes.

This process is especially not safe in case of pathologies of the tooth of wisdom, as it is in the process of growing close to the great blood-bearing vessels. Potency can be consumed in the bloodstream and sepsis.

Firing lymfovuzole will grow in size, it can be easily missed. With a lot of vinik uncomfortable vision. The body has a strong consistency, ruhlivy.

Faint teeth and clear, as there can be vicious firing of lymph nodes:

• pulp;
• periodontitis;
• tooth root cyst;
• gingivit;
• alveolitis;
• gn_yny per_ostitis (flux);
• rebuild.

I will always be respected for the symptoms and for the loss of mouth emptying, for the swelling of the lymph nodes to pass step by step. In neglected vipads, gnarly lymphadenitis develops, the vuzol hurts badly, grows in size, the temperature rises, and the temperature rises. In the world of progressing pathology, the embryo is established in the shia, in the clavicular region.

ENT infection

Viclikati zapalennya pіdkhelepny lіmphozlіv can not only teeth. The reason may be the condition of the throat, nose or throat. Gostriy tonsilitis (angina), otitis media or sinusitis can also be produced to the growth of universities before the lower gap.

With angina, patients have pain, sore throat, turbulent dry abnormal cough. Ignite the mucous membranes of the larynx, flashlights, Regional lymph nodes. If otitis media develop, then it hurts a lot, shoots in vusi, discomfort in the eyes expands into the region of the head, lower slit, shia.

In case of sinusitis, it is painful to hurt, the zone of hypochondria and mizh briv, there is a gnarly rhinitis, the scent collapses. The chronic form of a congestion may cause more symptoms, the presence of a nasal congestion, periodically pathology becomes stricken.

If the lymph nodes do not cope with their function, they will be able to see the growth of their development, the illumination of the process, there will be a problem in the economy. The self-feeling of the ailing one is lost. The process can start the order of the lymph nodes.

on cob stage ailment I see a weakness, nezduzhannya, b_l in myazah. Such symptoms can be diagnosed from deciliters to decimals. As the temperature rises, lymphadenopathy develops, in all cases there is a visip on the screen.

Diagnostics and treatment of lymphadenopathy

If there is a reason for burning and correct lіkuvannya, Likar to look around and to the patient's medical records. On the receipt of a license, a promising area is inflamed, due to the consistency and rupture of universities, zyasovu, the involvement of regional organizations in the pathological process. Make a name without pratsi to emerge mainly to get sick, as it is necessary to have a term lіkuvati, so that you do not allow the development of gnіy lіmphadenitis.

The delivery of laboratory analyzes of blood and slaughter, ultrasound examination, computer tomography, Biopsia.

For the cause of lymphadenopathy, infection, viruses, fungal disease For the problem of the tooth, it is the solution of the main problem and the result of the reduction of the burning and the development of ailments. When you are suspected of oncological processes, take biomaterial from a heated university and conduct a biopsy - a price analysis for the detection of cancer cells.

Likuvannya prescribes a therapist, ENT, dentist, surgeon, oncologist or an infectious disease specialist in the presence of pathology. With a state of fire, antibiotics, antibiotics, antibacterial drugs, Antіmіkotyki.

Likuvati firing lymph nodes in case of ruptured tooth, stomatitis, periodontitis, alveolitis, crown retention is required from a dentist. An ailment tooth is being filled, or it is seen, the lykuvannya of mucous membranes should be carried out for the help of antiseptic rinsing;

Iakshcho ill health is neglected, developing gnarly lymphadenitis, and pathology is required by the way of the surgical center of the university for the circulation of necrotic mass. The organ is flushed and drainage from the soft gumi. Complex therapy for ailments to pass drug treatment: Antibiotics, anesthetics, antibiotics.

It is not possible to l_kuvati lіmfovuzli with winterizing compresses, as much as possible to energize, speed up the approval of the masses!

Firing lymph nodes under the lower slit є the reaction of the organism to the penetration of pathogenic microorganisms. Organize lymphatic systems and absorb bacteria, do not allow them to actively multiply and expand throughout the entire body. Chance to find the main ailment, the weakening of the cause of the pathology of the change ignition process, Zapobіgaє development accelerated.

Have great people on shii limfovuzli are not washed. When palpation (promatsuvanny), it is possible to penetrate the important elements of the immune system only in the groin, in the groin depressions and under the lower gap. Increase the stench in case of diagnosed problems with health.

If the transverse size is 1 cm, it’s already awkward to slip or to wind it through the screen. It would not become the reason for the increase in lymph nodes, such a camp is called lymphadenopathy. The development of this syndrome in the area of ​​\ u200b \ u200bthe main source of \ u200b \ u200bvimaghag respect and most often - a qualified drug.

Mechanism of development that vidi

Even more forgiven, lymph nodes are a kind of lymph system, like one hour by the most important structures for immunity. They see immunocompetent cells, captured foreign particles (antigens) are invariably implanted, allowing lymphocytes to virobate specific antigens.

Getting a foreign cloth in a university is a teacher for immunity. At the end of the process, the lymph fabric is being repaired intensively and, apparently, it has grown.

Stan, with which the lymph node is obsessed, is called hyperplasia.

This reaction is not specific. Tobto, you can win on the only pathological processes. Most often hyperplasia of lymph nodes in supervoltage:

• Stimulation of immune responses by non-microbial factors.
• Infectious disease (state abo chronic).
• Puffs of hematopoietic and lymphoid systems.
• Metastasis of malignant neoplasms.

Be it from the cycle of pathological conditions of the development of hyperplasia of lymphoid tissue. Such a symptom can be found in decilcochs, in one form of one person (for example, groin and lymphadenopathy), and to talk about generalized lymphadenopathy. The growth of only one group or a single university is called regional lymphadenopathy.

Shiina lymphadenopathy can be either isolated or supported in a generalized process.

anatomical features

In the area of ​​\ u200b \ u200bthe wider gathering and filtering of the lymph from the deciles to the body. According to the current and high tide, we see the following groups of lymph nodes:

• Anterior surfaces.
• Anterior gliboks.
• Bichni (lateral) surfaces.
• Bichni gliboks.

Fallow growth and glibini zalagannya, stench filter lymph rіznih mісць: ENT organs, empty company, mov, thyroid gland that іnshih. Isolated pathology in one of the structures to produce local hyperplasia shiinyh universities.

Systemic discomfiture, in case of which there is a small amount of disease, or the whole body, is supervised by generalized lymphadenopathy.

regional processes

Shiyni universities are most often connected with bacterial or external infections. Significantly, the disease is isolated as a symptom of autoimmune abnormal oncological processes.

Be it fired up changes in the areas of electricity flow, wicked in response to reactions from nearby universities. In the case of infection, it is so called reactive lymphadenopathy that is called reactive lymphadenopathy: when it does not, the university itself does not fight, but its tissue grows in response to the infusion of an infectious agent. So, local hyperplasia is often caused by:

• Scarlet fever.
• Differentiation.
• Ailments of the kitty's grubby (Felinosis).
• Tuberculosis.
• Syphilis.
• Tularemia.
• Karinci.
• Anginakh.
• Gostrykh and chronicle sickness.
• Fungal infections empty company and upper dikhalnyh nobles.

Before the turnover, far from all infectious diseases are included, for which hyperplasia of high lymphatic universities is indicated.

The fast development of hyperplasia is more favorable for gostrich інфекція(Angina, diphtheria, scarlet fever). It’s not easy to get overwhelmed great views in the area of ​​efficient lymph nodes. Significantly, there are signs and symptoms: increased temperature, sore throat, cough and cough.

Universities are often and uncomfortable to grow in case of chronic and chronic processes (boreliasis, syphilis, tuberculosis). These types of messages about reactive hyperplasia do not exist: they mean the multiplication of the student in the middle of the university, which in the bag can increase its functionality. Moreover, lymfovuzole itself becomes a disease of infection (typical for tuberculosis) and requires no surgical treatment due to its visualization.

Symptoms of hyperplasia in the case of one pathology may contradict in a different way in the period of illness.

Knowing about that, according to the size of lymph nodes, it is possible to assess the dynamics of the side of the main disease and the effectiveness of the indicated therapeutic scheme.

Systemic discomfort

Tsya category basically includes autoimmunity. Ailments from the full fabric of the blood system, and so on, inject lymph fabric into the mill. Lymphadenopathy can be one of the symptoms when:

• Rheumatoid arthritis.
• Systemic chervonia vovchak.
• Ailments accumulated (amiloidosis).
• Sarcoidosis.

Common lymph nodes can be increased in the small boundaries: from 1 to 5 cm and more. Let us consider those who do not indicate painful symptoms. On the dot, the consistency of the universities does not change, or the stench grows shitty. You can become loose around the world or solder between yourself and with navkolishny fabrics, molding bags.

Reliable diagnostics of systemic ailments without laboratory tests instrumental methods not merciful. Lіkuvannya trivale, vimagає post-compliance and control.

oncological processes

In the body of people, everything is interconnected, especially rare tissues - blood and lymphs. To that, in the middle of plump ailments, most often shiyni limfovuzli grow in two types:

1. Introduction of metastases from adjacent or distant pukhlin.
2. Hemoblastosis is an evil or chronic disease of the blood and blood-forming system.

In medical descriptions of the disease of long-term metastases in lymph nodes in the lactic acidosis cancer, in the cerebral membranes, in the other organs.

It will remain an hour to see the growth of the hematopoietic system grow. Gostri leukozy vrazhayut cystic brain, Zmіnyuchi leukocyte storage of blood. Lymphoid fabrics on universities in the future will grow up to compensate for the lack of maturity of sick clients.

In the presence of an infusion, leukemia can turn into chronic form... Before the hour of remission, the shiyny universities are ready to turn to the norm. Repeated aggravation can become the first symptom of sharpening.

may you expedite

Infectious disease in one of the options can be affected by hospitality in one of the options. In such a vipad it is already talking about lіmphadenitis. Limfovuzol is getting sick, the shkira above him is chervonin. I don’t have to live any therapeutic visits, є risky development of not uncomfortable phlegmon of shia.

Infections, metastases, and systemic discomforts can lead to gluten-free lymph nodes in the conglomeration. If you need help from a doctor, you may need help from a surgeon.

Childish vik

Immunity childish immunity does not adequately respond to new children. In Pershu Cherga, the most common and microbial sickness. Unsplit children are fed to the great rizik for the not uncomfortable ailment - diphtheria. At the same time, the anterior lymph nodes often increase.

The practitioner has to get stuck with streptococcal tonsilitis (angina). Infectious mononucleosis (Epstein-Barr's ailment) is not often detected from the "common" infections. Systemic illness, such as juvenile rheumatoid arthritis, also characteristic of childish vik... It is necessary to remember that for an hour the oncological processes have “rejuvenated”.

Isolation of children to visit a single university on their children can be indicative of the importance of systemic problems. To that lymphadenopathy in children is not at all guilty of being lost without respect.

diagnostics come in

Depend on the memory required, that the improvement of lymph nodes in the country is only a symptom of the disease. Viyaviti dzherelo or the cause of this phenomenon will be able to be easily navigated in specials medical institutions, And without instrumental i laboratory dosages- just uncomfortable.

An approximate diagnostic turn includes:

• Zagalny blood analysis. Shukayut snakes from a clerical warehouse, SHOE.
• Biochemistry until the end of the day is allowed to change the range of food, specific for the sick people.
• Analysis for antigenes to viruses and malignant cells.
• X-ray or computer tomography.
• The point of the biopsy of the urazhenny university is based on the best diagnostic data.

Punctuation of lymph nodes allows you to take a piece of tissue for histological reading. Most often it is also possible to allow the development of metastases from hemoblastosis.

However, you may not be able to quickly make an accurate diagnosis. Too vikoristovyutsya additional methods, which are guilty of picking up a license.

therapeutic come in

Kintsevoy meta be-like likuvannya є oduzhannya. In case of growing universities, it is necessary to know in the first place, and then - to put down the reason why you have woken up with a symptom. Beast of respect, some of the different mechanisms can lie at the base of that deception.

State of the Infectious Disease in consultation with a therapist, a sign of anti-microbial anti-tartar drugs... At the time of a difficult interruption, a hospitalization, internal dribblers is shown.

Cytostatics and hormones are widely stagnated in lykuvanny systemic diseases with the resulting tissue. Thoughtless self-righteousness can be very important side reactionsі provide faster development. In case of infectious processes, the stench is often just a contraindication.

It is not effective to treat puhlin maloimovirno without victorious surgical practices. Hemoblastosis can be subject to special chemotherapy and continuous control regimens.

It is impossible to forget about reactive changes in lymph nodes, as all the superfluous is not tied to blood or pathology. The growth of lymph nodes to come back to normal only after the weakening of the cause, as if it wouldn’t have been.

That is, when "bumps" appear, or those rounded gaps in the region, it is necessary to safely go to the doctors to carry out a qualified look, laboratory diagnostics and the sign of adequate treatment.

The statistic presents a classification (localized and generalized form) and causes of lymphadenopathies (nonspecific and specific infections, systemic and allergic diseases, malignant swelling). An algorithm for the differential diagnosis of lymphadenopathies in children, including anamnesis, clinical examination and laboratory-instrumental diagnostics, has been introduced. Particular respect is given to the nutrition of the differential diagnosis of infectious and neoplastic eradication of lymphatic universities and tactics of a doctor when a child has malignant poop.

Key words:children, lymphadenopathy, classification, reasons, differential diagnosis.

A.M.OZHEGOV

Izhevsk State Medical Academy

Differential diagnostics of lymphadenopathy in children

The article gives the classification (localized and generalized forms) and explaines the causes of lymphadenopathy (non-specific and specific infections, system and allergic diseases, malignant tumors). The algorithm of differential diagnosis of lymphadenopathy in children, including clinical history, clinical examination and laboratory and instrumental investigations are given. Particular attention is paid to the differential diagnosis of infectious and neoplastic lymphadenopathy and tactics of a doctor when assuming a malignant tumor in a child.

Key words:children, lymphadenopathy, classification, causes, differential diagnosis.

Lymphadenopathy (paws) - one of the most frequent pathological stanis in CLINIC PRACTICE... From the paws of the mind, be it the change of lymphatic universities (LU) for size, and / or consistency, and / or quantity. This is an important and important role, LU is one of the first to take the path of widening infections and foreign antigens (allergens, puffy cells, etc.). The very same paws є some of the early symptoms of infectious, allergic, systemic, chubby and others ill. For a successful diagnosis of the cause of the paws of a pediatrician, it is necessary to develop information in the area of ​​near-border pathology.

In total, people have close to 600 lymphatic universities, which grow in groups of universities. Normally, you can vvazat the camp, as long as you are not more than three groups of LUs (food, groin and groin). The size is less than 1 cm, the stench is crumbling, soft and painless.

Classification of paws nosological forms, Shu supervodzhuyutsya urazhennyam LU. In clinical practice, the most manual and simple process of seeing localized and generalized paws (Fig. 1). Prior to the generalized paws, the LU can be cut in two or more inane areas (for example, shiin and groin, groin and groin). Localized paws - striking LU in one or two sumy anatomical zones. In case of a large illness, it is important to override one or more decile groups of the LU. More important is the value for any reason Paws on ignition and neoplastic, specific and non-specific.

It is well known from the literature that the middle of children with unspecified paws is close to becoming localized (lymph nodes of the head and shoulder - 55%, groin - 14%, groin - 5%, supraclavicular - 1%);

The causes of paws in children are shown in Fig. 1.

Malunok 1.

Causes of lymphadenopathies in children

It is a common cause of an increase in peripheral LU in children with a virus or bacterial infection. Significantly, it is possible to diagnose the diagnosis of systemic immunological and oncological illnesses. Nareshty, a number of altogether rare diseases, but not to enter until the changes in pathogenetic groups, can also supervise the changes in peripheral LUs (sarcoidosis, accumulation of paws, immunodeficiency, ailments).

If paws are evident, for everything, it is necessary to assess whether or not it is a variant of norms or a manifestation of some kind of ill-health. For the whole necessary medical history, a respectful physical examination and standard laboratory techniques. It’s not a tribute to anybody, it’s possible to use a systematic or malignant disease, it’s recommended to be careful and repeated.

In case of adolescence on the bacterial firing of the LU, it is necessary to conduct a course of antibacterial therapy with an assessment of the effect, nutritional information about the need surgical treatment... The type of muscle therapy (thermal procedures, UHF) must be taken care of. Naybіlsh physiological є independent development of the LU.

Greater detail and degradation of the situation is necessary for the identification and verification of the cause of the paws, such as a syndrome, such as a supernatural disease, or a systemic discomfort, or an ailment of a lymphatic evil system, a good-natured and malignant. In the differential diagnosis of paws, the key value is an analysis of scarg, anamnesis and data of objectival conditioning.

skargi on the appearance of a sore swelling, or a "bump", one often feels the signs of an intangible intoxication (fever, head bill, Mlyav_st, p_vischeni stomluvan_st). Increased passion and itchy skin Might be a mother with Hodgkin's lymph in children, who want to grow up, not among older ones. When generalized paws slid respect for the emergence of signs of systemic ailments (weakness, lack of durability, increased obesity, arthralgia, mialgia, pithiness, appetite for fear, loss of weight). Not so often the growth of lymph nodes is seen by daddies or a likarev vipadkovo.

Anamnesis. When taking an anamnesis, it is necessary to clarify the presence of anterior prophylactic splinters, since the regional improvement of LU can be of a post-vaccination nature. Generalized paws may be a persistent symptom of syrovatkovoy ailment and is often indicated in allergic dermatoses, so it is important to clarify the allergological anamnesis.

Correctly selecting the epidanamnesis is especially important in case of adolescence for specific infectious lymphadenitis (cat ailment, toxoplasmosis, clichorous boreliasis, tuberculosis, tularemia, etc.). He is guilty of including information about contacts with infectious diseases, wild and domestic critters, seeing a louse or silly mischief, bites and comas.

For differential diagnostics, it is important to improve the health of the educational institution and to develop it. So the increase in growth and development of the LU stretching 2-3 times is often indicated in case of lymphadenitis, and the trivial improvement in general growth - in case of neoplastic processes. Detection of ailments of blood, autoimmune and malignant maladies among the relatives of a patient with unspecified paws, the malignancy of malignant lesions of the LU. The risk of oncological incidence is even greater when the child has clinical signs of immunodeficiency (parts of viral infections, recurrent herpes, infectious mononucleosis, etc.).

Ob'ktivny look around. After the diagnosis of peripheral LUs, you should be ready to fix it from the last look of the region, the growth and the palpation. When characteristic of LUs, include: localization, width (single, group - up to three or more), size (even and width in cm abo mm), consistency (pulp, dough, thick), painfulness, with palpation with navkolishnіm tissue), education of shkіri over lesions of LU (changed, not changed), as well as the manifestation of fluctuations, lymphangitis, lymphostasis. Appointments of the obligatory responsibility are clearly displayed in the outpatient card of the sick child, and are very important for the dynamic guardianship.

Healthy children cannot be palpated. Zbіlshennya їkh - permanent signs with redness, not infrequently with toxoplasmosis, mite bites in the head area and shia with mite boreliasis.

shiyny i adolescent lymphadenitis(LA) it takes place before the hour of breaking teeth, with gingivitis, peridontitis. Variety of LU is indicated in case of stomatitis, especially swirling. Chronic nasopharyngeal infection (adenoiditis, chronic tonsillitis) is a common cause of anterior lymphadenopathy. In some cases, you can take for LU an increase in an astonishing sleepy bark, a yak, on the view of LU, covered with a childish fastidiousness, that will not be accepted. Kista sleek zazvychay viglyadaє yak painless fluff of myakoi, doughy consistency. Pukhlina can know і appear to know for a shot of the mimic vyporozhnennya brush. In pediatric practice, the improvement of the upper anterior LUs and is tied with the asymmetry of the face, and in some cases it is taken for the improvement zalozi with epidemic parotitis. A slid of memory, but an increase in LU is not typical for epidemic parotitis. At the same hour, in case of infectious-allergic parotitis, the regional improvement of the LU is practically permanent. Greater LUs are one of the most important key symptoms infectious mononucleosis.

The onset of improvement in supraclavicular and supraclavicular LU is indicated in 60-90% of patients with Hodzhkin's lymphoma. The supraclavicular paw has a high risik of malignancy, estimates yak 90% in patients over 40 years old and 25% in individuals up to 40 years old. Groin and groin LU grow in case of nonspecific lymphadenitis and generalized paws of a growing genesis.

The consistency of the lost LU remains due to the prescription of the process. The consistency of the LU is indicative of a recent battle, and of a chronic process. Ailment and a decrease in the decay of the LU are observed with swiveling ignition changes in them and the development of periadenitis. Evidence of fluctuations during palpation of an affected LU to indicate the "melting" of the fabric in the middle of the LU and one witness for surgical involvement.

The emergence of shkiri over the LU infection, as well as swarms of hyperaemia in the course of lymphatic vessels (lymphangitis) is a common knowledge in LA, which develops with pizza, furunculosis, and pyoderma.

Otzhe, symmetrically and bilaterally (<2 см) увеличение ЛУ, характеризующееся мягкоэластичной консистенцией, хорошим отграничением отдельных ЛУ, отсутствием воспалительных изменений мягких тканей, обычно вызвано их гиперплазией и характерно для viral infections... Asymmetric value (> 2 cm) increase in LU, which is characterized by significant strength, stress, disgusting in the interconnection of new fabrics, signs of burning (hyperemia, local hyperthermia, damage) bacterial infection... Asymmetrically, more often than not, the growth of the LU, which is characterized by general growths, clear edges, minimal signs of heat (the skirts above them are erythematic, rather not warm), flexible. LU with systemic non-swollen ailments does not depend on the characteristics of normal types, behind the blame for their growth in size. Zbіlshenі, shіlnі, ale not straining ("schіlno-humous" consistency), painless, kindly intertwined from the new fabrics of the LU without a sign of flaring characteristic of the debut lymph. Nadal, in the world of growth, such LUs take in the lumpiness and interconnection of all kinds of fabrics and suspicious LUs, a conglomeration of LUs is formed. LU kam'yanist_y їlnosti often є inherited metastatic lesions.

Objectively, children in polyclinic practice are often interrupted by depriving them of palpation of the LU and a larger superficial glance, which is naturally unacceptable. The increase in LU in most cases is of a secondary nature, being one of the syndromes of the main disease. Relently carried out on'є

Seryoznu respect, then come to look around, I’ll turn shkіrnykh crooked and slimy to be "serviced" by the given group of LU zones. For example, caries, teeth, herpetic symptoms, stomatitis, tonsillitis can be the cause shy lymphadenitis... Kitty podryapini viyavlyayutsya at Felinosis; sad, scuffs, pustules - with a banal aircraft. That child from the LU needs to get rid of it, for the figurative hanging of the presumed clientele, "the diagnosis can be made in the pants."

Viklyuchne diagnostics value can be inspected of the mucous oropharynx. Necrotizing tonsilitis can occur with infectious mononucleosis and leukemia, hemorrhage with gastrointestinal leukemia.

Zbіlshennya rozmіrіv pechіnki - a frequent henchman with paws, tied with viral hepatitis B, infectious mononucleosis, toxoplasmosis, tuberculosis, hospitable leukemia. Hepatomegaly can also be diagnosed with adenovirus infection, Hodgkin's lymphoma, VIL infection. The improvement of the spleen is an important diagnostic sign of infectious mononucleosis, hemolytic anemia, leukemia, Hodgkin's lymphoid.

It is necessary to be cared for, in the midst of a large number of generalized paws in patients and in the accumulation of anamnestic and critical signs that are allowed even when to the first With a larger and smaller step, let the diagnosis be tolerated, or I would like to bring the paws into one of the pererakhovannye vische groups. For example, the manifestation of a fever, catarrhal symptoms, pharyngitis and unrepentant ekzanthem and witness about the high quality of virus infections. Navpaki, vіdsutnіst catarrhal yavisch / faringіtu at generalіzovanoї paws Je drive for retelnogo viklyuchennya іmunozapalnih i onkologіchnih zahvoryuvan, Especially when poєdnannі of such Find our yak vtrata crowbars, under study is nezrozumіla lihomanka, persistuvannya gostrofazovih Change log (pіdvischennya Choe, DRR) bіlshe 4 tizhnіv, zbіlshennya LU in okremich groups (lower neck and supraclavicular) and up to the size of 3 cm.

3 laboratory methods the greatest value for the first screening is the analysis of blood. Naybіlsh informative indicators: absolute neutrophilosis in cases of destruction and loss of SHOE in case of severe LA, absolute lymphocytosis in the presence of mononuclear cells in infectious mononucleosis, blasts in hemoblastosis. Slіd pam'yatati scho poєdnannya lihomanki, paws i pіdvischenoї kіlkostі mononuklearіv in periferichnoї krovі viznachaєtsya yak mononukleozopodіbny syndrome, yaky Mauger Buti Wink іnfektsіynogo mononucleosis tsitomegalovіrusnoї that VІL-іnfektsіy, toxoplasmosis, tuberkulozu, mycoplasma іnfektsії, streptokokovogo faringіtu, vіrusnogo hepatitis B i malyarії ...

The pre-treatment of nasopharyngeal swabs on flora and sensitivity to antibiotics can be considered appropriate for antibiotics in patients with severe LA, as the authors can often indicate the identity of the microfloria, visions from the nasopharynx and lymph nodes.

For the differential diagnostics of specific infectious paws, it is widely used serological (IFA, RNGA, etc.) and methods for identifying the antigen of the child (PIF, PLR). The results of the given dosage, especially in the case of Epstein's observance - Barr infection, chlamydia and cytomegalovirus infection, toxoplasmosis is responsible for the assessment of the history of the disease (including laboratory data)

LU ultrasound black empty, The region of the region, with the qualified visitor, should be highly informative and permitting to characterize the localization, form, size of the LU, the appearance of indications in the furnace and the seed. LUs with a diameter of less than 1 cm in size come close to fatty tissue and are readily visible. LU up to 1.5-2 cm is clearly visible, if the stench is designed for efficient structures or changes in topographic-anatomical relations. Echography is based on the dynamic method of caution, but does not allow the reason for the increase in LU to be identified. In case of a malignant lesion of the LN, as a rule, the hypoechogenic structure of the LN is considered.

X-ray methods of vikoristoyutsya for advanced intra-thoracic (mediastinal group), breast and inguinal nodes at adolescence for lymphoma, neuroblastoma, tuberculosis, sarcoidosis, histoplasmosis, primary cancer of the legacy... The computer and nuclear magnetic resonance tomography allow the most accurate verification of the LU of the middle and the black empty.

In case of unspecified paws, there is a great value of histological and immunological and immunological knowledge of material, which is discarded by the path of the educational biopsy of the LU. The diagnostic value of the biopsy will be maximal, if the most pathological and pathological changes in the LU are found, if they are not available.

Unimportant for those who have an absolute large number of paws in children to be of a good character and for the verification of these reasons, a wide range of needs is needed, mainly the development of children with serious therapy, which is not adequate for the shortest possible time. Obviously, we have found the cob brain of such a robot, in conjunction with the frost-brain and the pediatrician, oncohematologist, surgeon, pathologist, radio-roentgenologist and the manifestation of a complex technical and laboratory basis.

Characteristics of ailments, for supravodzhuyutsya for lymph nodes, in children

The main illnesses, which are supported by LUs in children, are shown in Fig. 1.

Nonspecific regional lymphadenitis to become from 55 to 75% of all paws in children; We can be hospitable, ready to stream and chronic. Most often the state of health of the head and the head, which is tied to the great number of outgoing diseases of the infection (carious teeth, stomatitis, tonsilitis, pharyngitis, gingivitis, congenital diseases) In the summer period, the pitoma of the groin and groin aircraft through the adjustment of rucous activity and traumatism. LA buvaє rarely without apparent reason. MA 3 stages of development: lymphadenitis (serous abnormal), periadenitis, adenophlegmon; The manifestation of all the stages is unnecessary and the ailment can end up in any one of them. With LA, you can feel the palpation of a dense, painless, crumbling LU, which is clearly oxidized, the skin above it is not changed, the temperature is subfebrile, the SHOE is normal or even accelerated. In case of periadenitis, the firing expands to the navkolishnі fabrics. LU clearly do not palpate, but rather a sore and slightly ruffled infiltration. The shkira above him, as a rule, is changed. It is indicative of a fever, neutrophilic leukocytosis, accelerated SHOE. With a gross inguinal-steginal LA, symptoms may appear in a teasing of the oleophilus. For adenophlegmonia, it is characteristic of unclean boundaries, hot hyperemic skin, fluctuations and swelling of navkolishny tissue. Possibility of encircling the company’s appearance and head crumpling and cuts. The temporal fever is more likely to occur, leukocytosis is rapidly accelerated (30-50 mm / year). Nybilsh is a frequent student of a non-specific aircraft є β -haemolytic streptococcus group A. Oday an hour, stretching out a very nonspecific LA has become more erased. Nabagato rіdshe sustrіchayutsya LA s high fever, Variety of muscular manifestations and significant damage in the hemogram.

Specific regional lymphadenitis

Tuberculosis of peripheral lymphatic universities

The treatment of LU can be associated with primary tuberculosis complex, earlier as a result of hematogenous dissemination of tuberculous infection. For diagnostics of important epidanamnesis: family contact; implantation of dairy products in territories that are unfavorable for tuberculosis of the great horny thinness (mycobacterium tuberculosis of the scourge type); can be atypical with microbacteria (zokrema, type avium) Children up to 5 years old. Most often it is against shiin and supraclavicular LUs, more and more groin and supraclavicular; the process will lead to one-sided localization. Got a little rugged, welded one to one, fix the packets with small and small crumbs, in the future there is a problem, a lot of fabrics, some fluctuations in massety, appear to grow Most of the ailments are poor, in the presence of symptoms of intoxication. In the hemogram - leukocytosis, monocytosis, lymphopenia, a slight increase in SHE with gostromu... Most children have little or no sensitivity to tuberculosis, hyperergic reactions are rare. Specific changes on organ roentgenograms breast cancerі soft tissues in the area of ​​lesions of the LU (calcification); impregnation of vapna can be detected і with ultrasound of the LU. Residual diagnosis is made in case of mycobacterium tuberculosis in the form of LU; in case of histological pre-disease LU for manifestations of elements of tuberculous hump and cases of caseous necrosis.

Felinosis (kitty's ailment, good lymphoreticulosis)

Zbudnikami zahvoryuvannya Je Bartonellahenselae(Рикетсії) that Afipiafelis... In the anamnesis є contact with the cat, often during the winter-winter period. When you look around, a red papule is indicated, or a pustule, otochened with a vines of hyperemia, with the further statements of a twist in the mice, or a bite. After 1-3 days of the primary affection, the increase (up to 3-5 cm) and the soreness of regional LUs are more likely to occur; the stench is dense, sickly, slightly rotten. In the presence of symptoms of intoxication (febrile fever, mіalgії). The form of infection with lesions of the liver, spleen, myocardium and central nervous system is rarely developed. And the analysis of blood can be compared to eosinophilia and is slightly accelerated by SHOE.

Klishovy boreliasis (Lyme ailment) - natural and middle-class transmigration, which is characterized by the poly-systemic nature of the battle and significant clinical polymorphism. Zbudnik - Borrelem Burgdorfer. Infections develop in 2-45 (often 7-14) days after the bite of the mite. When you look around, a red maculi appears, or a papule in the bite of the mite, with the further shaped ring-like eritemi, which can be misplaced. Sposter regional LA (LA up to 1.5-2 cm in diameter, crumbling, less painful).

Specific generalized lymphadenopathy

A common cause of generalized paws is viral or bacterial infection.

Infectious mononucleosis and mononucleosis-like syndrome of infectious nature. infectious mononucleosis - polyetiological illness, how to be vicious with viruses from the family Herpesviridae(EBV, CMV, herpes virus type 6), which is against fever, angina, polyadenitis, liver and spleen malnutrition, the appearance of atypical mononuclear cells in the peripheral blood.

The majority (90%) have ethiological factor ill-health є virus of Epstein - Barr (WEB), in general, the message about WEB-positive option. WEB-negative infectious mononucleosis (mononucleosis syndrome) develops in 10% of cases and may cause CMV infections, toxoplasmosis, human immunodeficiency virus, herpes virus (raptus ectomycete) virus HHV-6, you can, HHV-7) і viruses hepatitis B and A.

Earbud of gostriy ailment at the viglyadi of the feisty and catarrhal angina. It is indicated that the growth of the shinnyh (the larger world), groin and groin LUs. Shiyni LU grow symmetrically along the sides, can reach great razmіrіv, Elastic consistency, not welded to navkolishny fabrics, slightly ailing. Half of the children are more likely to develop liver and spleen. It may also be maculopapular abnormal urticarial visip (the most characteristic is the appearance of a visipus in the form of antibiotics). In hemogram - leukocytosis, lymphocytosis, monocytosis, the presence of atypical mononuclear cells, in addition to the development of SHOE; often there is an increase in pecin aminotransferases. In twisted droplets, carry out DNA diagnostics by the PLR ​​method and start specific antibodies of the classes IgMі IgG to herpes viruses for additional ІFA.

Chronic active WEB-infection. Diagnostic criteria - persistent fever, paws, hepatosplenomegaly, hepatosplenomegaly, cytopenia, viremia due to PLR blood.

cytomegalovirus infection Often, it is asymptomatic by pulling out with the GDVI mask. Ridsche - mononucleotid syndrome, identical to WEB-positive infectious mononucleosis, З prolonged feverish (post-lay, Typhoid type) on the first plane; generalized paws and pharyngitis are much weaker.

Zbіlshennya LU is denoted as yak in case of congenital, so in case of darned ill. In diagnostics maє more important covering epidanamnesis. To be able to achieve overwhelming and powerful LUs, elastic consistency, slightly painful (in the first days), or painless, crumbling, not welded together with oneself or with exuding fabrics; in children of a young age, polylymphadenopathy is more common. Symptoms of intoxication are evident. May be hepato-lienal syndrome, myocarditis, arachnoiditis, chorioretinitis. In the newborn child - polymyphadenopathy, zhovtyanitsya, hepatosplenomegaly, signs of internal cranial hypertension, eye damage, sudomy. In the hemogram - eosinophilia, common lymphocytosis, monocytosis, accelerated SHOE. Diagnosis is verified by way of detecting the antigen of the pruritus by the method of PLR and specific IgMі IgG antibodies to toxoplasma in syrovatz blood by the IFA method.

HIV infection in the stage of the first manifestations, it is typically characterized by the appearance of fever, a sign of pharyngitis and generalized paws. Characteristically, there is also the presence of headache, mialgia / arthralgia, polymorphic viscous, inferior mucous lesions, possible hepatosplenomegaly, diarrhea.

Persistent generalized paws for large ailments on VIL-infectious diseases, the first manifestation of ailments. The increase in LU with VIL-infection is characterized by offensive features: increase in two and more groups of LU (especially shinnyh, supraclavicular, groin, liktyovyh); LU size 2-3 cm, slightly larger; LU is soft or dense, sometimes sickly, crumbly, not welded between itself and with delicious fabrics. All children with persistent generalized paws are subject to obsolescence for VIL-infection by the IFA method.

Generalized paws and exanthemic infections

rubella Maybe supervised generalized paws, I would like to partly in the classic picture on the first plan to include the improvement of the rear and rear LUs. bark infection In some cases, it is possible to develop generalized paws with hepatosplenomegaly, and to improve medical conditions. for vіtryanoї vіspi generalized paws are uncharacteristic, wanting to increase LU in different groups can be promoted as bacterial acceleration. raptus exanthema (Shosta ailment, 3-denna a fever, how to get sick with herpes viruses HHV-6, HHV-7) - widening of the incidence of young children, which is characterized by feverish stretching for 3-6 days, when the temperature is lowered, macular visip appears with important lesions of the shia and tuluba, maybe peripheral paws (part of it).

Described more common types of generalized paws in cases of infection with parvovirus (B19) with a type of visip (a combination of varicose veins of disguise, instead of frequent visip on proximal symptoms of diseases of the disease) adenovirus ( epidemic keratoconjunctivitisі pharyngocon'junctual fever - increased fever, catarrhal symptoms, conjunctivitis, often pluvkovy, anterior paws), by some enteroviruses.

Generalized paws and infections of the lower respiratory tract

A number of respiratory pathogens in possible lesions of the lower types of dyshalal paths can be superimposed on the generalized and mediastinal paws. They are referred to as internal respirators ( M.pneumoniae, C. pneumoniae), Zbudniki legioneliasis, tuberculosis, histoplasmosis, coccidiomycosis.

M.pneumoniaeі C. pneumoniaeє widely extended by gostrich respiratory infections, It is important for children of the school age and young adults. Klinichny show of the primary infection by the aforementioned diseases vary from a little or no symptomless infection process to pneumonia and the possible form of developmental posalegenic syndromes (for example, paws are more typical for M.pneumoniae; shkіrnyh visipan, arthritis, diarrhea, liver damage, heart, nervous system) .

Tuberculosis organ_v dikhannya can supervise generalized paws. In times localized legacy forms alert me to the date of the medical (often in root of the lung) I peripheral (most common) LU. The most frequent legacy manifestation of tuberculosis in young children is the primary tuberculous complex (lymphadenitis of the root of the lung, lymphadenitis, in the field of infiltration in parenchymal diseases) and diseases of bronchial infections of the bronchial In pidlіtkіv, the same forms are restructured, and in older adults.

dyssemination of tuberculosis characterized by prolonged fever, hepatosplenomegaly, generalized paws and roentgenologic syndrome of miliary disease.

Generalized paws and infections of the shlunkovo-intestinal tract

With yersiniosis and pseudotuberculosis the thermal appearance of the small intestine and mesenteric LU can be measured. In some cases, peripheral LU also grows - groin and shiin, maybe mediastinal paws. key picture including fever, gastrointestinal symptoms, "raspberry tongue", pharyngitis, scarlet-like visip with advancing peeling (often in viglyad "shkarpetok" and "punch" and near great loams). You can buy vuzluvata eritema, arthritis / arthritis, hepatosplenomegaly, zhovtyanytsya.

Nonspecific generalized lymphadenopathy

Lymphadenopathy with primary immunodeficiency

Primary immunodeficiencies - congenital defects of the immune system and can contradict hypoplasia LU (Bruton's agammaglobulinemia), as well as with severe lymphoproliferation. Paws are most common in cases of autoimmune lymphoproliferative syndrome (ALPS), variable immunological deficiency (clot) and chronic granulomatous ailment (CGD). All primary immunodeficiency disorders are characterized by recurrent severe bacteria, fungi and viral infections.

Diagnostic criteria:

• polylymphadenopathy, especially with ALPS, with any LU it can vary from 2-3 cm to packets of internal, internal lymph nodes, so that there is difficulty in dysfunction, in the case of hepatosplenomegaly;
• at STODOL - splenomegaly і / or generalized paws in ⅓ ailments, strength to Legendary і shlunkovogut zhvoryuvan, Slowness to malignant new conditions and autoimmune processes;
• ChGD is manifested by hospitable abscess infections of the shkiri, legeny, intestinal tract, cysts, LU, liver, spleen with the development of chronic granulomatous inflammation;
• with ALPS and STODOL, there is a possibility of developmental hematological damage: hemolytic anemia, thrombocytopenia, neutropenia;
• immunogram:

ALPS IgM food 5 g / l with normal abnormal concentrations of the other classes of immunoglobulins, lymphocytosis, increased amounts CD 3 klіtin;

STODOLA - a decrease in the level of all classes of sirovatkovyh immunoglobulin ( IgA,M,G);

CGD - test for the assessment of the dysfunctional "vibuhu" of neutrophils: NST-test, chemiluminescence of leukocytes (the metabolic activity of neutrophils is reduced).

Trivale generalization of the LU in a child's life is meant for a certain anomaly of the constitution - lymphatic-hypoplastic diagnosis ... The name of the diagnosis does not represent great difficulties. Children may have a characteristic look, fluff, it means the pastyness of the fabric, the whiteness, the decrease in turgor and myazic tone, the strength to infectiousness.

Іnshі form of paws, not tied with infectious diseases and hemoblastoses

1. Medication of paws can be buty with alopurinol, atenolol, captopril, antibiotics (penicilin, cephalosporin), sulfanilamides and other drugs. Change the LU to change in 2-3 days after you change the drug.

2. Pislya prophylactic splinters of the power of post-vaccination paws.

3. Shkirnі allergic diseases (atopic dermatitis іn.) I psoriasis. With advanced atopic dermatitis at the height of the sharpening, it is considered generalized paws.

4. Systemic immunoassay (autoimmune) disease. Dani sickness can be superficially generalized paws, especially often in cases of one-hour manifestation of fever, skinny, arthralgia / arthritis, mutilation of mucous membranes, hepatosplenomegaly, serositis and lesions of nirok. Particularly often generalized paws are spared to with ailments Stilla, systemic chervonia vovchak, Sjogren's ailments and іn.

5. hemophagocytic syndrome, association with infection, and macrophage activation syndrome.

5. Thyrotoxicosis.

6. Ailments accumulated (ailments of Gaucher, Nimman - Pika and in.).

Improvement of lymph universities with evil new establishments

Malicious illness є the reason is close to 1% of all paws. The group includes: host leukemia, non-Hodgkin lymphomas, lymphogranulomatosis (Hodgkin lymphoma), histiocytosis, metastasis of solid fluff.

lymphoma of Hodgkin Play with all groups of children, with the blame of children of the 1st rock of life and little - up to the 5th age. Anamnesis may have a trivial history - up to 6 months or more. The main symptom is the behavior of asymmetric LU improvement; the stench is painless, shchy, ruhlivi, stribuchi (Krasnobaev's symptom), without signs of burning, often in viglyadi conglomerates (Kisel's symptom). In 90% of cases, supraphrenic LU is the primary cause, in 60-80% of cases, up to 60% - mediastinal; There can be better ones over- and on-and-off keys, grooves, as well as inner-womb and groin LUs. In case of severe internal chest LUs, one of the first manifestations of ailments є cough, difficulty in dysfunction, hard work, hardness, bile with dysfunctions; vigorous development to the syndrome of the upper empty veins: obstruction of accusation, pletor, enlarged veins. The middle extranodular localization means (up to four times) the spleen, liver, pleurisy, and other organs. Patients have symptoms of puffy intoxication (fever, who cannot be cured by antibiotics; no sweat; - loss of weight by 10% or more for 6 months in the middle). In the blood, with an extended process, there is a small amount of leukocytosis, hypochromic microcytic anemia, eosinophilia, lymphopenia, and an increase in SHOE. To verify the diagnosis, an examination of the biopsy of the LU with histological and immunological preliminaries is carried out.

Non-Hodgkin's Lymphoids (NHL) often manifested in 5-10 rockies, sometimes up to three rockets. On the basis of Hodzhkin's lymphoma, which is typical of the process of growing chickens and generalization, the anamnesis of ailments is not long, from week to day, up to 1, maximum 2 months. Klinichny show to lie in the primary localization of chickens and masi. Half of the children are primarily affected by the LU of the black empty; in the classroom, it means the improvement of the abdomen with the backward stanchion, or the picture stubborn belly, abo intestinal imperfection... Localization of pukhlin in front middleі thymus (20-25% vipadkіv) produce up to the development of symptoms of depression (cough, bad breath, syndrome of the upper empty vein); as a rule, the supraclavicular LUs improve and rapidly progress; it is not easy for the pukhlin to fall into a pleural vipot, but the symptoms of dysfunctional deficiency come to a head; vipit in the pericardium can lead to the tamponade of the heart. 10-15% of NHL children are localized in the life of Valdeyer's children, heads and children sluggish vines, Lack of lower slit, unilateral improvement of the pharyngeal mydalene with general symptomatology. With the initial reduced peripheral LU (15%), more often the growth of the diaphragm, the asymmetric growth of the lymph node and rocky deterioration without signs of burning is promoted. Symptoms of the biological activity of chickens (no reason fever, loss of mass, no fatigue) are indicated in 10-15% of ailments. Zagalny blood analysis, as a rule, in the norm; rare anemia, leukopenia with lymphocytosis, pancytopenia. When a child is admitted to the NHL, it is inappropriate to be hospitalized in a special admission.

Gostry leukemia often visit children from 2-5 years of age. Characteristic lymphoproliferative syndrome: peripheral LU grows up to 2-3 cm, shchilny, not welded together, painless; it is not uncommon to indicate the improvement of the LU in the middle of the conglomerates; improvement of liver and spleen. Children have symptoms of puffy intoxication, anemic and hemorrhagic syndromes. Hemogram: anemia, thrombocytopenia, leukopenia, abo leukocytosis, neutropenia, blastemia, "leukemic failure", accelerated SHOE.

Histiocytosis from Langerhans' cells. The first manifestations of ailments can be an increase in peripheral LU and hepatosplenomegaly. Children are encouraged to experience the reduction of flat cysts of the crypt of the skull and pelvis in the form of stamped round defects, which can be either lonely or multiple; the destruction of the cysts is painless, not very painful due to the radiological knowledge. It is not uncommon for a ryasna nodular or maculopapular visip. You can be exophthalmus and appearances non-bloody diabetes(Polіdipsіya, polyurіya with a low tolerable slit, a decrease in mass). Residual diagnosis arises in case of immunohistochemical preliminary biopsy of shkiri, knitted fabric abo LU.

If the child has symptoms of intoxication of an unclear genesis, the doctor is to blame for all the thought about the manifestation of the malignant swelling and come to proper respect for the inversion of the theory of hypotheses and of the students of the advanced hypothesis.

Diagnostic tactics for unspecified lymphadenopathy

A retinal anamnesis of ill health and observational data is the basis of differential diagnostics for paws. Infections are the most common cause of paws in children. To that end, it is necessary to eliminate infectious diseases (Fig. 1).

On the basis of scarg, epidanamnesis, active data, the results of laboratory-instrumental and immunological conditions, more than 80% of cases in children are verified to be the cause of the paws. Also, the primary assessment of the anamnesis and physical data in the given specific serological conditions does not give clarity about the specific cause of the LU damage, for now the tactics are found in the form of the paws. The algorithm for differential diagnostics of the paws of the representations in Fig. 2.

There are literary data, less than 5% of patients with paws on the cob stage of the development of biopsies. Protect biopsies of LU were guilty of buttily carried out, as in the child's paws є signs of evil or serious illnesses (lymphoma, tuberculosis, sarcoidosis).

Yaksho unspecified paws є localized , Decision about those, if you need a biopsy, the most important. The most important task for a doctor of any kind is to carry out a differential diagnosis between infectious and fluffy LU. For the infectious disease of the LU, it is characteristic of the disease (contact with the child, the sick creatures and people, the information of the wounds, the garden), the learning of the registered LUs, the display of the sickness , regression stretching 2-4 times. The paws, as a rule, will be accompanied by symptoms (short-term temporal temperature, catarrhal symptoms, often locally hot on the skin, mucus, visip). In the hemogram leukocytosis, leukopenia, atypov mononuclear cells, lymphocytosis appear.

Malunok 2.

Algorithm for differential diagnosis of lymphadenopathies

For puhlinnogo urazhennya LU characterized trivale їh zbіlshennya of povіlnim zrostannyam (at nehodzhkіnskih lіmfomah duzhe Shvidky zbіlshennya LU) schіlno-elastichna abo stony schіlna konsistentsіya often conglomerate LU bezbolіsnі at palpatsії, bіlshe 3 cm zmenshatsya abo prodovzhuyut zbіlshuvatisya at dinamіchnomu sposterezhennі; Epidanamnesis is not characteristic. In the case of patients, maybe a trivial one, a feverish person is unclear, no sweat, a waste from a vase, the appearance of a local heat.

As a child, she has a spoky anamnesis, in a new day of scarg, and physical condition does not allow to alert the sign of serious illness (IL-infection, tuberculosis, lymphoma), it is necessary after 2-4. Stretching out for an hour, you can change any of the paws. Patients with risk factors and signs of evil illnesses, as well as in some paws persistent for 2-4 types, are guilty of being born with biopsies.

Nutrition about the sign of antibacterial therapy in case of unspecified paws in a child with spirits. Our country has antibiotics wide range children from unspecified paws are victorious in the quality of one as a sign of differential diagnostics. The appearance of the effect of antibacterial therapy is seen as one of the evidence for the biopsy of the LU. American academy family members vvazhaє, as there are a lot of unspecified paws, it is impossible to get caught by unidentified viruses and to appear spontaneously. It is well known from the literature that from 29 to 64% of unspecified paws are violated without any therapy. On the whole, a 2-4-type HIV-positive tactic is used to guard over such patients. Antibiotics are indicated only when there are clinical and laboratory signs of bacterial infections.

Uninvolved on your own modern methods before the diagnosis, including the biopsy of the LU, in 15-20% of cases the reason for the paws so and not to go into the back. Such children go to the trivial dispensary caution of the pediatrician, hematologist. Їm regular blood analysis, assessment of LU will be carried out. Otrimanі danі fіksuyut in outpatient cards. The improvement of the LU in the dynamism of such children is shown for repeated biopsies.

Prognosis for unspecified lymphadenopathy

Patients with persistent paws, as they have an unspecified message for consultations of females and biopsies, more than 25% of them appear in the background as if they are ill, it is not easy. With the presence of clinical and laboratory data and active signs of evil and serious systemic ailments with unspecified paws in children, the prognosis is friendly: more of such paws are allowed spontaneously.

LITERATURE

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2.Reznik B.Ya. Practical hematology of a child's life / B.Ya. Reznik, A.V. Zubarenko. - Kiev "Health", 1989. - 398 p.

3. Zaykov S.V. Differential diagnosis of lymphadenopathy syndrome / S.V. Zaikov // Clinical immunology. Allergology. Infectology. - 2012, No. 4. - S. 16-24.

4. Tereshchenko S.Yu. Peripheral lymphadenopathy in children: differential diagnosis / S.Yu. Tereshchenko // Consilium Medicum, Pediatrics. - 2011, No. 4. - S. 54-59.

5. Tereshchenko, S.Yu. Generalized lymphadenopathy of infectious etiology in children / S.Yu. Tereshchenko // Russian medical journal. - 2013, No. 3. - P. 129.

9. Krasnov V.V. Clinical and laboratory characteristics of cytomegalovirus infection in children / V.V. Krasnov, A.P. Ritual // Practical medicine. - 2012. - No. 7. - S. 137-139.

12. Cunha B.A . The atypical pneumonias: clinical diagnosis and importance / Cunha B.A. // Clinical microbiology and infection: the official publication of the European Society of Clinical Microbiology and Infectious Diseases. - 2006. - Vol. 12 (Suppl 3). - P. 12-24.

13. Practical handbook of child ailments: immunology of a child's health / V.F. Kokolina [and others] / Ed. V.F. Kokolina. - M .: Medpraktika-M, 2006. - T. VIII. - 431 p.

14. Care for child oncology / L.А. Durnov [and others] / Ed. L.A. Durnovo. - M., 2003 .-- 503 p.

15. A practical guide to child ailments: hematology / oncology of a child's health / V.F. Kokolina [and others] / Ed. V.F. Kokolina. - M .: Medpraktika-M, 2004. - T. IV. - 791 p.

1. Differencial'naja diagnostika limfadenopatij u detej: posobie dlja vrachej-gematologov i pediatrov. - Rjazan ', 2002 .-- 40 s.

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3. Zajkov S.V. Differencial'naja diagnostika sindroma limfadenopatii / S.V. Zajkov // Klinicheskaja immunologija. Allergologija. Infektologija. - 2012, No. 4. - S. 16-24.

4. Tereshhenko S. Ju. Perifericheskaja limfadenopatija u detej: differencial'naja diagnostika / S.Ju. Tereshhenko // Consilium Medicum, Pediatrija. - 2011, No. 4. - S. 54-59.

5. Tereshhenko, S. Ju. Generalizovannaja limfadenopatija infekcionnoj jetiologii u detej / S.Ju. Tereshhenko // Rossijskij medicinskij zhurnal. - 2013, No. 3. - S. 129.

6. Asano T. High prevalence of antibodies against Bartonella henselae with cervical lymphadenopathy in children / Asano T., Ichiki K., Koizumi S. et al. // Pediatrics international: official journal of the Japan Pediatric Society. - 2010. - Vol. 52, No. 4. - P. 533-535.

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One of the difficult to diagnose and rare forms of lesions of lymphatic universities is mediastinal lymphadenopathy. The term "lymphadenopathy" itself is a pathological change and change in the consistency of young groups of lymphadenopathy. Qia pathology does not boast about a nosological oddity, but є an anxiety symptom, seriously ill... However, lymphadenopathy according to ICD 10 (international classification of ailments of the 10th glance) has its own okremiy code - R 59.

see lymphadenopathy

Lymphadenopathy is small in number of forms, which occur as a result of the localization and the stage of expansion of the pathological process:

• Local. Only one lymph university is growing.
• Reactive. Є a common general reaction of the body to the introduction of infectious agents (viruses, bacteria). As a rule, there are little symptoms and regression in the world from the main disease.
• Generalized. It is a very important form, when not one group of lymph nodes is broken.

middle lymphadenopathy

Middle lymphadenopathy or mediastinal lymphadenopathy- the price of changes in lymph nodes, localized in the middle area, in the direction of their growth. Buvag one- and two-sided.
middle- the whole internal chest space, from the sides, surrounded by internal organs and structures. Bіchnі stіnі presentedі internal surfaces lungs, which cover the pleural membrane. Rear and front plates approved ridge stop and the sternum is visible. In the middle of the vastness there are a number of organs: bifurcation of the trachea, root and gates of the lungs, stravohid, thymus, heart, nerves and sunshine.
In addition, the middle is to take revenge on the group of lymph nodes:

• Gliboki top and bottom shiins.
• Paraesophageal (ie, how to feel stravohid).
• Aortic.
• Bronchial, including bifurcation lymph nodes. *
• Loaded.
• Paratracheal lymph nodes.

The institute doesn’t just pick up the lymphatic origin not only from the overheated organs, but from the other organs of the empty and the pelvis. To this, the pathology of the middle of the lymph nodes can be visualized whether igniting or malignant changes in various organs and systems.
* Bifurcation and paratracheal lymph nodes. So tse take?
Lymphatic universities, developed in the area of ​​trachea on the head bronchi, are called bifurcations. Їх number does not change 14, and the diameter is not more than 45-50 mm. Paratracheal є by a great group of universities, so that the trachea is sore on all the time.

We recommend it! For the elimination and prevention of lymph nodes and those igniter get sick lymphosistemi, who are caught in the body of early infections, weakened immunity for some reason, our readers are successful. Respectfully instilled by the methods, we have made the proponation of your and your respect.

Ethiology of ailments

For a number of reasons that can lead to an increase in lymph nodes in the middle, there are: Besides, the following symptoms are characteristic: cough, hoarseness in the voice (due to laryngeal larynx), difficulty in moaning, delicacy, inappropriate views when it is a bit of a heartbeat, there is an increase in obesity, a decrease in the mass of til, bluish appearance of shkirny curves - cyanosis.
During the passage of ailments in the classroom, the signs are more flared: pathological weakness, deterioration in the rhythm of the heart, bumps on the teeth and a feverish woman.

In middle-class children, lymphadenopathy can be manifested by strong perspiration, especially at night, to swindlers.

lymphadenopathy of the lungs

Legeneva or bronchopulmonary lymphadenopathy signals about the pathological process itself in the leg tissue. Most often, the most specific disease: tuberculosis or sarcoidosis (good systemically ill, Whenever there is a purchase of clitin - granulomas in the organs). Ridsche - metastases in the leg, trauma inheritance.
The symptoms are similar: ill-feeling when kovtanni, bad, frequent cough, not a fever and bile in the chest.

Doslidzhennya methodology

Even earlier, the diagnosis of lymphadenopathy in the middle and roots of the legends on the cob stage was important to diagnose. If the main ailment has progressed, the first signs appear.
Defeat the patient, who is turned on with similar symptoms, is complex and scrupulous. In the general order, clinical and biochemical analysis of blood and external analysis of blood, oglyad radiography of the breast, electrocardiogram and echocardiography for the prevention of heart pathology are recognized.
Ultrasound of the pre-detection of the black emptying and the extra-ural space can help to detect a swollen process in them, which can give metastasis in the middle. With the method of rejecting more detailed views about the internal organs, a computer or magnetic resonance tomography is carried out. Such methods of advancement will help you to find out how to do it and how to do it. Attach visnovki during CT scan or MRI can be seen in the following rank: middle lymphoma of the middle (that is, more of a group of lymphadenopathies), or mediastinal lymphadenopathy is abnormal.
For a specific process (tuberculosis or sarcoidosis), we will show you: Mantoux reaction or granuloma biopsy. With adolescence on evil new affirmation to get shelter for the appearance in new tumor markers.