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Dear readers, today I am going to talk about a pathological state of inflammation in the lymph nodes called: Adenopathy or Lymphadenopathy, then I will detail a bit of theory, because it is a medical scientific issue and requires taking technical information of its own. its scope, among which, I will publish: its definition, causes, diagnoses, treatments and other points inherent in this state of health. The adenopathy is defined by the presence of abnormal lymph nodes in number, size or consistency. Lymphadenopathies can be localized, when they affect a lymph node area, or generalized if they affect two or more non-contiguous ganglionic areas. In Primary Care (PC), the most frequent cause of adenopathy is that of infectious or reactive origin. The exhaustive anamnesis and a careful physical examination, followed by adequate complementary tests, allow reaching the diagnosis in 90% of the cases. The physical characteristics of lymphadenopathy (size, consistency, adherence to deep planes) and its location are of great help to reach the diagnosis. The adenopathy of evolution of less than 2 weeks or more than 1 year without variation in its size has a very low probability of being malignant. Age is the most important prognostic factor in terms of the likelihood of benignity or malignancy. When there is no etiological diagnosis and the patient's condition is good, it is prudent to maintain an observation period of 3 to 4 weeks. The supraclavicular adenopathy should always be referred, for study, to the next level of care. Treatment with antibiotics or corticosteroids is not appropriate when there is no etiological diagnosis. The growth of the lymph nodes can be produced by several causes: physiological immune response to an antigen, infiltration by inflammatory cells, invasion of neoplastic cells or infiltration by macrophages loaded with metabolites in diseases of deposits.

Causes of adenopathy

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• It is necessary to suspect that the etiology is infectious if there are any accompanying symptoms that make us think of a viral or bacterial infection: rash / enantema, coryza, odynophagia, otalgia, entry door to an infection (pustule, wound, etc.) , together with painful, soft and mobile lymphadenopathies. • If the patient is young and has a fever, night sweats, weight loss and grouped, firm, mobile and non-painful lymphadenopathies, the possibility that the cause may be a Hodgkin's lymphoma will be taken into account. • We must think of a metastasis when the adenopathy is localized, hard, not painful and adhered to deep planes. • It may be an autoimmune disease when, in addition to adenopathies, there is skin rash, arthralgias and muscle weakness.

Diagnostic management

The vast majority of patients with adenopathies are diagnosed in PC with a careful history and a complete physical examination. First, a differential diagnosis should be made between a lymphadenopathy and other subcutaneous masses and tumors, such as lipomas, epidermoid cysts, branchial cyst, thyroglossal duct, parotiditis or inflammation of a submaxillary gland, thyroid nodules, inguinal hernias, etc. Once it has been determined that it is an adenopathy, the cause and possible seriousness should be sought, taking into account the age of the patient, the physical characteristics of the suspicious lymph nodes, their size, location and extension; and try to fit these data with the clinical context previously obtained with the anamnesis. Age is the most important prognostic factor in terms of the likelihood of benignity or malignancy. Often we will have a definitive diagnosis of a cause, usually treatable. In other cases, it will be necessary to carry out complementary studies that confirm the diagnostic suspicion. When, after the completion of the complementary tests, a diagnosis is not reached and the patient presents a good clinical situation, it is prudent to follow the adenopathy for about 3 or 4 weeks. If the suspicion of malignancy is high or if the lymphadenopathy persists, it should be referred to the next level of care.

Anamnesis

In the search for the origin of adenopathy, it is important to obtain the following information: • Family history of neoplasia. • Age: children and young adults usually present with benign pathology, but after 50 years the incidence of malignant processes increases. In a series of 628 patients who underwent biopsy at a reference center, it was found that, in those under 30 years of age, the percentage of benign or self-limiting processes was 79%; while in those over 50 years old this percentage was reduced to 39%. • Profession: professional exhibitions (silica, beryllium, etc.). • Contact with pets, (cat scratch disease, toxoplasmosis), insect bite. • History of travel to risk areas (typhoid fever, anthrax, histoplasmosis, brucellosis). • Time of evolution: if it is less than 2 weeks or more than 1 year without having experienced significant changes in its size, it has a very low possibility of being due to a neoplastic process6. Less frequently, low-grade Hodgkin lymphomas, non-Hodgkin lymphomas, and, exceptionally, chronic lymphatic leukemia may be found. • Drugs: allopurinol, phenytoin, captopril, carbamazepine, atenolol, quinidine, cotrimoxazole. • Habits: tobacco, alcohol, exposure to ultraviolet radiation, which can lead to a metastatic etiology. • Relationship with patients (tuberculosis) and sexual contacts that may indicate, among the differential diagnoses of cervical or inguinal adenopathies, the existence of sexually transmitted diseases. Patients with human immunodeficiency virus (HIV) most frequently present with Kaposi's sarcoma or non-Hodgkin's lymphoma. • The associated symptoms, in many cases, point towards a pathology: asthenia, odynophagia, wounds, mosquito bites, night sweats, weight loss, etc.

Physical exploration

In addition to a general physical examination, a complete scan of all lymph node areas should be performed in order to classify adenopathy as localized or generalized. If it is a localized adenopathy, a thorough examination of the anatomical area drained by this group of lymph nodes will be performed, looking for wounds in the extremities, insect bites, mycosis, inflammation, skin lesions, etc. The characteristics of adenopathies that must be taken into account include: size, consistency, adhesion to deep planes and presence or absence of pain: • Size Among the physical characteristics of the adenopathies, the size is the one that provides the most information to guide the diagnosis towards benign or malignant disease. Ganglia smaller than 1 cm in diameter are considered normal (0.5 cm in epitrochlear nodes and 1.5 cm in inguinal lymph nodes). The presence of a supraclavicular ganglion, whatever its size, even in children, should always be considered pathological and be referred for study, since the percentage of malignancy in this location is very high. When the size is greater than 4 cm, the patient should be referred immediately for a biopsy. • Consistency The lymph nodes with a soft consistency are usually of infectious origin, those with a firm consistency are typical of lymphomas and the hard ones are characteristic of lymph node metastases. • Mobility Lymph nodes infiltrated by lymphomas or those of infectious origin are usually mobile while metastatic lymph nodes are usually fixed by being attached to deep planes. • Pain Painful adenopathy usually indicates an underlying infectious process that causes rapid distention of the capsule. More rarely it is due to necrosis in a metastatic ganglion. Lymphadenopathies of metastatic cause are usually not painful. However, pain is not a good discriminatory criterion between benignity and malignancy. • Location The detailed exploration of the affected lymph node can give important clues to reach the diagnosis. Therefore, knowledge of the anatomical areas drained by each lymph node area is essential: - Occipital, preauricular and retroauricular: drain the territory of the scalp and nape. They are rarely malignant. - Cervical: the adenopathies in this location are the most frequent. Produced mostly by mouth and neck infections. Less frequently due to neoplastic processes of face, neck, lung and breast structures. Lymphomas also appear frequently in this location. - Supraclavicular: are always pathological. The left supraclavicular ganglion (Virchow's ganglion) is infiltrated by metastatic cancer from a primary carcinoma of digestive, testicular, ovarian or renal origin. Right supraclavicular nodes are related to metastases of mediastinal, lung, esophagus or kidney carcinomas. The performance of the Valsalva maneuver by the patient during the palpation of the supraclavicular area increases the possibility of palpation of a nodule. - Axillary: infections of the upper limb, breast cancer and Hodgkin and non-Hodgkin lymphoma (usually not the first affected area, but it may be the first to be localized). - Inguinal: usually due to a sexually transmitted disease, or lower limb infection. They can also be infiltrated by lymphomas (rarely the first manifestation) and metastases of tumors of the rectum and genitals. Splenomegaly: splenomegaly appears in many processes that involve lymphadenopathy. Its presence directs the diagnosis towards a systemic disease, such as infectious mononucleosis, lymphoma, leukemia, sarcoidosis, toxoplasmosis and less frequent haematological disorders. To investigate the presence of fever or signs of infection, skin lesions or hemorrhagic diathesis. Given the frequency of pathology, it is important to explore especially the otorhinolaryngologic area.

The source of this information

Although there is no specific treatment for lymphadenopathy, there is a natural or alternative method that helps when they are inflamed, such as placing compresses: Well with a cloth dampened with warm water or specific compresses for this temperature, if it is prepared much better chamomile, in the area of the lymph nodes that are affected, when these compresses cool, re-moisten them with warm water and continue to place them in the area in question, it is important to avoid the application of air currents in their application, they must be applied in closed areas. This home remedy helps a lot while the patient goes to the doctor or suffer from this condition constantly and is waiting for the diagnosis of it.

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This remedy is effective for my dear readers, since personally, I do it, because I suffer from General Adenopathy, I am proudly Venezuelan, I live in Venezuela, and as you know my country is going through a long time of an existential crisis in All areas, and while you get the money to be able to do diagnostic tests of any disease, you have to use natural or alternative remedies to improve yourself and follow the best possible.

I hope this information helps those with this type of condition, but that if you go to the doctor to determine the causes, diagnosis and treatment.

I wish you good luck and health.

Thanks for your attention

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