lower leg swelling and lymph DDx 2

what causes onconic pressure

albumins in blood plasma which pull water into circulatory system

what causes hydrostatic pressure

gravity or obstruction

if there is unilateral leg swelling what should we suspect 

DVT 

if there is bilateral lower leg swelling what should we suspect 

systemic process 

how will pt with DVT present

calf pain or tightness worse with walking

50% asymptomatic

what are risk factors/predispositions for DVT 

minor trauma 

excessive immobilization 

smoking 

oral contraceptives

cancer 

how will cellulitis present

diffuse spreading infection of the dermis and subcutaneous tissue

begins as tender small patch (swollen, red painful)

what lab findings are consistent with cellulitis

leukocytosis or neutrophilia

how will venous insufficiency present 

itching and dull ache in the affected leg 

can be secondary to trauma or DVT 

how will primary varicosities present

pt complains of dull aching heaviness in LE thats worse with standing

abnormally dialed and tortous veins

what populations are most affected by primary varicosities

overweight

pregnant

how will reflex sympathetic dystrophy present 

persistent pain and swelling after trauma hyperactivity of SNS

how will pt describe pain with reflex sympathetic dystrophy 

sharp, burning pain (stage 1)

mottled atrophic cold skin (stage 2) 

aching throbbing pain with dystrophic changes obvious (stage 3) 

how will congestive heart failure present

bilateral leg edema

difficulty breathing with exertion or lying supine in sleep

what will an evaluation look like in a pt with congestive heart failure 

rales on auscultation 

chest film may show cardiomegaly 

haziness of vessel outlines

interstitial pulmonary edema 

if lymph nodes are hard, fixed, and matted what should we suspect

metastatic disease

if lymph nodes are rubbery and mobile what should we suspect

lymphoma

if there is lymphadenopathy with splenomegaly or hepatomegaly what should we suspect 

lymphoma

leukemia

mononucleosis 

what are the s/s of non-hodgkin lymphoma

painless lymphadenopathy w/ fever

drenching night sweats

weight loss more than 10% of body weight

what will labs show in non-hodgkin lymphoma

peripheral blood normal

possible meningeal involvement (malignant cells in CSF)

what are the classical findings of hodgkins lymphoma 

painless mass in neck 

fever

weight loss

night sweats 

generalized pruritis (itching) 

what population is commonly effected by chronic lymphocytic leukemia

>50 year olds

how will chronic lymphocytic leukemia present 

fatigue 

lymphadenopathy 

hepatomegaly 

splenomegaly 

what will labs show for chronic leukocytic leukemia

WBC >20,000

75% of cells are lymphocytes

what is the etiology of lymphogranuloma venerum

intercourse or contact with contaminated exudate

how will lymphogranuloma present in males 

inguinal buboes 1-4 weeks after exposure 

how will lymphogranuloma venerum present in females

lymph drainage to perirectal glands

what population is most at risk for cat scratch disease

children

young adults

what is the presentation of cat scratch fever 

fever 

headache 

malaise

papule/ulcer at inoculation site