Abdominal Lymph Node Enlargement Explained

Introduction:

The abdominal lymph nodes are scavengers that help get rid of infections or inflammation within the abdomen. They also help in draining inflammatory debris away from the abdomen to systemic blood circulation. They can temporarily enlarge and may cause some abdominal symptoms, however, the chronic enlargement of these lymph glands is considered to be pathological and often require thorough investigations to diagnose the underlying cause. In this article, we would discuss the possible underlying causes of enlargement of abdominal lymph nodes, their target approach, and management of the underlying disorder.

What Are the Symptoms of an Enlarged Lymph Node?

Patients often do not feel any symptoms unless advanced stages of lymph node enlargement are present. The common symptoms that patients report are:

1. Low-grade fever.

2. Mild to moderate abdominal pain.

3. Diarrhea or constipation.

4. Weight loss.

5. Low hemoglobin levels in the blood.

6. Active bleeding from the mouth or anus.

The patient often reports such symptoms over a long period of time. The physician in charge of looking after that patient should have a high level of suspicion to diagnose the disorder. It is important for a physician to have a low threshold for investigating an individual who is presenting with unusual weight loss or low hemoglobin, or personal or family history of any abdominal tumors.

What Are the Functions of Lymph Nodes and Lymph Glands?

The lymph nodes are human tissues that work as scavengers to help get rid of infections, by providing local immunity and draining inflammatory debris away from inflamed tissues to other lymphoid organs such as the spleen, bone marrow, and a few others. These lymph nodes are normally scattered throughout the human body, but in the abdomen, they are comparatively in large numbers.

What Are Acute and Chronic Lymph Node Enlargement of the Abdomen?

In acute (that last for a short time) infection or inflammation, these lymph nodes enlarge for a short duration of time and gain back to their normal size once the infection or inflammation goes away.

However, in contrast to this, the chronic (ongoing) infection or inflammation, these lymph nodes tend to remain enlarged for a long duration of time and usually, the presence of lymph nodes over a long period of time suggests ongoing problems within the abdomen.

What Are the Causes of a Lymph Node Enlargement?

Few of the causes or conditions causing lymph node enlargement are,

• Lymphoma.

• Breast cancer.

• Lung cancer.

• Pancreatic cancer.

• Gastrointestinal cancer.

• Yersinia enterocolitica infection.

• Gastroenteritis.

• Infection of bacteria, viruses, and parasites.

• HIV (human immunodeficiency virus) infection.

• Tuberculosis.

• Appendicitis.

• Crohn’s disease.

• Diverticulitis.

• Pancreatitis.

• Rheumatoid arthritis.

What Are the Possible Differential Diagnoses?

1. Tuberculosis lymphadenitis.

2. Low-grade abdominal lymphoma.

3. Yesenia-induced lymphadenitis.

4. Sclerosing mesenteritis.

5. Small bowel tumors or abdominal tumors.

What Are the Diagnostic Procedures Available to Diagnose Enlargement of Lymph Nodes?

• Complete blood picture with a peripheral film.

• ESR (erythrocyte sedimentation rate).

• CRP (C-reactive protein).

• LDH (lactic acid dehydrogenase).

• Uric acid.

• Renal function tests and electrolytes.

• Blood IGRA (interferon-gamma release assay) for tuberculosis.

• Abdominal computed tomography (CT) or CT scan of the chest and pelvis.

• Positron emission tomography (PET).

• CT scan to look for distant organ involvement.

• And lastly, the underlying cause of enlarged lymph nodes can reliably be confirmed with the lymph node mesenteric biopsy.

What Is Lymph Node and Mesenteric Biopsy?

The lymph node and mesenteric biopsy can be performed in a single setting. It is basically a procedure where a radiologist passes a needle under the guidance of a CT scan, to reach one of the enlarged lymph nodes and small intestine mesentery on the back of your stomach, take tissue out of it, and send it to a histopathology lab to see under a microscope. The procedure is safe in expert hands.

It is important that the patient meets with a radiologist in person to discuss the pros and cons of performing lymph node biopsy under ultrasound or CT scan guidance. The word biopsy is often tempting for the patients, and people often get anxious while listening about a biopsy. Still, as already said, the procedure is relatively safe in expert hands. Secondly, at times, the biopsy is deemed necessary because, without biopsy, no other tests can reliably exclude or confirm the potential diagnosis in question.

How to Manage Enlarged Lymph Nodes?

Initial diagnosis of the enlarged lymph nodes in the abdomen can be established with the help of a multidisciplinary team consisting of a gastroenterologist, a radiologist, and an infectious disease expert. Once the diagnosis is established, the patient can then be referred to a physician or a surgeon with expertise in the management of that individual disorder. The medical implication of individual disorders is entirely different.

Sclerosing mesenteritis, which is benign (not harmful), requires just observation unless complicated. While other disorders like low-grade lymphoma require aggressive anti-tumor treatment and more frequent follow-ups with a medical oncologist and a radiologist.

Similarly, infections like Yesenia enterocolitis and tuberculosis require a single or combination antibiotic therapy for a prolonged duration of time, respectively, by following up with an infectious disease specialist.

In cases where the patients with small bowel tumors or any other abdominal tumor, who are found to be a candidate for surgical resection, should be referred to a surgeon with relevant expertise in the field.

Follow-up and Long-term Management:

The long-term management of enlarged abdominal lymph nodes depends upon the cause of the disorder. The infections like tuberculosis and Yesenia do not require a long-term follow-up after their successful treatment with antibiotics. However, disorders like small bowel tumors or lymphoma, a blood-related tumor, require a long-term follow-up with a medical oncologist, surgical oncologist, and a radiologist who will provide repeated surveillance CT scans of the abdomen to monitor the disease.

How to Prevent Lymph Node Enlargement?

As such, there are no preventive measures that physicians can recommend to their patients in order to prevent the enlargement of abdominal lymph nodes. However, it is imperative for patients to seek medical advice as soon as possible if they report any unusual weight loss, low-grade fever, low blood hemoglobin, or new onset of any symptoms while having a strong family history of abdominal diseases like abdominal tuberculosis and abdominal tumors.

Conclusion:

Not all the enlarged lymph nodes are cancerous. But it is vital to seek a doctor’s assistance to rule out severe complications. Enlarged lymph nodes present for a long time are to be examined at the earliest.