What is the cause of swollen abdominal lymph nodes in children?

Abdominal lymphadenopathy is a common disease in children. There are currently a variety of treatments with relatively good results. For parents, when a child is diagnosed with swollen abdominal lymph nodes, if they do not have relevant knowledge, they will become extremely nervous and suspicious, always thinking that their child should not suffer from a disease that sounds quite serious. To this end, let us understand what causes swollen abdominal lymph nodes in children to avoid missing treatment or misdiagnosis.

Causes of mesenteric lymphadenitis (swollen abdominal lymph nodes) in children

Mesenteric lymphadenitis in children is a common disease in children. It is generally believed to be caused by upper respiratory tract infection, bloodstream infection of streptococci or viruses (i.e. after a cold), and is also believed to be related to intestinal inflammation and parasitic diseases. It is more common in the terminal ileum (clinical manifestations include right lower abdominal and periumbilical pain, etc.). The lymph nodes are multiple and congested and swollen. There may be a small amount of inflammatory exudate in the abdominal cavity. Microscopically, the lymphatic sinuses were dilated and neutrophils entered the lymphatic sinuses from small blood vessels and phagocytosed bacteria. Acute mesenteric lymphadenitis is often associated with upper respiratory tract infections.

Children are in the growth and development period, their immune systems are active, their immune functions are strong, and their lymph follicle germinal centers are obvious. On the other hand, since children's bodies are not yet fully developed, various intestinal bacteria, viruses, toxins, etc. may pass through the intestinal mucosa and cause mesenteric lymphadenitis.

Clinical diagnosis of mesenteric lymphadenitis in children (clinical diagnosis of mesenteric lymphadenopathy in children)

Since mesenteric lymphadenitis in children often occurs at the terminal ileum, it is relatively difficult to diagnose the disease clinically and is easy to misdiagnose. Currently, the diagnosis of this disease mainly relies on medical history, clinical manifestations and routine blood tests.

The application of ultrasound has opened up a new examination approach for the diagnosis of this disease.

Acute mesenteric lymphadenitis

The ultrasound manifestations are characteristic, namely, the number of mesenteric lymph nodes in the ileum and colon regions increases, the diameter increases, the shape is oval, the structure is target-like or the inside is uniformly low-echoic and there is no fusion. A qualitative diagnosis can be made based on these characteristics.

1. Differentiation from acute mesenteric tuberculosis: Acute mesenteric tuberculosis manifests itself on ultrasound as round or oval enlargement of the mesenteric lymph nodes, with incomplete capsule, fusion, and uneven internal echoes. In the late stage, scattered liquefaction areas and strong light groups or spots accompanied by acoustic shadows may appear. It may be accompanied by a large amount of ascites, intestinal adhesions and other changes, which are different from this disease.

2. Differentiation from malignant lymphoma: Mesenteric malignant lymphoma is manifested on ultrasound as enlarged lymph nodes that tend to be round and have a small aspect ratio.

The affected segments are longer and may have fusion, central necrosis, and punctate calcification, which are significantly different from this disease.

3. Differentiation from acute appendicitis: Acute appendicitis is manifested by enlarged lymph nodes in the right lower abdomen on ultrasound, which is similar to the ultrasound manifestations of acute mesenteric lymphadenitis, but the number of enlarged lymph nodes is small, generally ≤3. At the same time, there are ultrasound manifestations of acute appendicitis, which makes it easy to differentiate from this disease.

Criteria for lymphadenopathy

Combining the standards for determining lymphadenopathy at home and abroad, the standards for determining lymphadenopathy are:

If more than two lymph nodes are imaged in the same area of ​​the mesentery, those with a long-axis diameter >1.0 cm or a short-axis diameter >0.5 cm are considered enlarged.

Normal mesenteric lymph nodes are mostly located around the umbilicus, and may be seen as one or several, kidney-shaped or bean-shaped, with clear boundaries and smooth surfaces. Blood flow signals are often not detected in the lymph nodes or only point-like blood flow signals can be detected.

Sonographic manifestations of acute mesenteric lymphadenitis

The enlarged lymph nodes are mostly located in the right lower abdomen or periumbilical area, or the lymph nodes in both the right lower abdomen and periumbilical area are enlarged. The enlarged lymph nodes are mostly several or more, distributed in isolation or in clusters without fusion. The enlarged lymph nodes around the umbilicus are usually multiple and clustered, while the enlarged lymph nodes in the right lower abdomen are usually solitary. The enlarged lymph nodes are also kidney-shaped, with a smooth and complete surface and a clear boundary between the cortex and medulla.

CDFI: Rich color blood flow signals can be seen in the center of the enlarged lymph nodes. A small amount of fluid dark area can be seen in the right iliac fossa triangle of some patients.

Clinical manifestations and symptoms of mesenteric lymphadenitis (swollen abdominal lymph nodes) in children

Fever, abdominal pain, vomiting, or diarrhea or constipation may occur. Abdominal pain sometimes feels like cramps in the lower right abdomen, but can also occur in other parts of the body.

Lymphatic tuberculosis is accompanied by low fever and changes in stool symptoms. Lymphatic tuberculosis is generally caused by tuberculosis in other parts of the body.

Treatment of mesenteric lymphadenitis in children (treatment of mesenteric lymphadenopathy in children)

This disease is mostly a viral infection and may heal naturally. Under normal circumstances, lymph nodes will not degenerate and will not leave any problems!

After anti-inflammatory and antispasmodic treatment (commonly known as anti-inflammatory and analgesic, treatment must be carried out under the diagnosis and guidance of a doctor), the condition will improve and recover! Enlarged lymph nodes are caused by inflammation and should be treated with sufficient antibiotics as soon as possible to completely cure the enlarged and inflamed lymph nodes.

However, if the disease recurs or is not treated thoroughly, it may turn into chronic mesenteric lymphadenitis. Children often experience abdominal pain at irregular intervals in an irregular location, and drug treatment requires a long time. In addition, chronic mesenteric lymphadenitis can also be caused by tuberculosis, accompanied by intestinal tuberculosis or tuberculous peritonitis, and a history of contact with tuberculosis. The clinical manifestations include symptoms of chronic tuberculosis poisoning, low fever, night sweats, fatigue, poor appetite, and abdominal pain. Enlarged lymph nodes with obvious tenderness can be palpated in the right lower abdomen or left upper abdomen.

Anti-tuberculosis treatment is generally effective. Surgery may be considered if necessary.

If the child has received the BCG vaccine, lymph node tuberculosis is basically not considered. It was considered to be simple lymphadenitis. Because successful BCG vaccination can also cause the PPD redness to be that big. If the medical history is typical, the abdominal tenderness is widespread, and there is no abdominal muscle tension, non-surgical treatment can be performed first, intravenous antibiotics, or heat-clearing and detoxifying agents can be used. Changes in abdominal signs should be closely monitored, and if other precipitating diseases are found, they should be treated promptly. It should be noted that it must also be differentiated from lymphoma, which may also manifest as enlargement of the mesenteric lymph nodes and require biopsy for differentiation.

The above is an introduction to what causes swollen abdominal lymph nodes in children. What needs to be reminded here is that because children have low body resistance, if they do not have good eating habits and neglect their health care, the abdominal lymph nodes in children will be very swollen. Therefore, in order to prevent abdominal lymphadenopathy in children, please take preventive measures in time.