hello everyone in this video we are going to completely decode the most common form of extra pulmonary tuberculosis which is tuberculosis lymphadenitis now before we get into the how and about of db ring fatinitis let's quickly recall that tuberculosis is a bacterial infection which is usually caused by mycobacterium tuberculosis and in other cases by mycobacterium volvis and some atypical mycobacteria the main mode of transmission of tuberculosis is by droplet infection and droplet nuclei often by the cuff and sneeze of an infected individual now although tb mainly affects the lungs where it is known as pulmonary tuberculosis in about 15 to 20 percent of active cases the infection spreads outside of the lungs and this is known as extra pulmonary tuberculosis twenty to forty percent of extra pulmonary tuberculosis can be attributed to tuberculos lymphadenitis so this is the most common type of extra pulmonary tuberculosis now in tuberculosis lymphadenitis the most common site of infection is the cervical lymph nodes and especially the upper deep survival lymph nodes apart from that it can also affect the axillary lymph nodes the periodic the mesenteric and the inguinal lymph nodes in the cervical the most common area of occurrence is in the upper deep survival lymph nodes especially the jugular digastric lymph node and in the posterior triangle of nodes now in most instances as i told you uh this is the jubilee digastric lymph node okay it is part of the upper deep cervical lymph nodes so in most instances the bacilli enter this lymph node through the tonsillar crypts of the palatine tonsil okay so from here it spreads to here apart from that in about 20 of the cases the lymph nodes in the posterior triangle are affected by the involvement of adenoids which are present on the roof of the nasopharynx okay now more rarely the infection can spread from the apex of the lungs towards the supraclavicular uh lymph nodes by penetrating the suprapleural membrane okay and this will cause the enlargement of supraclavicular lymph nodes apart from that axillary and inguinal lymph nodes the axillary and inguinal lymph nodes are commonly involved in hematogenous or retrograde lymphatic spread the clinical features they include an increasing painless swelling of one or more of the lymph nodes associated with evening pyrexia cough when there is involvement of pulmonary tuberculosis and malaise apart from that we also seek failure to thrive if the software is a child okay so now coming to the most important part of tuberculosis lymphedinitis which are the stages of infignitis okay so first up we have the adrenopathy followed by matu formation of a cold abscess which progresses onto a cholesterol and finally results in a status formation let's look at all of these stages one by one now so in the first stage of the stage of lymphedemitis we notice non-tender firm discrete and mobile lymph nodes that are palpable so there are two things that i want you to note here one that these are palpable non-tender swellings okay and this is because tb is not associated with acute inflammation besides that histologically they show non-specific reactive hypoplasia okay so these are palpable non-tender form discrete mobile lymph nodes in the next stage or the stage of periodontitis or mating we observe large firm swellings that are fixed to the surrounding tissues and to each other and this uh this nature of matting or being fixed to each other is due to the involvement of the capsule of the maintenance remember that this matting is pathognomic of tuberculosis okay now the next stage is the formation of cold axis now this is due to gaseoating necrosis that happens within this it leads to extensive and caseiated mold which may liquify and break down giving rise to variable consistency with soft areas of cold abscesses and formula foods okay so the things that you have to keep in mind regarding the cold axis are that it is not associated with signs of cold uh of acute inflammation like other abscesses okay it is a cold axles and it shows no local rise of temperature no tenderness no redness and appears to be a soft fluctuate fluctuation okay now in the next stage so far we saw that this collapses is confined by the deep facial but in this stage the first formation will fierce the deep facial and form a swelling under the skin and this will result in two collections of us okay one below the deep facial and one below the skin which communicate through a narrow opening now this stage is called the stage of cholesterol abscess and it derives its name from a cholesterol which as well has two components okay finally the last stage is the stage of sinus formation so so far the pulse had been confined by deep facial then it fears the deep fascia now it was confined by the skin now in the last stage it finally erupts through the skin and forms a persistent discharging science okay so there is a formation of a persistent discharging sinus and the discharge from the sinus it will naturally be infected and can surround the surrounding skin causing extensive tuberculosis also now what you have to notice about the sinus is that they can be multiple they might have a wide opening undermine edges a bluish discoloration will be present around the sinus as well as there will be no integration okay so with this we have completed all the stages of tuberculosis lymphedemic and i want you to pause the video here now and try to recall all the stages of tuberculosis lymphedemic along with the clinical features associated with them now if you got these right which were the stage of firm non-tender pipeable swelling followed by martin followed by casey eating necrosis which led to cold absence which piers the deep facial to form cholesteropsis finally rupturing through the skin to form assignments you're absolutely right and here's a thumbs up for you and if you didn't get this right it's okay just remind okay so with this we come to the end of the video where we have seen the overview of cervical impedinitis we have seen the mode of infection the site of infection as well as the stages and the clinical features in the next video we will continue on to the clinical manifestations the treatment and the diagnosis so thank you so much for watching i hope this helped you in some way and i'll see you in another lecture see you have a good day