05 - Enlarged spleen

Question 1

What does the spleen do?

Answer 1

Destroys old red blood cells

Holds an emergency reserve of blood
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Recycles iron and metabolises haemoglobin

Synthesises antibodies (and complement proteins) and removes antibody coated bacteria

Question 2

What is the reticulo-endothelial system? cells?

What happens?

Answer 2

phagocyte system

Cells from reticular connective tissue and lymph nodes (macrophages)

Create new RBCs and WBCs and destroy the old ones.
Form bile pigments and plasma protein
Store iron
Clear heparin

Question 3

Egs of some macrophages

Answer 3

Monocytes in blood and bone marrow
Kupffer cells in liver
Microglia in CNS
Osteoclast in bone

Question 4

Causes of splenomegaly

Answer 4

haemolytic anaemia, leukemia, lymphomas, portal hypertension, haemoglobinopathies, AIDS, infections,.

Question 5

Usual cause of splenic rupture? rare cause?

Mx?

Answer 5

Associated with trauma (sport injury, RTC)

Bleeding, shock

Can occur rarely in mononucleosis

FAST USS to confirm then remove

Question 6

Major complication of splenectomy long term?

Mx of this ?

Answer 6

Infections

Immunisations
: MMR, HiB and all Menigitis (live vaccinations are safe). Require reimmunisation every 5 years

Prophylaxis
Those at high risk - (above 50, Hx pneumonia and malignancy) phenoxymethylpenicillin, amoxicillin and erythromycin

Question 7

what is portal hypertension?

causes?

Answer 7

Hypertension in heptic portal system

pre- intra- and posthepatic. Thrombus formation, atresia, liver cirrhosis, fibrosis, sarcoid, TB, pericarditis.

Question 8

Signs of portal hypertension ? risks of?

Answer 8

ascities, dilated veins, splenomegaly, jaundice, tenderness

varicies / bleeding

Question 9

Mx of portal hypertension

Answer 9

portosystemic shunt