ABSITE Review - Spleen Flashcards
Where is the splenic vein in respect to the splenic artery?
Posterior and inferior
What is the function of the spleen?
Serves as an antigen presenting center for macrophages; largest producer of IgM
What are Howel-Jolly bodies?
Nuclear remnants
What are Heinz bodies?
Hemoglobin deposits
What are pappenheimer bodies?
Iron deposits
What is the function of the red and white pulp?
Red pulp 85% - acts as a filter for aged or damaged RBCs
White pulp 15% - immunologic function; contains lymphocytes and macrophages
Where is the major site of bacterial clearance that lacks preexisting antibiotics?
White pulp
Where is an accessory spleen most commonly found?
Splenic hilum 20%
What are some indications for splenectomy?
ITP > TTP
What antibodies are present in ITP?
Antiplatelet antibodies (IgG) - bind platelets, causes decrease PLTs
What is the treatment for ITP?
Steroids (primary therapy), plasmapheresis, gammaglobulin for steroid-resistant disease
Splenectomy indicated for those who fail steroids –> removes IgG production and source of phagocytosis; 80% respond after splenectomy
Give platelets 1 hour before surgery
What is the etiology of TTP?
Loss of platelet inhibition - leads to thrombosis and infarction, profound thrombocytopenia
What are the symptoms of TTP and how it is treated?
Sx - Purpura, fever, mental status changes, renal dysfunction, hematuria, hemolytic anemia
Tx - 80% respond to medical therapy, plasmapheresis (primary), steroids, ASA
What are the MC bacteria involved in postsplenectomy sepsis syndrome?
S. pneumoniae (#1), H. influenzae, N. meningitidis
What age is needed before a splenectomy to decrease the risk of postsplenectomy sepsis syndrome?
At least 5 years old –> allows antibody formation
How long after splenectomy the postsplenectomy sepsis mostly occurs?
Within 2 years of splenectomy
What are the vaccines needed before splenectomy?
Pneumococcus, Meningococcus, H. Influenza
What are the usual postsplenectomy changes?
Increase RBCs, increase WBCs, increase PLTs,; if PLT > 1x10^6, need ASA
What is the #1 benign splenic tumor?
Hemangioma
What is the #1 malignant splenic tumor?
Non-Hodgkin’s lymphoma
When is surgery indicated for splenic cysts?
Surgery if symptomatic or > 10cm
What labs alterations are seen in hypersplenism?
Decrease PLTs, RBCs, and WBCs; splenomegaly occurs as well
When is a splenectomy indicated in hypersplenism?
Symptomatic hypersplenism associated with CLL, CML, NHL, Hodgkin’s, hairy cell leukemia, hemolytic anemias, sarcoidosis
What is Felty’s syndrome?
Rheumatoid arthritis, hepatomegaly, splenomegaly
What is the MC congenital hemolytic anemia requiring splenectomy? What is the cause? What is the treatment?
Spherocytosis
Spectrin deficit (membrane protein) deforms RBCs and leads to splenic sequestration
Tx - splenectomy and cholecystectomy
Where is the defect in Elliptocytosis?
Spectrin and protein 4.1 deficit (membrane protein)
What precipitates G6PD deficiency?
Infection, certain drugs, fava beans
What is the MC thalassemia?
Beta-thalassemia
What is the difference in major and minor beta-thalassemia?
Major - both chains affected
Minor - 1 chain, asymptomatic
What is the staging system for Hodgkin’s lymphoma?
A - asymptomatic
B - symptomatic (night sweats, fever, weight loss) –> unfavorable prognosis
Stage I - 1 area or 2 contiguos areas on the same side of diaphragm
Stage II - 2 noncontiguos areas on the same side of diaphragm
Stage III - involved on each side of diaphragm
Stage IV - liver, bone, lung, or any other nonlymphoid tissue except spleen
What are the classic cells of Hodgkin’s lymphoma?
Reed-Sternberg cells
What is the MC type of Hodgkin’s lymphoma?
Nodular sclerosing
What is the MCC of chylous ascites?
Lymphoma
How is the prognosis of Non-Hodgkin compared to Hogkin’s lymphoma?
Worse prognosis
What are causes of spontaneous splenic rupture?
Mononucleosis, malaria, sepsis, sarcoid, leukemia, polycythemia vera
What is the cause of splenic artery aneurysm?
Fibromuscular dysplasia or atherosclerosis in females
