anatomical pathology: spleen Flashcards
What is two causes of congenital abnormalities in the spleen
- Accessory spleen (additional spleen)
- Congenital asplenia/polysplenia (septum separates multiple spleens)
What is hypersplenism
Association between peripheral blood pancytopenia & splenic enlargement
What is the causes of hypersplenism
Primary (idiopathic)
Secondary
What is congestive splenomegaly
Persistent elevation of splenic venous blood pressure causing splenomegaly up to >1kg
What is the appearance of the capsule & cut surface in congestive splenomegaly
Capsule: thickened & fibrotic
Cut surface: beefy red with not clearly visible white pulp with Gamna Gandy bodies (healed infarction)
What is the three categories of congestive splenomegaly & causes
- Pre-hepatic: thrombosis of extrahepatic portion of portal/splenic vein
- Hepatic: cirrhosis
- Post-hepatic: raised pressure in IVC to spleen via portal system (ascites & hepatomegaly) & decompensated right heart failure/pulmonary or tricuspid disease
What is the appearance of systemic infectious splenomegaly
Moderate splenomegaly
Congestion & macrophages hyperplasia
Prominent white pulp
What is the appearance of bacterial infectious splenomegaly
Neutrophil accumulate in sinuses & medullary cords
Becomes soft due to proteolytic enzyme action
If extreme can cause acute septic splenitis
What is the appearance of viral infectious splenomegaly
More severe splenomegaly
Susceptible to rupture
What is the appearance of chronic malarial infectious splenomegaly
Massive splenomegaly
Splenic capsule is thickened & fibrotic
Cut surface is slate grey
What is the causes of granulomatous inflammation splenomegaly
Bacterial: TB
Fungal: histoplasmosis or cryptococcus
Protozoal: toxoplasmosis
What is two causes of immune disorder mediated splenomegaly
- Felty’s syndrome (RA, splenomegaly & neutropenia)
- SLE
What is two causes of RBC abnormalities splenomegaly
- Sickle cell anaemia
- Hereditary spherocytosis
What is four causes of neoplastic splenomegaly
- Haemangioma
- Acute & chronic leukaemia
- Myeloproliferative disorders
- Hodgkin’s lymphoma & non-Hodgkin’s lymphoma
What is three causes of storage disease splenomegaly
- Niemann Pick disease
- Gaucher’s disease
- Mucopolysaccharidoses
What is apparent in storage disorder splenomegaly
Red pulp expansion by macrophages
What is the three causes of splenic infarction
- Occlusion of splenic artery/branches
- Secondary to emboli arising from the heart
- Local thrombosis due sickle cell anaemia, myeloproliferative disorder & malignant infiltrates
What is the most common cause of a ruptures spleen
Blunt abdominal trauma
What is the consequence of rupture of the spleen
Massive life threatening intraperitoneal haemorrhage
What is the treatment for a ruptured spleen
Emergency splenectomy
What is splenic atrophy
Reduce in size & function of the spleen due to secondary causes
What is the cause of splenic atrophy
Intestinal malabsorption or sickle cell disease
Why does sickle cell disease cause splenic atrophy
Multiple splenic infarcts that causes the spleen to reduce in size & function
