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ABSITE > appendicitis & spleen > Flashcards

appendicitis & spleen Flashcards

1
Q

rate of postop abscess formation after complicated/perforated appy?

A

10-20%

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2
Q

appendiceal mass 3 cm on appendectomy for presumed appendicitis

A

> 2cm should be treated as ca; do hemicolectomy with nodal resection (onc resection)

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3
Q

asx simple splenic cyst mgmt

A

no size cute off; leave alone if sx
BTK “consider 5 cm”

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4
Q

sx simple splenic cyst mgmt

A

fenestrate if very close to capsule
partial splenectomy if >1/3 spleen exists
full splenectomy if <1/3 spleen exists (functional loss)
unroof and aspirate is too high recurrence

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5
Q

US and splenic anatomy

A

not great… need a CT scan (I.e. for abscess)

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6
Q

Sequestration crisis

A

in sickle cell disease - lethargy, LUQ pain, lightheaded, tachy, hypotensive.
anemic.

tx: supportive care and transfusions as needed, with decision regarding splenectomy.

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7
Q

splenic aa aneurysm surgical indication

A

pregnancy or > 2cm
(endovascular coil or surgery if too close to hilum)

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8
Q

splenic aa aneurysm CT scan finding

A

double rupture!

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9
Q

G6PD triggers

A

Recent infection»> sulfonamides, fava beans, antimalarials, and nitrofurantoin

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10
Q

hereditary spherocytosis surgical indication

A

splenectomy at 6 YO
brings up Hgb by 3 g/dL

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11
Q

why cholecystectomy with splenectomy in 6YO spherocytosis

A

bilirubin stones usually formed

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12
Q

\splenic opsonization proteins

A

Tuftsin and Properdin peptides

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13
Q

post splenectomy smear

A

Howell Jolly bodies (basophilic nuclear remnants of the cells that don’t get filtered out by the spleen), Pappenheimer bodies (Fe), target cells (immature RBC), heinz body (denatured Hgb), Spur cell (deformed membrane)

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14
Q

how to identify accessory spleen

A

tagged RBC study

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15
Q

MC location for accessory spleen

A

hilum

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16
Q

splenorenal and gastrosplenic ligament contents

A

splenorenal: pancreatic tail and splenic vessels
gastrosplenic: short gastrics (MC bleeding after splenectomy) and gastroepiploics

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17
Q

where do splenic aa and vein run compared to pancreas

A

Splenic artery is found SUPERIOR to the pancreas; vein runs POSTERIOR to pancreas and INFERIOR to artery

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18
Q

hereditary spherocytosis defect, inheritance

A

AD, spectrin protein

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19
Q

TTP HUS defect

A

ADAMTS13 defect

metalloproteinase vWF cleaving protein

needs plasmapharesis wa

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20
Q

ITP defect

A

2b3a and 1a2a glycoprotein Ab’s made in the spleen

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21
Q

ITP mgmt

A

IVIG and steroids
splenectomy If recurs. – good response to steroids = good response to splenectomy

22
Q

when to transfuse in ITP?

A

after artery is clamped (splenectomy)

23
Q

PK deficiency and anemia/thrombocytopenia

A

congenital hemolytic anemia from glucose metabolism issue
Tx: splenectomy reduces transfusion requirements

24
Q

MC splenic tumor benign and overall

A

hemangioma (resect if sx only)

25
Q

MC splenic tumor malignant

A

angiosarcoma (vinyl chloride and thorium dioxide)

high mortality… resect if able

26
Q

other malignant splenic tumor

A

Nonhodgkins lymphoma = MC CLL
splenectomy if huge spleen; needs chemotherapy after staging

27
Q

wandering spleen dx and tx

A

presents as torsion

RLQ CT/US failure fusion of dorsal mesogastrium
lack of splenic ligaments
splenopexy if no infarct
otherwise splenectomy

28
Q

postop LUQ fluid collection after splenectomy?

A

panc leak; perc drainage and send for amylase

29
Q

AAST splenic injury grades

A

I: Lac of capsule, < 1cm parenchymal depth
II: lac with 1-3 cm parenchyma, hematoma 10-50% of surface area
III: laceration > 3 cm parenchyma or involves trabecular vessels
Hematoma > 50% surface area or expanding, or any ruptured hematoma
IV: Lac involving segmental or hilar vessels producing major devascularization > 25% spleen
V: Lac causing completely shattered spleen
Hilar vascular injury which devascularized spleen

30
Q

mgmt of splenic injury based off of grading

A

IV and V = angioembolization

31
Q

opsi (overwhelming post splenectomy infection) bugs

A

S. pneumo > N. meningitidis, H. flu

32
Q

appendicitis first sx

A

anorexia

33
Q

appendicitis WBC

A

can be normal

34
Q

appendicitis CT scan findings

A

diameter > 7 cm, wall > 2mm, fat stranding, no rectal contrast in lumen

35
Q

appendicitis presentation in pregnancy

A

MC cause of pain in 1st trimester
MC occurence in 2nd trimester
most likley to perf to 3rd trimester

36
Q

what improves intraabdominal abscess formation rates after perf appy

A

converting to OPEN (not drain placement) 2018 Cochrane review

37
Q

lap positioning preg appy

A

side bump
Veress Palmars point
5 mm trocar RUQ
Target and triangulate once ID’d appy

38
Q

contraindication to CRS/HIPEC?

A

extraabdominal mets.

39
Q

what will a coombs test distinguish between?

A

TTP and Evans (ITP+IAHA)

40
Q

post splenectomy sepsis aabx

A

IV vanc/Rocephin or
IV Vanc/cefotaxime

41
Q

MC variant of for splenic vasculature?

A

short splenic trunk with 6-12 long branches into the spleen

42
Q

what veins dilate (varices) after splenic vein thrombus?

A

short gastrics, gastroepiploics, and coronary vein (feeds directly from cardia to the PV)….
PV, SMV, IMV are all patent/not an issue

43
Q

red pulp vs white pulp

A

red: filter RBC; thin walled sinusoids separated by cords of Red cells

white: immune… B cell follicles and periarterial lymphatic sheath PALS T cells

44
Q

functions of spleen

A
  1. store plt
  2. filter out senescent rBC
  3. PIT RBC by removing intracellular products
  4. immune
  5. opsonization tuftsin/properdin
45
Q

howell jolly body

A

nuclear remnants that aren’t filtered out… =damaged spleen

46
Q

pappenheimer body

A

iron deposits left in RBCs, flecks

47
Q

target cell

A

immature RBC released by spleen

48
Q

heinz body

A

intracellular denatured Hgb in RBC

49
Q

spur cell

A

deformed membrane of RBC

50
Q

only absolute contraindication to splenectomy

A

cirrhosis with portal HTN

51
Q

ttp hus sx

A

fat rn

fever
anemia
thrombocytopenia
renal failure
neurologic ams

52
Q
A

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