Ch. 6 Spleen Flashcards
Its the largest structure of the reticuloendothelial system
Spleen
It’s an intraperitoneal organ located within the left upper quadrant of the abdomen whose primary objective is to filter the peripheral blood
Spleen
The largest lymphatic organ of the body
spleen
The _______ plays an important role in defense against infection in children while in adults, it produces lymphocytes and monocytes
Spleen
The spleen is responsible for ____________ in the fetus
Erythropoiesis
At what week gestation does the spleen begin to develop?
5th
What is the role of the spleen in adults?
produce lymphocytes & monocytes
RBC production in adults is primarily performed by what?
bone marrow
The spleen’s hematopoietic function which can return in cases of severe anemia
extramedullary hematopoiesis
What specialized tissue is the spleen composed of?
white & red pulp
List the functions of the spleen
- Defense against disease
- Hematopoiesis/erythropoiesis
- Destruction and removal of flawed red blood cells and platelets
- Blood reservoir
- Storage of iron
Although red blood cell production in the adult is primarily performed by the bone marrow, the spleen hematopoietic function can return in cases of ______________.
Severe anemia
Specialized lymphatic tissue within the spleen
White pulp
Specialized tissue within the spleen that performs its phagocytic function
red pulp
A type of cell that Engulfs and destroys pathogens
Phagocytes
White pulp of the spleen does what?
produces and houses lymphocytes, carrying out the spleens lymphatic tissue
Red pulp of the spleen does what?
contains RBC’s and macrophages, performs the phagocytic function
The splenic process of removing irregular red blood cells from the bloodstream
culling
The splenic process of cleaning red blood cells of unwanted material
pitting
Doppler evaluation of the splenic artery normally demonstrates what kind of flow pattern?
low-resistance
What is the vascular anatomy of the spleen?
The splenic artery is a branch of the celiac trunk, which may be also referred to as the celiac artery or celiac axis. From the celiac trunk, the splenic artery courses laterally toward the spleen.
The ________ _______ can be confused for the main pancreatic duct in some patients because it takes a similar course in the body.
Splenic artery
What is the best patient position to best visualize the spleen?
Taking a deep breath with the patient lying on his or her right side
The splenic vein exits the spleen and travels along the posterior border of the pancreatic tail and body. It joins with the ______ posterior to the pancreatic neck to form the portal vein. Flow within the splenic vein will be toward the liver.
superior mesenteric vein
What is the normal sonographic appearance of the spleen?
Its frequently isoechoic to the liver, although it may be slightly more echogenic
a small, round island of splenic tissue often located near the splenic hilum or tail of pancreas
accessory spleen
This is also referred as a splenule, a splenunculus, or a supernumerary spleen
Accessory spleen
Where is the accessory spleen usually located?
near the hilum or possibly near the tail of the pancreas
The spleen may appear to be divided by a hyperechoic line in some individuals which is called..
Splenic cleft
What are the two uncommon congenital anomalies of the spleen?
Asplenia and polysplenia
Congenital absence of the spleen
asplenia
Development of multiple small masses of the splenic tissue
polysplenia
The implantation of ecotopic splenic tissue
Splenosis
The size of the spleen varies with ___ & ___.
age & sex (decreasing with advanced age)
Asplenia and polyslenia have been associated with
cardiac malformations & heterotaxia syndromes (organs in chest/abdomen are abnormally arranged)
Splenosis is a complication of
splenic trauma
A highly mobile spleen
wandering spleen
An individual with a wandering spleen could suffer from ___________ because of the vessels of the spleen may twist secondary to the hypermobility of the organ
Splenic torsion
The twisting of the splenic vasculature causing a disruption in the blood supply to the spleen and subsequent ischemia
splenic torsion
What is the most common abnormality of the spleen?
splenomegaly
the spleen should never measure more than ___ in length and ____ in thickness
12cm; 5cm
Reduction in the number of leukocytes in the blood
leukopenia
Splenic size varies with age, size and gender but should not exceed
12-13 cm in length, 6 cm in thickness
As the spleen enlarges, it tends to become more
hypoechoic
What is the most common cause of splenomegaly?
portal hypertension
Suspicion of splenomegaly should arise when the spleen extends
beyond the inferior pole of the left kidney
When portal hypertension is suspected as the cause of splenomegaly what should be closely evaluated?
splenic hilum for evidence of varices
Massive splenomegaly can lead to
spontaneous splenic rupture
If portal hypertension is suspected, a sonographer should closely evaluate the _____________.
Splenic hilum
A herpesvirus that can lead to infectious mononucleosis
Epstein-Barr infection
True or False: Epstein-Barr infection will typically result in splenomegaly in both adults and children.
True
A cyst in the spleen that results from the parasitic infestation of an organ by a tapeworm Echinococcus granulosus
hydatid cyst
Caused by staphlyococcus aureus, streptococcus, salmonella
pyogenic abscess
A history of ___ increases the patients likelihood of developing a pyogenic abscess
bacteremia
Fungal abscess most often results from what?
Candida
Who’s more likely to be affected by a fungal abscess?
immunocompromised
Area in the spleen that has become necrotic owing to a lack of oxygen, sudden onset of LUQ pain
splenic infarct
In the chronic stage, splenic infarct tend to appear more ___ compared to adjacent normal tissue
echogenic
Clinical findings of ______:
Palpable, enlarged spleen
Hemolytic abnormalities
Trauma
Infection
Possible elevated white blood cell and/or red blood cell count
splenomegaly
Sonographic findings of ______:
1. Enlargement of the spleen to greater than 12 to 13 cm in length or 6 cm in thickness
2. Spleen extends beyond the inferior pole of the left kidney
splenomegaly
Clinical findings of ______:
1. Asymptomatic
2. Pain can occur with hemorrhage
simple splenic cysts
Sonographic findings of ______
1. Round
2. Smooth-walled mass
3. Anechoic mass
4. Posterior enhancement
simple splenic cysts (aka epithelial cyst)
Clinical findings of ______
1. fever
2. leukocytosis
3. LUQ tenderness
4. left flank pain
5. splenomegaly
splenic abscess
Sonographic findings of ______
1. Complex appearance
2. May contain debris or gas (that produces dirty shadowing)
3. Can be completely hypoechoic
4. Fungal abscess may appear as small solid masses or have a target or bull’s-eye appearance
5. Color Doppler will demonstrate increased flow around the mass but not within it
splenic abscess
An area within the spleen that has become necrotic because of a lack of oxygen
splenic infarct
Sickle cell disease, bacterial endocarditis, tumor embolization, vasculitis, lymphoma can be causes of??
Splenic infarct
The ____________ is typically seen sonographically as a hypoechoic, wedge-shaped mass.
Splenic infarct
Clinical findings of _____
1. sudden onset of LUQ pain
splenic infarct
Sonographic findings of ______
1. acute infarct - hypoechoic, wedge-shaped mass within the spleen
2. chronic infarct - hyperechoic, wedge-shaped mass within the spleen
splenic infarct
The spleen is often injured in cases of ________ ______.
Blunt trauma
Clinical findings of_______
1. blunt trauma to the LUQ
2. severe LUQ pain
3. decreased hematocrit level indicating active bleeding
splenic trauma
Sonographic findings of ______
1. Acute hemorrhage—complex or hypoechoic
2. Middle stage—echogenic (with clot formation) or isoechoic
3. Later stages of hemorrhage—anechoic or hypoechoic
4. Chronic hematomas may have a complex appearance or calcified walls
splenic trauma
The most common benign tumor of the spleen
Hemangioma
The most common mass of the spleen is?
benign hemangioma
Clinical findings of a ______
1. Asymptomatic
2. Pain occurs with hemorrhage
Splenic Hemangioma
Sonographic findings of ______
1. Well-defined, hyperechoic mass
Splenic Hemangioma
Small echogenic calcifications that result from inflammation of the tissue in that area
granulomas
Small echogenic foci scattered throughout the spleen most likely represent
multiple benign granulomas
Granulomas can be found in patients who have a history of:
- Histoplasmosis
- Tuberculosis
- Sarcoidosis
Clinical findings of ______ Disease of the Spleen:
1. asymptomatic
2. may have a history of histoplasmosis, tuberculosis, or sarcoidosis
Granulomatous
Sonographic findings of ______ Disease of the Spleen:
1. Small, echogenic foci that may shadow
Granulomatous
Benign splenic mass that has been associated with Beckwith-Weidermann syndrome and tuberculous sclerosis
Splenic hamartoma
These tumors have been associated with Beckwith-Weidermann syndrome and tuberous sclerosis
Splenic hamartoma
Clinical findings of ______:
1. asymptomatic
2. pain can occur with rupture
3. patient may have history of beckwith-weidemann syndrome or tuberous sclerosis
Splenic Hamartoma:
Sonographic findings of _______
1. hypoechoic mass or masses (echotexture can vary however)
2. color doppler may reveal hypervascularity
Splenic Hamartoma
What is the primary malignant tumor of the spleen?
Angiosarcoma
Diffuse involvement of lymphoma or leukemia of the spleen will often lead to:
splenomegaly
What is the most common malignancy of the spleen?
lymphoma
Lymphoma can be classified as
Hodgkin lymphoma or non-Hodgkin lymphoma
The ____________ cells indicates Hodgkin lymphoma
Reed-Sternberg
Clinical findings of _______:
1. LUQ pain
2. Fever
3. Weight loss
4. Malaise
Splenic Malignancy
Sonographic findings of _______:
1. Diffuse - splenomegaly
2. Focal - hypoechoic masses
Splenic Malignancy
benign lesion that is a congenital malformation of the lymphatic system
splenic lymphangioma
Clinical findings of _______:
1. Nausea
2. LUQ pain
3. Abdominal distention
Splenic Lymphangioma
Sonographic findings of ______:
1. Multicystic masses
2. Masses may contain hypoechoic or anechoic locules and hyperechoic septations
Splenic Lymphangioma
Echogenic line within the spleen immediately following trauma
laceration
Splenic rupture can lead to implants of ectopic tissue referred as
splenosis
Most common mass of the spleen is the
benign hemangioma
The presence of ___ indicates Hodgkin’s lymphoma which can be treated and carries a high recovery rate
Reed-Sternberg cells
Which lymphoma type is more common in the spleen, but not as easily managed
non-hodgkins lymphoma
The most common primary locations of metastatic disease to the spleen are
breast, lung, skin (melanoma), ovary
Benign tumor of the spleen composed of lymph spaces, congenital malformation of the lymphatic system, more common in children
splenic lymphangioma
A group of inherited blood disorders that affect hemoglobin (ex. sickle cell anemia)
sickle cell disease
Those with _____ have abnormal, crescent-shaped RBC’s that tend to attach to each other and obstruct normal vascular channels, causing many complications. More common in African-American, Middle East, Mediterranean, and Hispanic children of Caribbean descent in the US.
Sickle cell anemia
The gradual fibrosis and dysfunction of the spleen secondary to a disease
autosplenctomy
Occasionally, focal masses (round, hypoechoic) of normal splenic tissue may be noted in _____
sickle cell disease
Patients undergoing a ______ may have decreased hematocrit and complain of bone pain. These patients are at increased risk for gallstones, multiple organ damage, blindness, and stroke.
sickle cell crisis
