Ch. 6 Spleen Flashcards by Destiny S

Its the largest structure of the reticuloendothelial system

Spleen

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It’s an intraperitoneal organ located within the left upper quadrant of the abdomen whose primary objective is to filter the peripheral blood

Spleen

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The largest lymphatic organ of the body

spleen

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The _______ plays an important role in defense against infection in children while in adults, it produces lymphocytes and monocytes

Spleen

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The spleen is responsible for ____________ in the fetus

Erythropoiesis

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At what week gestation does the spleen begin to develop?

5th

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What is the role of the spleen in adults?

produce lymphocytes & monocytes

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RBC production in adults is primarily performed by what?

bone marrow

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The spleen’s hematopoietic function which can return in cases of severe anemia

extramedullary hematopoiesis

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What specialized tissue is the spleen composed of?

white & red pulp

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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

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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

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Specialized lymphatic tissue within the spleen

White pulp

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Specialized tissue within the spleen that performs its phagocytic function

red pulp

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A type of cell that Engulfs and destroys pathogens

Phagocytes

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White pulp of the spleen does what?

produces and houses lymphocytes, carrying out the spleens lymphatic tissue

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Red pulp of the spleen does what?

contains RBC’s and macrophages, performs the phagocytic function

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The splenic process of removing irregular red blood cells from the bloodstream

culling

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The splenic process of cleaning red blood cells of unwanted material

pitting

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Doppler evaluation of the splenic artery normally demonstrates what kind of flow pattern?

low-resistance

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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.

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The ________ _______ can be confused for the main pancreatic duct in some patients because it takes a similar course in the body.

Splenic artery

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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

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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

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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:

1. Histoplasmosis 2. Tuberculosis 3. 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