Ch. 60 Spleen and Splenectomy

Question 1

1. Which arteries supply the spleen?
2. What is the venous drainage of the spleen?

Answer 1

1. Splenic a. (branch of celiac trunk) and short gastric arteries that arise from gastroepiploic a.
2. Portal vein, via the splenic vein and the L gastroepiploic vein

Question 2

What are the signs/symptoms of ruptured/injured spleen?

Answer 2

• Hemoperitoneum
• Kehr’s sign: L shoulder pain seen with splenic rupture
• LUQ abdominal pain
• Ballance’s sign: LUQ dullness to percussion

Question 3

How is a spleen injury diagnosed?

What is the treatment?

Answer 3

• Abdominal CT, if the patient is stable
• FAST exam, if patient is unstable

Treatment:

1. Nonoperative in a stable pt with isolated splenic injury
2. FAST laparotomy with splenorrhaphy (salvage) or splenectomy in unstable pt
3. Embolization in selected pts

Question 4

What are possible postsplenectomy complications?

Answer 4

• Thrombocytosis
• Subphrenic abscess
• Overwhelming Postsplenectomy Sepsis (OPSS)
  
  • Encapsulated:
    
    • ​S. pneumo**
    • Neisseria meningitides
    • H. influenza

Question 5

What are the findings on postsplenectomy RBC smear?

Answer 5

• Howell-Jolly bodies
• Heinz bodies

Question 6

When and how should thrombocytosis be treated?

Answer 6

When platelet count is >1 million, most surgeons will treat with aspirin

Question 7

What is the most common cause of splenic vein thrombosis?

Answer 7

Pancreatitis

Question 8

What is the most common cause of ISOLATED GASTRIC varices?

What is the treatment?

Answer 8

Splenic vein thrombosis (usually from pancreatitis)

Treatment: Splenectomy

Question 9

Which patients develop hyposplenism?

Answer 9

Patients with ulcerative colitis

Question 10

What vaccinations should every patient with a splenectomy receive?

Answer 10

• Pneumococcus
• Meningococcus
• H. influenzae type B

Question 11

What is idiopathic thrombocytopenic purpura (ITP)?

What is the most appropriate treatment upon diagnosis?

What is the most common cause of failure to correct thrombocytopenia after splenectomy for ITP?

Answer 11

Autoimmune (antiplatelet antibodies IgG in >90% of patients) platelet destruction –> troublesome bleeding and purpura

Treatment: Glucocorticoid therapy

What is the most common cause of failure to correct thrombocytopenia after splenectomy for ITP?
Missed accessory spleen

Question 12

What is TTP?

What is the treatment of choice?

Answer 12

What is TTP? Thrombotic Thrombocytopenic Purpura

What is the treatment of choice?
Plasmapheresis (splenectomy reserved as a last resort–very rare)

Question 13

A 60 y/o male pt with hepatitis C with a previous hx of variceal bleeding is admitted to the hospital with hematemesis. His BP is 80/60 mmHg, physical exam reveals splenomegaly and ascites, and initial hematocrit is 25%. Prior to endoscopy, what is the best initial mgmt of the pt?

Answer 13

IV octreotide

B-blocker to prevent future variceal bleeding