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ABSITE 2022 > Chapter 34 - Spleen++ > Flashcards

Chapter 34 - Spleen++ Flashcards

1
Q

Where is the splenic v in relation to splenic a?

A

Posterior and inferior. It is behind the pancreas.

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2
Q

Spleen is the largest producer of what antibody?

A

IgM

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3
Q

What % of the spleen is red pulp? Function?

A

85%; acts as filter for aged or damaged RBCs

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4
Q

What is “pitting” caused by spleen seen on path slides for RBC?

A

Removal of abnormalities in RBC membrane

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5
Q

What are Howell-Jolly bodies?

A

Nuclear remnants

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6
Q

What are Heinz bodies?

A

Hemoglobin

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7
Q

What is culling in regards to spleen function?

A

Removal of less deformable RBCs

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8
Q

What % of the spleen is white pulp? Function?

A

15%; immunologic function, contains lymphocytes and macrophages; major site of bacterial clearance that lacks preexisting abs; site of removal of poorly opsonized bacteria/debris

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9
Q

What is tuftsin?

A

An opsonin; facilitates phagocytosis (produced in spleen)

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10
Q

What is properidin?

A

Activates alternate complement pathway (produced in spleen)

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11
Q

When does hematopoiesis occur in the spleen?

A

Before birth and in conditions such as myeloid dysplasia

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12
Q

Where is the most common location of accessory spleen?

A

Splenic hilum (20%)

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13
Q

What is the most common nontraumatic condition requiring splenectomy?

A

ITP. Medical indications are now greater cause for splenectomy than trauama.

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14
Q

What happens in ITP?

A

Antiplatelet IgG binds platelets, cause dec. platelet count –> gingival bleeding, petechiae, bruising, soft tissue ecchymosis

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15
Q

Treatment for ITP in children? Adults?

A

Children <10, usually resolves spontaneously; steroids (primary therapy), plasmapheresis, gammaglobulin for steroid-resistant disease, splenectomy for those who fail steroids… meds first, then surgery if that fails.

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16
Q

Why does splenectomy fix ITP?

A

Spleen is normal; removes IgG production and source of phagocytosis (80% respond)

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17
Q

TTP associated with what conditions?

A

Medical reactions, infections, inflammation, autoimmune disease

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18
Q

What happens in TTP?

A

Loss of platelet inhibition leads to thrombosis and infarction, profound thrombocytopenia; purpura, fever, AMS, renal dysfunction, hematuria, hemolytic anemia. ADAMST13 association.

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19
Q

Treatment for TTP?

A

Plasmapheresis (primary), steroids, ASA - 80% respond to medical therapy. No defined role for surgery.

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20
Q

Most common cause of death due to TTP?

A

Due to ICH or acute renal failure

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21
Q

Risk of postsplenectomy sepsis?

A

0.1%, increased risk in children; highest in pts with splenectomy due to hemolytic disorders or malignancy

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22
Q

Most common bacteria causing OPSS?

A

S. pneumonia, N. meningitidis, H. flu

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23
Q

Most episodes of OPSS occur within what time frame?

A

2y post-splenectomy

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24
Q

Ideally how old should a child be before splenectomy?

A

5; allows Ab formation, child can get fully immunized

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25
Q

Vaccines needed before splenectomy?

A

Pneumococcus, meningococcus, H. flu

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26
Q

Postsplenectomy lab changes?

A

Increased RBCs, WBCs, platelets; if plt >1x10^6, need ASA.

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27
Q

What is the #1 splenic tumor overall as well as the #1 benign splenic tumor? Treatment?

A

Hemangioma; splenectomy if symptomatic

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28
Q

What is the #1 malignant splenic tumor?

A

Non-Hodgkin’s lymphoma

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29
Q

When is operation indicated for splenic cyst?

A

If symptomatic or >10cm

30
Q

Lab changes in hypersplenism?

A

Decreased platelets, WBCs, and RBCs. Pancytopenia.

31
Q

What is the definition of hypersplenism?

A

Dec. in circulating RBC, plts, or WBC, AND normal compensatory hematopoietic response in bone marrow, AND correction of cytopenia by splenectomy W/ or W/OUT splenomegaly

32
Q

What is the most common cause of hypersplenism?

A

Secondary: increased venous pressure (portal HTN, CHF), malignant disease, chronic inflammatory disease (SLE), myeloproliferative disease, infectious, amyloidosis, AIDS, hemolytic anemias, polycythemia vera

33
Q

Sarcoidosis of the spleen causes what?

A

Anemia, decreased platelets

34
Q

What is Felty’s syndrome?

A

RA, hepatomegaly, splenomegaly

35
Q

What is Gaucher’s disease?

A

Lipid metabolism disorder leading to splenomegaly

36
Q

What is the most common congenital hemolytic anemia requiring splenectomy?

A

Spherocytosis (HS)

37
Q

What is the defect in spherocytosis?

A

Spectrin deficit (membrane protein) causing deformed RBCs and splenic sequestration

38
Q

What does spherocytosis lead to?

A

Pigmented stones, anemia, reticulocytosis, jaundice, splenomegaly

39
Q

Treatment for spherocytosis?

A

Splenectomy and cholecystectomy

40
Q

What is elliptocytosis?

A

Spectrin and protein 4.1 deficit (membrane protein); causes symptoms similar to spherocytosis

41
Q

What does pyruvate kinase deficiency cause?

A

Results in congenital hemolytic anemia; altered glucose metabolism, RBC survival enhanced by splenectomy

42
Q

What is the most common congenital hemolytic anemia NOT involving a membrane protein deficit?

A

Pyruvate kinase deficiency

43
Q

What precipitates hemolysis with G6PD deficiency?

A

Infection, certain drugs, fava beans; splenectomy usually not required

44
Q

Is splenectomy required for sickle cell anemia?

A

Spleen autoinfarcts, splenectomy NOT required

45
Q

Use of splenectomy in beta thalassemia?

A

May decrease hemolysis and symptoms; most die in teens secondary to hemosiderosis

46
Q

What cells are characteristic of Hodgkin’s disease?

A

Reed-Sternberg cells (lacunar histiocytes)

47
Q

How is Hodgkin’s disease staged?

A

Stage I: 1 area or 2 contiguous areas on same side of diaphragm; stage II: 2 noncontiguous areas on same side of diaphragm; stage III: involved on each side of diaphragm; stage IV: liver, bone, lung or any other nonlymphoid tissue except spleen

48
Q

What are the different types of Hodgkin’s lymphoma? What has the best prognosis? Most common?

A

Lymphocyte predominant (best prognosis), lymphocyte depleted (worst prognosis), nodular sclerosing (most common)

49
Q

What is the most common cause of chylous ascites?

A

Lymphoma

50
Q

What % of non-Hodgkin’s lymphomas are B cell?

A

90%

51
Q

Treatment for hairy cell leukemia?

A

purine analog meds; splenectomy if symptomatic splenomegaly

52
Q

What are the causes of spontaneous splenic rupture?

A

Mononucleosis, malaria, sepsis, sarcoid, leukemia, polycythemia vera

53
Q

What is splenosis? Cause?

A

Splenic implants; usually related to trauma

54
Q

When do you see Howell-Jolly bodies?

A

In hyposplenism

55
Q

What is the most common cause of splenic artery or splenic vein thrombosis?

A

Pancreatitis

56
Q

What patients get splenic artery aneurysms?

A

Females; secondary to fibromuscular dysplasia, atherosclerosis

57
Q

What are pappenheimer bodies?

A

Iron deposits

58
Q

Embryology of spleen

A

mesoderm, capillary network develops in 30 days, B&T cells show up in 13 weeks, IgG and IgM available in 3rd trimester

59
Q

What do you suspect if a patient with hematologic disease has persistence after splenectomy?

A

accessory or acquired splenosis

60
Q

What is a feared complication after splenectomy that can demonstrate itself as sepsis w/ an intra-abdominal fluid collection?

A

pancreatic injury - drain, abx

61
Q

What is the most common visceral artery aneurysm?

A

splenic artery aneurysm

62
Q

If you are mobilizing the splenic flexure, what must you mutch for near the spleen?

A

inferior pole arteries - can cause problematic bleeding

63
Q

What extra medication must be given to young children s/p splenectomy?

A

penicillin for PNA ppx x2 years

64
Q

How do you treat a splenic abscess?

A

splenectomy and abx

65
Q

When does OPSI usually occur?

A

within the first 2 years post-splenectomy

66
Q

Who is at greatest risk of getting OPSI?

A

Postsplenectomy sepsis is greatest in patients with underlying hematologic conditions. The risk in children is higher than in adults. Sepsis is seen particularly in children younger than 15 years of age, mostly in those younger than 5.

67
Q

In pts w/ G6PD def, what are some triggers for anemia?

A

Infection is common. Also sulfonamides, fava beans, antimalarials, and nitrofurantoin.

68
Q

Hypotension, abdominal tenderness, and splenomegaly are common symptoms of what process?

A

Hypersplenism

69
Q

After partial splenectomy, at what portion of remaining spleen can function be expected to be maintained (not requiring postop vaccination)?

A

Splenic function is preserved in patients with more than one-third of the spleen remaining.

70
Q

What initial tests are helpful in determining accessory/remnant spleen in patients s/p splenectomy who have recurrent symptoms?

A

Radionucleotide imaging and blood smear.
Expect to see spleen tissue in hilum and lack of Howell-Jolly bodies on blood smear.

ABSITE 2022 (50 decks)

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