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06 - absite > Chapter 34: Spleen > Flashcards

Chapter 34: Spleen Flashcards

1
Q

Type of arteries: short gastric and splenic artery

A

End arteries

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2
Q

Where is the splenic vein?

A

Posterior and inferior to splenic artery

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3
Q

Serves as antigen-processing center for macrophages

A

Spleen

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4
Q

Largest producer of IgM

A

Spleen

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5
Q

Breakdown of spleen

A

85% red pulp

15% white pulp

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6
Q

Function of red pulp

A

Acts as a filter for aged or damaged RBCs (pitting and culling)

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7
Q

Red pulp: what is pitting

A

Pitting: removal of abnormalities in the RBC membrane

  • Howell-Jolly bodies: nuclear remnants
  • Heinz bodies: hemoglobin
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8
Q

Red pulp: what is culling

A

Removal of less deformable RBCs

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9
Q

Function of white pulp

A

Immunologic function; contains lymphocytes and macrophages

  • Major site of bacterial clearance that lacks preexisting antibodies
  • site of removal of poorly opsonized bacteria, particles and cellular debris
  • antigen processing occurs with interaction between macrophages and helper T cells
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10
Q

An opsonin; facilitates phagocytosis -> produced in spleen

A

Tuftsin

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11
Q

Activates alternate complement pathway -> produced in spleen

A

Properdin

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12
Q

Occurs in spleen before birth and in conditions such as myeloid dysplasia

A

Hematopoiesis

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13
Q

Spleen is a reservoir for __

A

platelets

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14
Q

where are accessory spleens found?

A

accessory spleen (20%): most commonly found at splenic hilum

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15
Q

indications for splenectomy

A

ITP far greater than for TTP

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16
Q

Most common non traumatic condition requiring splenectomy

A

ITP

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17
Q

caused by anti-platelet antibodies (IgG) - bind platelets; results in decreased platelets
- petechiae, gingival bleeding, bruising, soft tissue ecchymosis

A

Idiopathic thrombocytopenic purpura (ITP)

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18
Q

What causes ITP?

A

from many etiologies: drugs, viruses, etc.

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19
Q

What does the spleen look like in ITP?

A

spleen is normal

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20
Q

When does ITP usually resolve spontaneously?

A

in children

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21
Q

Tx: ITP

A

Steroids (primary therapy); gamma globulin if steroid resistant

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22
Q

When is splenectomy indicated in ITP?

A

For those who fail steroids: removes IgG production and source of phagocytosis, 80% respond after splenectomy

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23
Q

Pre op management of ITP

A

Give platelets 1 hour before surgery

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24
Q

What is thrombotic thrombocytopenic purpura (TTP) associated with?

A

Medical reactions, infections, inflammation, autoimmune disease

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25
Q

Pathophysiology of TTP

A

Loss of platelet inhibition - leads to thrombosis and infarction, profound thrombocytopenia

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26
Q

Purpura, fever, mental status changes, renal dysfunction, hematuria, hemolytic anemia

A

TTP (thrombotic thrombocytopenic purpura)

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27
Q

Tx: TTP

A

80% respond to medical therapy

- Plasmapheresis (primary); immunosuppression

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28
Q

MCC death in TTP

A

most commonly due to intracerebral hemorrhage or acute renal failure

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29
Q

When is splenectomy indicated in TTP?

A

splenectomy rarely indicated

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30
Q

0.1% risk after splenectomy, increased risk in children

A

post-splenectomy sepsis syndrome (PSSS)

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31
Q

most common causes of post-splenectomy sepsis syndrome

A

1) s pneumoniae

h. influenzae, n meningitidis

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32
Q

what is post-splenectomy sepsis syndrome secondary to?

A

specific lack of immunity (immunoglobulin, igm) to capsulated bacteria

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33
Q

post-splenectomy sepsis syndrome is highest in patients…

A

with splenectomy for hemolytic disorders or malignancy

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34
Q

adults vs children: increased risk of mortality after developing post-splenectomy sepsis syndrome

A

children

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35
Q

what is the best age for a child if splenectomy is necessary?

A

5 years old: allows antibody formation; child can get fully immunized

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36
Q

when does post-splenectomy sepsis syndrome occur?

A

most episodes occur within 2 years of splenectomy

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37
Q

prophylactic antibiotic regimen for children

A

6 months of prophylactic antibiotics (controversial) - to decrease chances of post-splenectomy sepsis syndrome

38
Q

vaccines needed before splenectomy

A

pneumococcus, meningococcus, h.influenzae

39
Q

definition of hypersplenism

A

decrease in circulating cell count of erythrocytes and/or platelets and/or leukocytes
- and -
normal compensatory hematopoietic responses present in bone marrow
- and -
correction of cytopenia by splenectomy
- with or without -
splenomegaly

40
Q

two types of hemolytic anemias - membrane protein defects

A

spherocytosis

elliptocytosis

41
Q

most common congenital hemolytic anemia requiring splenectomy

A

spherocytosis

42
Q

defect in spherocytosis

A

spectrin deficit (membrane protein) deforms RBCs and leads to splenic sequestration (hypersplenism)

43
Q

pathophysiology: spherocytosis

A

causes pigmented stones, anemia, reticulocytosis, jaundice, splenomegaly
- spectrin deficit

44
Q

tx: spherocytosis

A

splenectomy and cholecystectomy

- try to perform splenectomy after age 5; give immunizations first

45
Q

curative in spherocytosis

A

splenectomy

46
Q
  • symptoms and mechanism similar to spherocytosis; less common
  • spectrin and protein 4.1 deficit (membrane protein)
A

elliptocytosis

47
Q

membrane protein defect: elliptocytosis

A

spectrin and protein 4.1 deficit

48
Q

hemolytic anemia: non-membrane protein defects

A
  • pyruvate kinase deficiency
  • g6pd deficiency
  • warm antibody-type acquired immune hemolytic anemia
  • beta thalassemia
49
Q
  • results in congenital hemolytic anemia

- causes altered glucose mechanism; RBC survival enhanced by splenectomy

A

pyruvate kinase deficiency

50
Q

mc congenital hemolytic anemia not involving a membrane protein that requires splenectomy

A

pyruvate kinase deficiency

51
Q
  • precipitated by infection, certain drugs, fava beans

- splenectomy usually not required

A

g6pd deficiency

52
Q

management: warm antibody-type acquired immune hemolytic anemia

A

indication for splenectomy

53
Q
  • HgbA replaced with HgbS

- spleen usually auto infarcts and splenectomy not required

A

sickle cell anemia

54
Q

most common thalassemia; due to persistent HgbF

A

beta thalassemia

55
Q

difference between beta thalassemia major and minor

A
  • major: beta chains affected

- minor: 1 chain, asymptomatic

56
Q

is splenectomy required in sickle cell anemia?

A

spleen usually auto infarcts and splenectomy not required

57
Q

symptoms: pallor, retarded body growth, head enlargement

A

beta thalassemia

58
Q

management: splenomegaly in beta thalassemia

A

splenectomy (if patient has splenomegaly) may decrease hemolysis and symptoms

59
Q

cause of death in beta thalassemia

A

most die in teens secondary to hemosiderosis

60
Q

medical tx: beta thalassemia

A

blood transfusion and iron chelators (deferoxamine, deferiprone)

61
Q

Symptoms: hodgkin’s disease type a

A

asymptomatic

62
Q

symptoms: hodgkin’s disease type b

A

symptomatic (night sweats, fever, weight loss) –> unfavorable prognosis

63
Q

stage 1: hodgkin’s disease

A

1 area or 2 contiguous areas on the same side of the diaphragm

64
Q

stage 2: hodgkin’s disease

A

2 non-contiguous areas on the same side of diaphragm

65
Q

stage 3: hodgkin’s disease

A

involved on each side of diaphragm

66
Q

stage 4: hodgkin’s disease

A

liver, bone, lung, or any other non-lymphoid tissue except spleen

67
Q

best prognosis: hodgkin’s disease

A

lymphocyte predominant

68
Q

worst prognosis: hodgkin’s disease

A

lymphocyte deplete

69
Q

most common hodgkin’s disease

A

nodular sclerosing

70
Q

tx: hodgkin’s disease

A

chemo

71
Q

mcc of chylous ascites

A

lymphoma

72
Q
  • worse prognosis than hodgkin’s; 90% are b-cell lymphomas
  • generally systemic disease by the time the diagnosis is made
  • tx: chemo
A

non-hodgkin’s lymphoma

73
Q

tx: hairy cell leukemia

A

rarely need splenectomy

74
Q

causes of spontaneous splenic rupture

A

mononucleosis, malaria, sepsis, sarcoid, leukemia, polycythemia vera

75
Q

splenic implants; usually related to trauma

A

splenosis

76
Q

see howell-jolly bodies

A

hyposplenism

77
Q

most common cause of splenic artery or splenic vein thrombosis

A

pancreatitis

78
Q

post splenectomy lab changes

A

increased rbcs.
increased wbcs.
increased platelets.
- if platelets > 1 x 10^6, give ASA

79
Q 
#1 splenic tumor overall; 
#1 benign splenic tumor
A

Hemangioma

80
Q

Tx: splenic hemangioma

A

Splenectomy if symptomatic

81
Q

1 malignant splenic tumor

A

non-hodgkin’s lymphoma

82
Q

indications for surgery with splenic cysts

A

surgery if symptomatic of > 10 cm

83
Q

anemia, decreased platelets

- Tx: splenectomy for symptomatic splenomegaly

A

sarcoidosis of spleen

84
Q

rheumatoid arthritis, hepatomegaly, splenomegaly

- Tx: splenectomy for symptomatic splenomegaly

A

felty’s syndrome

85
Q

tx: splenic abscess

A

splenectomy usual (bleeding risk with percutaneous drainage)

86
Q

Tx: echinococcal splenic cyst

A

splenectomy

87
Q

results of splenectomy / hyposplenic condition - erythrocytes

A
  • howell-jolly bodies (nuclear fragments)
  • heinz bodies (hemoglobin deposits)
  • pappenheimer bodies (iron deposits
  • target cells
  • spur cells (acanthocytes)
88
Q

results of splenectomy / hyposplenic condition -

platelets

A

transient thrombocytosis

89
Q

results of splenectomy / hyposplenic condition

- leukocytes

A

transient leukocytosis
persistent lymphocytosis
persistent monocytosis

90
Q

guidelines for prevention of postsplenic sepsis

A
  • vaccinate with polyvalent pneumococcal vaccine at least 10-14d prior to splenectomy
  • if splenectomy urgent: wait 14d post procedure to vaccinate
  • for high risk patients (immunosuppressed, children

06 - absite (44 decks)

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