Dr. Pence - Clinical Approaches To Primary And Secondary Splenic Disorders Flashcards
Spleen should be what size relative to the kidney and liver
Smaller then the liver and larger then the kidney
Red Pulp Marginal Area
Macrophages, clean up debri and encapsulated organisms
White Pulp Periarteriolar lymphoid sheath (PALS)
T-cells
White pulp : Primary follicle
B-cells and Ab production
Red Pulp
Sinusoids network filled with blood that filters abnormal RBCs and plt
Pathway or blood from the splenic vein
Enters white pulp and then goes to the red pulp and then out the splenic artery to the Hepatic Portal Vein
Diseases that cause splenomegaly
Infections that stimulates reticuloendothelial system (M phagocytosis system)
RA, Neutropenia, splenomegally (SHELVES)
Feltis syndrome
What can happen if you have splenomegaly
- Usually just discomfort 2. Can rupture if it grows too fast or if you play contact sport with one 3. Hematologist cancer or disease 4. Associated with disease : portal HTN 5. Worsen a disease process : CYTOPENIA
Cytopenia and the spleen causes what
Hypersplenism = RBCs are destroyed, plt sequestered/ destroyed - anemia - Leukopenia - thrombocytopenia
Hypersplenism and SC what can happen SX TX
- SC Splenic sequesteration : pooling of blood in spleen (life threatening) 2. SX : 2g/dL Hgb, fast enlargement of spleen, Hypotension (SHOCK) 3. TX: splenectomy (if happens several times)
Hereditary spherocytosis and splenomegaly what can happen SX TX
- Spenic sequestering and lysis or RBCs due to abnormal shape 2. SX : severe anemia 3. TX : splenectomy
Idiopathic thrombocytopenia purpura and hypersplenism what can happen SX TX
- Abs agains plt makes the spleen take them up 2. Thrombocytopenia 3. TX: plasma exchange or steroids (splenectomy if doesn’t help)
M in the spleen are where
In the white pulp and phagocytose in the reticuloendothelial system
How will hypersplenism present HPI
-recent illness, -sick contacts, -weight loss, night sweats, -liver to cardiac conditions, -new medications
How will hypersplenism present PE
- conjunctiva (sclearal ictemus) - cervical LNs - LUQ fullness, castell point - skin rash
How will hypersplenism present Labs
- Cytopenia 2. Blood smear
Castells Point
Pressing up under the rib cage LUQ to feel for the spleen and if you feel it it is enlarged (If you dont feel it, then you have to do imaging to confirm with US FAST scan)
US of spleen should look like what and not like what
Should not be enlarges and NO dark space between the kidney and spleen (acites, blood from rupture)
What can cause splenic rupture 4 causes
- CLL 2. Mono 3. Hairy Cell Leukemia 4. Trauma
How to see SX or test for Splenic rupture
LUQ pain Kehr’s sign (phrenic nerve irritation = left shoulder pain during recumbent laying down with legs raised)
Splenic rupture prevention (when can people go back to play sports)
3 weeks after if non-contact sport 4 weeks after if contact sport (From onset of sx of enlargement of spleen)
How to do a splenectomy
Ligaments to remove : -Gastric splenic lig - Spleenorenal lig Vessels to remove : - splenic artery and THEN - splenic Vein **** dont touch pancreas**** = can lead to pancreatitis
Overwhelming post-splenectomy infection (OPSI) What is it and SX
Encapsulated organisms can infect the patient now with no marginal zone or R-E system to remove them SX : vague illness progressing to riproaring infection sepsis in 2-3 days (Highest risk first 3 years)
