Dr. Pence - Clinical Approaches To Primary And Secondary Splenic Disorders

Question 1

Spleen should be what size relative to the kidney and liver

Answer 1

Smaller then the liver and larger then the kidney

Question 2

Red Pulp Marginal Area

Answer 2

Macrophages, clean up debri and encapsulated organisms

Question 3

White Pulp Periarteriolar lymphoid sheath (PALS)

Answer 3

T-cells

Question 4

White pulp : Primary follicle

Answer 4

B-cells and Ab production

Question 5

Red Pulp

Answer 5

Sinusoids network filled with blood that filters abnormal RBCs and plt

Question 6

Pathway or blood from the splenic vein

Answer 6

Enters white pulp and then goes to the red pulp and then out the splenic artery to the Hepatic Portal Vein

Question 7

Diseases that cause splenomegaly

Answer 7

Infections that stimulates reticuloendothelial system (M phagocytosis system)

Question 8

RA, Neutropenia, splenomegally (SHELVES)

Answer 8

Feltis syndrome

Question 9

What can happen if you have splenomegaly

Answer 9

1. 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

Question 10

Cytopenia and the spleen causes what

Answer 10

Hypersplenism = RBCs are destroyed, plt sequestered/ destroyed - anemia - Leukopenia - thrombocytopenia

Question 11

Hypersplenism and SC what can happen SX TX

Answer 11

1. 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)

Question 12

Hereditary spherocytosis and splenomegaly what can happen SX TX

Answer 12

1. Spenic sequestering and lysis or RBCs due to abnormal shape 2. SX : severe anemia 3. TX : splenectomy

Question 13

Idiopathic thrombocytopenia purpura and hypersplenism what can happen SX TX

Answer 13

1. Abs agains plt makes the spleen take them up 2. Thrombocytopenia 3. TX: plasma exchange or steroids (splenectomy if doesn’t help)

Question 14

M in the spleen are where

Answer 14

In the white pulp and phagocytose in the reticuloendothelial system

Question 15

How will hypersplenism present HPI

Answer 15

-recent illness, -sick contacts, -weight loss, night sweats, -liver to cardiac conditions, -new medications

Question 16

How will hypersplenism present PE

Answer 16

• conjunctiva (sclearal ictemus) - cervical LNs - LUQ fullness, castell point - skin rash

Question 17

How will hypersplenism present Labs

Answer 17

1. Cytopenia 2. Blood smear

Question 18

Castells Point

Answer 18

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)

Question 19

US of spleen should look like what and not like what

Answer 19

Should not be enlarges and NO dark space between the kidney and spleen (acites, blood from rupture)

Question 20

What can cause splenic rupture 4 causes

Answer 20

1. CLL 2. Mono 3. Hairy Cell Leukemia 4. Trauma

Question 21

How to see SX or test for Splenic rupture

Answer 21

LUQ pain Kehr’s sign (phrenic nerve irritation = left shoulder pain during recumbent laying down with legs raised)

Question 22

Splenic rupture prevention (when can people go back to play sports)

Answer 22

3 weeks after if non-contact sport 4 weeks after if contact sport (From onset of sx of enlargement of spleen)

Question 23

How to do a splenectomy

Answer 23

Ligaments to remove : -Gastric splenic lig - Spleenorenal lig Vessels to remove : - splenic artery and THEN - splenic Vein **** dont touch pancreas**** = can lead to pancreatitis

Question 24

Overwhelming post-splenectomy infection (OPSI) What is it and SX

Answer 24

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)

Question 25

Overwhelming post-splenectomy infection (OPSI) Ho to prevent this

Answer 25

Vaccinate them for - streptococcus pneumoniae - Neisseria meningitis - Haemophilus influenza B

Question 26

Answer 26

Howell Jolly bodies

if no spleen or if non-functional spleen