everything splenic Flashcards
what on blood smear indicates functional asplenia?
Howell-Jolly Bodies
risk factors for overwhelming post-splenectomy sepsis:
highest risk in the first 2 years after surgery; children are higher risk than adults
highest risk population in adults for OPSI
pts with beta thalasemia
lower risk population in adults for OPSI
trauma patients
management of simple splenic cysts:
negligible malignant potential; only treat if symptomatic
most common locations of accessory spleens:
hilar region, splenic vascular pedicle, greater omentum
most common hematologic indication for splenectomy:
ITP (IgG antibodies against platelets)
surgical management of hereditary spherocytosis:
anemia improves with splenectomy (indicated in patients who are transfusion dependent)
most common tumor of post-splenectomy sepsis:
strep pneumo
what is wandering spleen?
aka ectopic spleen; result of either extreme ligamentous laxity or absence of normal ligamentous attachment between the spleen and the lateral abdominal wall; a long splenic pedicle prone to torsion; can cause intermittent abdominal pain, splenomegaly from venous congestion, and sometimes a mobile mass on PE
CT findings of wandering spleen:
whorled appearance of spleen or vascular pedicle
how much spleen must be preserved in partial splenectomy to preserve splenic function
1/3
most common benign neoplasm of the spleen
hemangioma
location of splenic artery
superior border of pancreas
location of splenic vein
within or posterior to pancreas
treatment of wandering spleen:
splenopexy
how is ITP diagnosed?
diagnosis of exclusion
What test is used to diagnose TTP?
Coomb’s test
cause of most splenic abscesses:
hematogenous spread from endocarditis, osteomyelitis, or IV drug use
treatment of splenic abscesses:
unilocular - treat with abx and perc drainage
multilocular - splenectomy, LUQ drain placement, and abx
disease in which antibodies are formed against platelets resulting in consumption of platelets and thrombocytopenia:
idiopathic thrombocytopenic purpura (ITP)
treatment of ITP in children:
self-limited; avoid surgery and medications unless life-threatening or symptomatic bleeding or refractory to medical management
treatment of ITP in adults:
first line treatment is steroids, then gammaglobulin (anti-IgG) if resistant; splenectomy curative 80% of the time
Second line txs of ITP:
rituximab (monoclonal ab for CD20)
thrombopopietin receptor agonists (romiplostim, eltrombopag)
splenectomy