everything splenic

Question 1

what on blood smear indicates functional asplenia?

Answer 1

Howell-Jolly Bodies

Question 2

risk factors for overwhelming post-splenectomy sepsis:

Answer 2

highest risk in the first 2 years after surgery; children are higher risk than adults

Question 3

highest risk population in adults for OPSI

Answer 3

pts with beta thalasemia

Question 4

lower risk population in adults for OPSI

Answer 4

trauma patients

Question 5

management of simple splenic cysts:

Answer 5

negligible malignant potential; only treat if symptomatic

Question 6

most common locations of accessory spleens:

Answer 6

hilar region, splenic vascular pedicle, greater omentum

Question 7

most common hematologic indication for splenectomy:

Answer 7

ITP (IgG antibodies against platelets)

Question 8

surgical management of hereditary spherocytosis:

Answer 8

anemia improves with splenectomy (indicated in patients who are transfusion dependent)

Question 9

most common tumor of post-splenectomy sepsis:

Answer 9

strep pneumo

Question 10

what is wandering spleen?

Answer 10

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

Question 11

CT findings of wandering spleen:

Answer 11

whorled appearance of spleen or vascular pedicle

Question 12

how much spleen must be preserved in partial splenectomy to preserve splenic function

Answer 12

1/3

Question 13

most common benign neoplasm of the spleen

Answer 13

hemangioma

Question 14

location of splenic artery

Answer 14

superior border of pancreas

Question 15

location of splenic vein

Answer 15

within or posterior to pancreas

Question 16

treatment of wandering spleen:

Answer 16

splenopexy

Question 17

how is ITP diagnosed?

Answer 17

diagnosis of exclusion

Question 18

What test is used to diagnose TTP?

Answer 18

Coomb’s test

Question 19

cause of most splenic abscesses:

Answer 19

hematogenous spread from endocarditis, osteomyelitis, or IV drug use

Question 20

treatment of splenic abscesses:

Answer 20

unilocular - treat with abx and perc drainage

multilocular - splenectomy, LUQ drain placement, and abx

Question 21

disease in which antibodies are formed against platelets resulting in consumption of platelets and thrombocytopenia:

Answer 21

idiopathic thrombocytopenic purpura (ITP)

Question 22

treatment of ITP in children:

Answer 22

self-limited; avoid surgery and medications unless life-threatening or symptomatic bleeding or refractory to medical management

Question 23

treatment of ITP in adults:

Answer 23

first line treatment is steroids, then gammaglobulin (anti-IgG) if resistant; splenectomy curative 80% of the time

Question 24

Second line txs of ITP:

Answer 24

rituximab (monoclonal ab for CD20)
thrombopopietin receptor agonists (romiplostim, eltrombopag)
splenectomy