I'm SPLEENish

Question 1

Massive ____

Associated with: CML, Myelofibrosis, Polycythemia vera

Answer 1

splenomegaly

Question 2

After splenectomy there is an increased risk of infection by encapsulated pathogens→
overwhelming post-splenectomy infection (OPSI) → prevention with vaccinations against (3)

Answer 2

S. Pneumococci
N. Meningococci
H. Influenzae type B (Hib)

2w post-op → (PCV-13) → 8w later → (PPSV-23)
2w post-op → (Men ACYW) → q5y
2w post-op → (HiB)

Question 3

MCC of traumatic splenic rupture

Answer 3

Blunt abdominal trauma (MVAs)

*contact sports

Question 4

MCC of atraumatic splenic rupture :

Answer 4

mononucleosis (EBV)

*malaria

Question 5

Clinical features of splenic rupture:

Diffuse abdominal pain, especially in the ___
+/- guarding
Kehr’s sign: referred pain in the ____

Hemorrhagic shock (__timing__)

Answer 5

left upper quadrant (LUQ)

left shoulder

often delayed

Question 6

In hemodynamically UNstable patients with trauma and concerns for splenic rupture/ intra-abdominal bleeding

Imaging:

Answer 6

U/S: focused assessment with sonography (FAST)

If (+) → Laparotomy

*if stable → CT abdomen

Question 7

Repeated ___ is crucial in conservative management of splenic rupture!

Answer 7

ultrasound

Question 8

Treatment of splenic hilar rupture:

Answer 8

Splenectomy

for high-grade spleen rupture or continuous bleeding

Question 9

Functional asplenia or Autosplenectomy

MCC:

Answer 9

sickle cell anemia

Question 10

Patients with no spleen have these 2 types of cells in peripheral blood smear

Answer 10

Howell-Jolly bodies (pink cells w/ 1-2 blue dots at rim)
Target cells

*Reactive thrombocytosis: usually after splenectomy

Question 11

An asplenic patient with fever requires immediate ___ treatment.

Answer 11

empiric antibiotic

*(vanco + ceftriaxone/cefotaxime)

Question 12

Splenic laceration management
Grade 1-3 → _____
Grade 3-4 → _____
Grade 5 → _____

Answer 12

1-3) observe & trend H&H
3-4) consult IR for embolization
5) Ex-lap

Pseudo aneurysm or extravasation of fluid on CTA if:
hemodynamically UN-stable or peritonitis → OR
hemodynamically stable or peritonitis → Embolization