Injury to Spleen Lecture

Question 1

Treatment depends on hemodynamic status, which can be classified as…

Answer 1

• Hemodynamically stable: Never hypotensive or tachy
• Responsive: tachy and hypotension resolve with volume repletion
• Unstable: does not respond to volume repletion

Question 2

Best imaging study to evaluate for splenic injury in a stable or responsive patient

Answer 2

CT

Question 3

Best study to evaluate for splenic injury in an unstable patient

Answer 3

FAST > if FAST positive > surgery; if negative > DPL

Question 4

Basic start to finish if splenic injury present in stable pt

Answer 4

1. Nonoperative management planned
2. PT admitted to ICU, surgical services ready
3. serial monitoring of H/H
4. Serial abdominal exams
5. low threshold for taking to the operating room (tachy, hypotension, peritoneal signs, need for transfusion)

Question 5

Increased susceptibility to encapsulated bacteria with asplenism

Answer 5

S. pneumo, N. meningitidis, H. influenzae, GBS, klebsiella pneumoniae, salmonella typhi

Question 6

Prophylactic tx of splenectomized pt

Answer 6

W/i 2 weeks

PPV-23 (pneumovax), HIB, meningococcal polysaccharide