Pathology of Spleen Flashcards
splenomegaly
is an enlargement of the spleen that often results from bllod borne infections
what are the main causes of congestive splenomegaly
cirrhosis of the liver
what is needed to determine the exact size of the spleen
volume measurements
what does volume depend on?
on age and weight
evaluating splenic contour and homogenecity determines whether
a disease process involves the spleen
evaluating the splenic parenchyma and vascular patterns to confirm what?
changes in the size, texture, and vascularity
the spleen may grow to enormous size with
with extension into the iliac fossa
the medial segment may cross the
midline of the abdomen to mimic a mass inferior to the left lobe of the liver
color Doppler shows
dilated splenic vessels that may be seen with portal hypertension
causes of splenomegaly
- heart failure
- portal hypertension )often associated with liver cirrhosis)
- Cirrhosis
- Cystic fibrosis
- portal or splenic vein thrombosis
treatment for splenomegaly
- watching waiting
- medications
- diet and lifestyle changes
- surgery
watch waiting
if there are no symptoms being experience, the doctor may suggest waiting to see if spleen concerns resolve on their own. They recommend reevaluating your condition in a few months, or sooner if you start experiencing symptoms
medications
certain drugs, such as antibiotics, may be used to treat any underlying concerns that could be causing your enlarged spleen
diet and lifestyle changes
making modifications to your diet and lifestyle may help improve certain conditions that can trigger spleen concerns, such as cirrhosis or rheumatoid arthritis. generally, this involves eating plenty of nutrient-dense foods, limiting your intake of sodium, and getting regular physical activity
surgery
in severe cases, spleen removal may be necessary, especially if the enlarged spleen is causing serious complications or other treatment options are limited
removal of the spleen is called
splenectomy
sickle cell anemia
an inherited blood disorder where red blood cells (RBCS) become sickle/crescent shaped.
sickle cell anemia causes
frequent infections, swelling in the hands and legs, pain, severe tiredness, and delayed growth or puberty
hemolytic anemia
is a disorder in which RBCs are destroyed faster than they can be made
the destruction of red blood cells is called
hemolysis
hemolytic anemia can be
inherited or acquired
inherited hemolytic anemia
happens when parents pass the gene for the condition on to their children
acquired hemolytic anemia
is not something you are born with. you develop the condition later
polycythemia vera
is a rare blood disorder in which there is an increase in all blood cells, particularly red blood cells.
the increase in blood cells make the
blood thicker
polycythemia Vera can lead to
strokes or tissue and organ damage
thalassemia
an inherited disorder characterized by abnormal production of hemoglobin, a protein in red blood cells that carries oxygen
leukemia is
different from most other cancers
where does leukemia start?
in the bone marrow
bone marrow is where
new blood cells are made
leukemia cells are
early forms of blood cells and are usually white blood cells
leukopoiesis
the formation of white blood cells
splenic granulomatous disease
refers to sequelae arising from granulomatous infection-inflammation of the spleen
focal disease of the spleen may be
single or multiple
focal disease of the spleen may be found in
a normal or in an enlarged spleen
major non traumatic causes of focal splenic defects
- tumor (benign or malignant)
- infarction
-abscess
-cyst
what is the most common benign tumor of the spleen
hemangiomas
splenic defects may be
discovered incidentally, as in another imagining study, or specifically, as in the case of a splenic infarction or abscess
hemangioma of the spleen
splenic hemangioma is a rare disorder but remains the most common benign neoplasm of the spleen
splenic abscess
infection is spread either from distant foci in the abdomen or an inflammatory process that extends directly from adjacent organs
clinical findings of splenic abscess
- may be subtle
- fever
- LUQ tenderness
- abdominal pain
sonographic findings of splenic abscess
- simple cystic to mixed echo pattern
- lesion may be hypoechoic, often hyperechoic foci that represents debris or gas
splenic infection
many infections can affect the spleen
most frequent feature of splenic infection is
splenomegaly
hepatosplenic candidiasis
is an infection that can affect the spleen
splenic infarction
is a condition in which blood flow supply to the spleen is compromised, leading to partial or complete infarction (tissue death due to oxygen shortage) in the organ
splenic infarction occurs
when the splenic artery or one of its branches are occluded, for example by a blood clot
most common cause of focal lesions is
occlusion of the major splenic artery or any of its branches
sonographic findings of splenic infarction
- may see localized hypoechoic area, depending on the time of onset
- fresh hemorrhage has a hypoechoic appearance
- healed infarctions appear as echogenic, peripheral, wedge-shaped lesions with their base toward the subcapsular surface of the spleen
splenic hamartoma
is a rare, benign proliferation that is often found incidentally while working up other complaints or at autopsy
splenic lymphoma represents the most common
-malignancy to involve the spleen
- it is a rare kind of cancer of spleen and bone marrow
there are two kinds of lymphomas
- non-Hodgkin lymphoma
- Hodgkin lymphoma
splenic lymphoma is
b-cell non-Hodgkin lymphoma
splenic lymphoma generally develops in people
aged over 60 years and affects males more than females
patients with lymphoma presents
extremely enlarged spleen
sonographic findings
- hypoechoic masses may be seen
- extremely enlarged spleen
clinical findings
- abdominal pain
- anemia which leads to extreme fatigue and breathlessness
isolated splenic metastases
is rare
splenic metastases is usually associated with
extensive metastases
splenic metastases usually from
- lung
- breast
- melanoma
- colon
- ovary
splenic metastases sonographically
hypoechoic/hyperechoic masses
the spleen is most injured as a result of
blunt abdominal trauma (high mortality rate)
if the patient has severe LUQ pain secondary to trauma
a splenic hematoma or subcapsular hematoma should be considered
a hematoma is
a collection of blood
if the capsule is intact, the outcome may be intraparenchymal or subcapsular hematoma: if the
capsule ruptures, a focal or free intraperitoneal hematoma may form
in delayed ruptures,
a subcapsular hematoma may develop with subsequent rupture
quick assessment of free fluid that may surround
the splenic capsule in a blunt abdominal trauma can be life-saving diagnosis for the patient
subcapsular hematoma
are a type of splenic hematoma that occurs beneath the splenic capsule
sonographer should quickly examine the
four abdominal pelvic quadrants
in splenic trauma fast scans the sonographer looks for
free fluid in the abdomen
how long should an entire splenic trauma fast scan take
less than 5 minutes
in splenic trauma fast scan the 4 areas that need to be scanned is
- area surrounding the kidneys (Morison’s pouch)
- sub diaphragmatic areas
- liver and splenic capsule
- bladder and anterior rectal area
clinical findings of splenic trauma
- patients typically has LUQ pain, left shoulder pain, left flank pain or dizziness
- may have tenderness over the LUQ, hypotension, and decreased hemoglobin, which indicates a bleed
- a timely response to this emergent situation may save the patient from having to undergo peritoneal lavage or exploratory surgery
what is the difference between intramuscular vs. subcutaneous?
is that intramuscular is inside the muscle or the muscles while subcutaneous is pertaining to the fatty layer under the skin
if the spleen has been lacerated and blood is contained within the splenic capsule, the most prominent sonographic finding is
splenomegaly, with progressive enlargement as the bleeding continues
what may be present with splenic trauma?
irregular splenic border, hematoma, heterogenous parenchyma subcapsular and pericapsular fluid collection, free intraperitoneal blood or left pleural effusion
