September 2, 2015 - The Spleen Flashcards

1
Q

Red Pulp

A

Takes up ~75% of the volume of the spleen. It is here where macrophages destroy red blood cells and recycle iron.

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2
Q

White Pulp

A

It is here where the T cells interact with dendritic cells and circulating B cells.

Contains ~30% of the lympoid cells.

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3
Q

Size of a Normal Spleen

A

Is about the size of your fist.

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4
Q

Functions of the Spleen

A
  • Removal of aged or abnormal blood cells
  • Immune function (particularly against encapsulated organisms)
  • Hematopoiesis in the fetus (and sometimes in adults)
  • Reserve pool and storage site
  • Recycling of iron
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5
Q

Howell-Jolly Bodies

A

Contain nuclear remnants. Their presence indicates a damaged or absent spleen.

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6
Q

Heinz Bodies

A

Contain denatured hemoglobin and are only visible with a special stain.

Can indicate G6PD deficiency, alpha-thalassemia, or hypospenism.

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7
Q

Common Enscapsulated Bacteria

A

Important to vaccinate against these before the removal of the spleen.

  • Streptococcus pneumoniae*
  • Hemophilus influenzae B*
  • Neisseria meningitidis*
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8
Q

Spleen and Hematopoiesis

A

Normally only functions as a hematopoietic organ during the 2nd trimester of a fetus, however it can also act in this way in hemolytic anemia that is chronic. (eg. Thalassemia or bone marrow disease)

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9
Q

Symptoms of Splenomegaly

A
  • Usually none unless very large
  • Pain or discomfort in LUQ
  • Early satiety due to compression of stomach
  • Pain referred to left shoulder
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10
Q

Castell’s Sign

A

Last intercostal space on the left side.

Normally is resonant on inspiration and expiration.

In splenomegaly, is dull or becomes dull on inspiration.

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11
Q

Splenomegaly Causes

A
  1. Congestive
  2. Infiltrative
  3. Infectious
  4. Inflammatory
  5. Hemolytic Disease
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12
Q

Congestive Splenomegaly

A

Engorgement and congestion in red pulp with increased vascularity and increased pooling.

Caused by portal hypertension. This can be due to cirrhosis, or non-cirrhotic PHTN.

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13
Q

Hemolytic Disease and Splenomegaly

A

Increased macrophage function due to phagocytosis of abnormal cells.

Increased blood pooling.

Extramedullary hematopoiesis.

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14
Q

Infection and Splenomegaly

A

Can be caused by many things, but in our society, the most common are viruses. Particularly EBV.

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15
Q

Inflammatory Splenomegaly

A

Can be caused by many conditions. It is important to look for inflammatory markers and antibodies.

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16
Q

Splenectomy Procedure

A
  1. Laparoscopic. Very good most of the time, but not good for retaining structure if needed for pathology or a diagnosis.
  2. Open laparotomy. Needed for large spleens, obese patients, multipkle prior surgeries, and to preserve spleen for pathology.
17
Q
A