Spleen

Question 1

Splenic Ligaments & Blood vessels

Answer 1

Gastrosplenic: short gastrics

Splenorenal: splenic artery & vein

splenocolic: unnamed retroperitoneal vessels
splenophrenic: unnamed retroperitoneal vessels

Question 2

Accessory spleen

Answer 2

Pt w/ persistent nosebleeds and gingival bleeding following splenectomy.

Dx: peripheral smear (look for Howell-Jolly bodies, should be present in asplenia)

Tx: re-exploration, resection of accessory spleen, med tx if no spleen found

Question 3

Splenic vein anatomy

Answer 3

Originates w/in splenorenal ligament, formed by union of lobar veins that emerge from hilum of spleen
Runs horizontally toward midline, below splenic artery at superior surface of tail and body of pancreas
Passes anterior to left kidney, renal hilum and renal vessels
Cross midline at L1, anterior to abd aorta and origin of SMA, terminates posterior to neck of panc, unites with SMV to form portal vein

Question 4

MC locations for accessory spleen

Answer 4

Splenic hilum (MC)
Tail of pancreas (2nd MC)
Greater omentum
Along splenic artery
Gastrosplenic ligament
Splenocolic ligament
Retroperitonteal

Question 5

Common changes after splenectomy

Answer 5

Leukocytosis
Thrombocytosis
Blood smear shows Howell-Jolly bodies & target cells

Question 6

Grading for splenic trauma

Answer 6

Grade I: Subcapsular hematoma <10% surface area, parenchymal lac <1cm depth, capsular tear

Grade II: sub capsular hematoma 10-50% surface area, intraparenchymal hematoma <5cm, parenchymal lac 1-3cm

Grade III: Subcapsular hematoma >50% surface area, ruptured sub capsular or intraparenchymal hematoma >=5cm, parenchymal lac >3cm

Grade IV: Parenchymal lac involving segmental or hilar vessels >25% devascularization, active bleeding confined within the capsule

Grade V: Shattered spleen, any injury with active bleeding extending beyond capsule into the peritoneum