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SURGERY (3RD YEAR) > SPLEEN 1.1 > Flashcards

SPLEEN 1.1 Flashcards

1
Q

What is the largest reticuloendothelial organ?

A

“The spleen.”

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2
Q

Where does the spleen originate during embryonic development?

A

“Arises from the primitive mesoderm as an outgrowth of the left side of the dorsal mesogastrium.”

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3
Q

At what gestational age is the spleen evident in an embryo?

A

“By the fifth week of gestation.”

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4
Q

What structure separates the spleen from the lower left lung and pleura?

A

“The abdominal surface of the diaphragm.”

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5
Q

What is the most common anomaly of splenic embryology?

A

“Accessory spleen.”

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6
Q

Where is an accessory spleen most commonly located?

A

“At the splenic hilum and vascular pedicle.”

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7
Q

What is the normal length of an adult spleen?

A

“7 to 11 cm.”

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8
Q

What is the normal weight of an adult spleen?

A

“150 g (range: 70-250 g).”

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9
Q

Which ligament connects the spleen to the colon?

A

“Splenocolic ligament.”

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10
Q

Which ligament connects the spleen to the stomach?

A

“Gastrosplenic ligament.”

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11
Q

Which ligament connects the spleen to the diaphragm?

A

“Phrenosplenic ligament.”

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12
Q

Which ligament connects the spleen to the kidney and tail of the pancreas?

A

“Splenorenal ligament.”

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13
Q

Which splenic ligament is vascular?

A

“Gastrosplenic ligament

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14
Q

What is the main blood supply to the spleen?

A

“The splenic artery.”

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15
Q

What is the most common anatomical type of splenic arterial supply?

A

“Distributed type (70%) with a short trunk and many long branches.”

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16
Q

What is the magistral type of splenic arterial supply?

A

“A long main trunk dividing near the hilum into short terminal branches

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17
Q

What is the minor blood supply to the spleen?

A

“Short gastric vessels from the left gastroepiploic artery within the gastrosplenic ligament.”

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18
Q

What forms the portal vein?

A

“The splenic vein joins the superior mesenteric vein.”

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19
Q

What are the two main components of the splenic parenchyma?

A

“Red pulp and white pulp.”

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20
Q

What is the function of the red pulp in the spleen?

A

“A dynamic filtration system that removes microorganisms

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21
Q

What is the role of white pulp in the spleen?

A

“Centers of lymphocyte proliferation involved in adaptive immunity.”

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22
Q

What is the function of marginal zone macrophages?

A

“They target and clear bacterial pathogens.”

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23
Q

What trauma grade of splenic injury typically indicates surgery for adults?

A

“Grade 4.”

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24
Q

What trauma grade of splenic injury indicates surgery for pediatric patients?

A

“Grade 5.”

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25
Q

What immune functions does the spleen perform?

A

“Innate immune response (marginal zone) and adaptive immunity (white pulp).”

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26
Q

What is the role of the spleen in red blood cell clearance?

A

“It clears damaged or aged red blood cells and recycles iron.”

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27
Q

What protein does the spleen produce to activate complement?

A

“Properdin.”

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28
Q

Which bacterial infections are asplenic patients particularly susceptible to?

A

“Pneumococcus and Haemophilus influenzae.”

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29
Q

What is splenomegaly?

A

“Abnormal enlargement of the spleen (≥500 g or ≥15 cm in length).”

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30
Q

What is massive splenomegaly?

A

“Spleen >1 kg in mass or >22 cm in length.”

31
Q

What is hypersplenism?

A

“Cytopenias in the context of a normally functioning bone marrow

32
Q

What is the first imaging modality for splenic evaluation in trauma?

A

“Ultrasound (FAST).”

33
Q

What are the benefits of a CT scan for spleen imaging?

A

“High resolution and detail of splenic parenchyma

34
Q

What imaging is used to determine if a splenic lesion is cystic or solid?

A

“MRI.”

35
Q

What is the purpose of splenic artery angiography?

A

“Localization and treatment of hemorrhage

36
Q

What is the main indication for nuclear imaging of the spleen?

A

“Locating accessory spleens after unsuccessful splenectomy for ITP.”

37
Q

What is the most common indication for splenectomy?

A

“Trauma (blunt or penetrating).”

38
Q

What is the most common elective indication for splenectomy?

A

“Idiopathic thrombocytopenic purpura (ITP).”

39
Q

In which autoimmune condition is splenectomy commonly performed?

A

“Warm-antibody autoimmune hemolytic anemia.”

40
Q

What is the expected response to splenectomy in hereditary spherocytosis?

A

“Improves or eliminates anemia.”

41
Q

What is the response rate for splenectomy in chronic lymphocytic leukemia (CLL)?

A

“75% response rate.”

42
Q

What is the typical result of splenectomy in patients with thalassemia?

A

“Diminished transfusion requirements and relief of symptoms.”

43
Q

When is splenectomy indicated for splenic artery aneurysms?

A

“For distal lesions near the splenic hilum.”

44
Q

What conditions may require partial splenectomy or cyst unroofing?

A

“Symptomatic nonparasitic cysts.”

45
Q

What is the main purpose of splenectomy for hematologic diseases?

A

“To cure or palliate hematologic disease

46
Q

What symptom relief is expected from splenectomy in polycythemia vera?

A

“Relief of abdominal pain and early satiety.”

47
Q

What is the role of properdin in the spleen?

A

“Initiates the alternate pathway of complement activation.”

48
Q

What type of immune response is the white pulp of the spleen involved in?

A

“Adaptive immunity.”

49
Q

What is hereditary spherocytosis?

A

Hereditary spherocytosis is the most common type of hemolytic anemia for which splenectomy is indicated and results from an inherited dysfunction or deficiency in erythrocyte membrane proteins like spectrin, ankyrin, band 3 protein, or protein 4.2.

50
Q

What causes pyruvate kinase deficiency?

A

Pyruvate kinase deficiency is caused by deficiencies in enzymes involved in glycolytic pathways.

51
Q

What role does glucose-6-phosphate dehydrogenase play in red blood cells?

A

Glucose-6-phosphate dehydrogenase helps maintain a high ratio of reduced to oxidized glutathione in red blood cells, protecting them from oxidative damage.

52
Q

What characterizes warm-antibody autoimmune hemolytic anemia?

A

Warm-antibody autoimmune hemolytic anemia is characterized by the destruction of red blood cells due to autoantibodies against red blood cell antigens.

53
Q

What is sickle cell disease?

A

Sickle cell disease is an inherited chronic hemolytic anemia resulting from the mutant hemoglobin (HbS) within red blood cells, inherited in an autosomal codominant fashion.

54
Q

What is thalassemia?

A

Thalassemia is a group of inherited disorders of hemoglobin synthesis, prevalent among people of Mediterranean extraction, and classified by the affected hemoglobin chain (alpha, beta, or gamma).

55
Q

What is idiopathic thrombocytopenic purpura (ITP)?

A

ITP, or immune thrombocytopenic purpura, is an autoimmune disorder characterized by a low platelet count and mucocutaneous and petechial bleeding.

56
Q

What is the first-line therapy for ITP?

A

The first-line therapy for ITP is oral prednisone at 1.0 to 1.5 mg/kg per day.

57
Q

When is urgent splenectomy indicated for ITP?

A

Urgent splenectomy is indicated for severe, life-threatening bleeding in ITP cases for both children and adults.

58
Q

What characterizes thrombotic thrombocytopenic purpura (TTP)?

A

TTP is characterized by thrombocytopenia, microangiopathic hemolytic anemia, and neurologic complications.

59
Q

What is the first-line therapy for TTP?

A

The first-line therapy for TTP is plasma exchange.

60
Q

When is splenectomy indicated for TTP?

A

Splenectomy is indicated for TTP patients who experience relapse or require multiple plasma exchanges to control symptoms.

61
Q

What is the role of splenectomy in chronic myeloid leukemia (CML)?

A

Splenectomy in CML addresses symptomatic splenomegaly and hypersplenism but does not alter the disease course or prognosis.

62
Q

What is hairy cell leukemia?

A

Hairy cell leukemia (HCL) is an uncommon blood disorder characterized by splenomegaly, pancytopenia, and abnormal lymphocytes in the bone marrow, accounting for only 2% of adult leukemias.

63
Q

What is Hodgkin’s lymphoma?

A

Hodgkin’s lymphoma is a disorder of the lymphoid system characterized by the presence of Reed-Sternberg cells, with over 90% of patients presenting with lymphadenopathy above the diaphragm.

64
Q

What is non-Hodgkin’s lymphoma?

A

Non-Hodgkin’s lymphoma encompasses all malignancies derived from the lymphoid system except classic Hodgkin’s disease.

65
Q

What is chronic lymphocytic leukemia (CLL)?

A

CLL is a subtype of non-Hodgkin’s lymphoma characterized by the progressive accumulation of old and nonfunctional lymphocytes.

66
Q

What characterizes myeloproliferative disorders?

A

Myeloproliferative disorders are characterized by abnormal growth of cell lines in the bone marrow.

67
Q

What is chronic myelogenous leukemia (CML)?

A

CML is a myeloproliferative disorder characterized by the abnormal growth of stem cells in the bone marrow with increased erythroid, megakaryocytic, and progenitor cells.

68
Q

What is acute myeloid leukemia (AML)?

A

AML involves the abnormal growth of stem cells in the bone marrow, with rapid and dramatic clinical presentation, differing from CML.

69
Q

What differentiates chronic myelomonocytic leukemia (CMML) from CML?

A

CMML is differentiated by monocytosis in the peripheral smear and bone marrow, unlike CML.

70
Q

What is essential thrombocythemia?

A

Essential thrombocythemia is characterized by abnormal growth of the megakaryocyte cell line, leading to increased platelet levels.

71
Q

What is polycythemia vera?

A

Polycythemia vera is a clonal, chronic, progressive myeloproliferative disorder with an increase in RBC mass, leukocytosis, thrombocytosis, and splenomegaly.

72
Q

What is myelofibrosis (AMM)?

A

Myelofibrosis, or agnogenic myeloid metaplasia (AMM), is a chronic hematologic disease with marrow fibrosis, splenomegaly, extramedullary hematopoiesis, and the presence of RBC and WBC progenitors in the bloodstream.

73
Q

What are sarcomas in relation to the spleen?

A

Sarcomas are the most common primary tumors of the spleen, often associated with exposure to vinyl chloride or thorium dioxide.

74
Q

What are isolated splenic metastases?

A

Isolated splenic metastases often originate from lung carcinoma, with other sources including liver, brain, colorectal, ovarian, and melanoma cancers.

SURGERY (3RD YEAR) (5 decks)

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