Spleen Flashcards
a splenic infarct is caused by an obstruction in which artery
splenic artery or one of its branches
blood supply to spleen and explain why splenic infarct is not often complete
splenic artery and the short gastric arteries
infarction not often complete due to the presence of a collateral circulation
what are some of the most common causes of splenic infarct
haematological disorders = lymphoma, sickle cell, chronic myeloid leukaemia or hypercoagulable states
embolic disorders = endocarditis, atrial fibrillation
clinical features of splenic infarct
LUQ pain which may radiate to left shoulder
fever, nausea, vomiting, pleuritic chest pain
can be completely asymptomatic
investigations into splenic infarct
CT abdo scan with IV contrast
routine bloods
management of splenic infarct
no specific treatments; analgesia and IV hydration prescribed
long term; avoid splenectomy due to risks of infection, vaccinations and low dose antibiotic cover if no other choice to splenectomy
post splenectomy what is it important the patient has
vaccinations up to date
low dose antibiotic cover due to the inability to now remove encapsulated bacteria
how does a splenic abscess form
post splenic infarct when the underlying cause was from a non-sterile embolus e.g. endocarditis
what is auto-splenectomy and what is the most common cause
progressive fibrosis and atrophy of the spleen resulting in asplenism (complete atrophy of the spleen)
most commonly seen in sickle cell disease due to repeated occlusion of the splenic artery
what bacteria cause the most problems post-splenectomy
encapsulated bacteria; N. meningitidis, S. pneumoniae, H. influenzae
what is the main risk with a splenic rupture
extremely vascular organ - can lead to large intraperitoneal haemorrhage and rapid haemorrhagic shock
what causes the majority of splenic ruptures
abdominal trauma e.g. punch, kick, fall onto side, seat-belt injuries in road traffic collisions
clinical features of ruptured spleen
abdo pain
signs of hypovolaemic shock
LUQ tenderness or peritonism as blood irritates diaphragm
in what situations would an immediate laparotomy be required
in a haemodynamically unstable patient showing signs of peritonism and with a history of trauma
what is the first line imaging in suspected splenic rupture
CT chest-abdo-pelvis with IV contrast - will allow visualisation of spleen and any other viscera involved
