Spleen Flashcards
Location of the spleen
LUQ, intraperitoneal
size of spleen (adult)
12 cm or less - longitudinal length
less than 8 cm - AP
less than 4 cm - wide, TRV
arterial blood supply of spleen
splenic artery - from celiac trunk/axis
courses along the superior pancreatic border to the hilum
venous system of spleen
splenic vein - joins with the superior mesenteric vein and forms the main portal vein
-splenic vein is located inferior and posterior to the pancreas body
4 normal spleen variants and their definition
- aplasia - spleen did not develop
- hypoplasia - defective development of tissue (under development)
- accessory spleen - aka: supernumerary spleen, splenunculus - ectopic splenic tissue
- wandering spleen - fusion failure of the dorsal mesentery with the posterior peritoneum
functions of spleen
filters blood
reservoir for blood
destroys red blood cells
produces lymphocytes and plasma cells
job of red pulp
stores rbcs, filtration
what is congestive splenomegaly and what are some causes
enlargement of spleen, increased amount of red pulp
causes: heart failure, cirrhosis, portal hypertension, portal/splenic vein thrombosis, cystic fibrosis, HIV/AIDS
clinical presentations of congestive splenomegaly
LUQ pain congestion/edema in lower extremities increased abdominal girth - ascites caput medusa - portal hypertension hepatomegaly
types of systemic infection/inflammation
mononucleosis tuberculosis histoplasmosis schistosomiasis sarcoidosis candidiasis
types of focal infection/inflammtion
parasitic - echinococcus
abscess
echinococcus infection of spleen
s/s: LUQ pain. fever, elevated wbcs
- focal/solitary cyst with or without daughter cyst
- hydatid sand with or without infolded membranes
- egg-shell calcifiction of borders
abscess infection/inflammation of spleen
s/s: LUQ pain, fever, elevated wbcs
- ill-defined, thickened, irregular borders
- acoustic enhancment is possible
- shadowing with intraluminal gas
treatment options for infection/inflammation of spleen
antiobiotic therapy percutaneous drainage with or without scolecoidal therapy surgical resection anthelmintic drug therapy high mortalilty rate with abscesses
what is a splenic hamartoma
benign rare solitary non-neoplastic, congenital mass composed of: normal splenic elements
another name for splenic hamartoma
splenoma
sonographic findings of splenomas
focal well-defined mass
variable echogenicity
what is a splenic hemangioma
congenital mass
benign
composed of vascular epithelial lined channels
what is the most common primary splenic tumor? and what is its incidence?
splenic hemangioma
more frequent in males, 20-50 years old
s/s of splenic hemangioma
asymptomatic
LUQ pain and fullness
sonographic findings of splenic hemangioma
less than 4cm
well defined borders
from hyperechoic to complex with areas of cystic degeneration
may contain foci of speckled calcifications
what is luekemia
primary malignancy of the blood-forming tissues characterized by an abnoromal increase in the WBCs
what are some blood-forming tissues
bone marrow
lymph nodes
spleen
luekemia is more common in
males
s/s of leukemia
easily bruises or bleeds pallor - pale in color fatigue recurrent infection non healing minor wounds
lab findings for leukemia
increased WBCs and anemia
a patient with leukemia comes in for an ultrasound - their spleen would look
enlarged - splenomegaly
what is lymphoma
primary malignancy of the lymphatic system
s/s of lymphoma
asymptomatic node enlargement **cervical, supraclavicular, axillary, inguinal low grade fever night sweats fatigue weight loss coughing abnormal pressure and congestion of face, neck and chest
sonographic findings of lymphoma
focal mass
hypoechoic
poorly defined margins
diffuse splenomegaly
what is another name for hemangiosarcoma
splenic angiosarcoma
incidence and outcome of angiosarcoma
very rare
50-60 years of age
poor prognosis - 80% mortality rate within 6 months of dx
lab findings for angiosarcoma
anemia
thrombocytopenia
s/s of angiosarcoma
abdominal mass LUQ pain fatigue fever weight loss GI bleeding
sonographical findings of angiosarcoma/hemangiosarcoma
splenomegaly
solitary, complex mass
multiple nodules of vaying size
what are true cyst
congenital cyst
have an epithelial or endothelial lining
true cyst are also called
epidermoid cyst
congenital cyst
true cyst are usually unilocular or multilocular
unilocular
post traumatic cyst
- aka
- incidence
aka Splenic pseudocyst
accounts for 80% of all splenic cyst
DOES NOT HAVE epithelial lining
3 infectious cyst
abscess
granulomatous
pneumocystis carinii
splenic cyst may sonographically appear as
anechoic, hypoechoic well defined walls posterior enhancement internal echoes fluid-fluid level wall thickening wall califications
types of blood disorders
hemolytic anemia
extramedullary hematopoiesis
sickle cell anemia
polycythemia vera
what is hemolytic anemia
disorder in which rbcs are destroyed faster than they are being produced
what is extramedullary hematopoiesis
where the production of RBCs and platelets occurs outside the bone marrow
myelofibrosis is cancer of the bone marrow. What are some of its clinical associations
anemia
splenomegaly
extramedullary hematopoiesis
progressive fibrosis of bone marrow
what is sicke cell anemia and what does it cause?
a genetic mutation in African Americans which causes the RBC to have an altered shape and plasticity
what does sickle cell anemia lead to
increased blood viscosity stasis small vessel occlusion infarction necrosis
if a child has sickle cell anemia, how will their spleen be as children compared to as an adult
as a child - splenomegaly
as an adult - atrophic spleen
what does chronic hemolytic anemia lead to
jaundice
what is polythemia vera
an acquired myeloproliferative disorder
the bone marrow produces too much RBCS, WBCS and platelets
what does polythemia vera cause
increase in blood viscosity poor profusion elevated hematocrit, rbcs and hemoglobin decreased oxygen saturation of blood splenomegaly thrombosis
types of storage diseases
Gaucher disease Diabetes mellitus Niemann - Pick disease Amyloidosis Histiocytosis Hemochromatosis
What is Gaucher disease?
Who does it most commonly affect?
s/s
sonographic findings
- genetic disorder
- children under 8 yrs
- bone pain and skin pigmentation
- splenomegaly, diffuse inhomogeneous nodular texture, fibrosis and infarction
storage disease - diabetes mellitus
vascular infarcts secondary to diabetes iniced small vessel atherosclerotic diease
what is Niemann-Pick disease
a fatal storage disease
affects female infants
hepatomegaly, digestive issues, lymphadenopathy
what is amyloidosis
systemic abnormal amyloid distribuition
nodular and diffuse
splenomegaly
what is Histiocyosis
fatal thrombocytopenia associated with hypersplenism (excessive removal of cellular blood components)
splenomegaly
what is hemochromatosis
excessive absorption and storage of iron = organ damage
iron deposits typically in liver = cirrhosis = portal hypertension and splenomegaly
what is infarction
when the blood supply to the area is compromised = ischemia and then necrosis
most common cause of foccal splenic defects
infarction
hypovolemic shock is a clinical presentation of what
truama to the spleen, blunt ot penetrating force
the spleen is the most frequently intraperitoneal organ in blunt abdominal trauma
T or F
true
sonographic findings of trauma
- hematoma (subcapsular or intraparencymal)
- hemoperitoneum or hemoretroperitoneum with capsular rupture
- depending on age and progression
- *earlystage - anechoic to hypoechoic
- *later stage - echogenic bledding with splenic parenchyma
- left pleural effusion
what is asplenia syndrome - what is is associated with
congenital abscene of spleen
-associated with bilateral right sideness
what is polysplenia syndrome
multiple islands of splenic tissue
-may have bilateral left-sidedness
which has these sonographic appearences
- biliary atresia
- genitourinary anomalies
- abnormal liver location
- azygous/hemiazygous continuation of IVC with interruption of hepatic segment
polysplenia syndrome
accessory spleens are most often located where
at the hilum
the sonographic appearance of the spleen in relationship to liver
isoechoic or hyperechoic and homogeneous
the most common focal neoplasm in the spleen is what
a cavernous hemangioma
risk factors for splenic infarction
bacterial endocarditis atherosclerosis sickle cell disease polycythemia splenomegaly gaucher disease portal hypertension vascular compromise of splenic artery
