SPLEEN 1.2

Question 1

What are some common infections that increase the risk for spontaneous splenic rupture in immunocompromised patients or those with a history of IV drug abuse?

Answer 1

Infectious mononucleosis, malaria, Listeria infection, fungal infections, Dengue, Q fever, lymphoma, angiosarcoma, amyloidosis, and pregnancy.

Question 2

How does splenic infiltration lead to a risk of spontaneous splenic rupture?

Answer 2

Infiltration of the splenic parenchyma leads to a thin capsule, increasing the risk of rupture.

Question 3

What are the common organisms involved in splenic abscesses?

Answer 3

Aerobes such as Streptococci and Escherichia coli.

Question 4

How do splenic abscesses present clinically?

Answer 4

Fever, left upper quadrant pain, leukocytosis, and splenomegaly.

Question 5

What is the first-line diagnostic tool for detecting splenic abscesses?

Answer 5

Ultrasound or CT scan.

Question 6

How long is the typical antibiotic treatment for a splenic abscess?

Answer 6

At least 14 days.

Question 7

What is the primary surgical treatment for splenic abscesses in unstable patients?

Answer 7

Splenectomy.

Question 8

What is the difference between a parasitic cyst and a pseudocyst in the spleen?

Answer 8

A parasitic cyst, typically from Echinococcus species, has an epithelial lining, while a pseudocyst is a result of trauma and lacks an epithelial lining.

Question 9

How is a symptomatic parasitic cyst in the spleen treated?

Answer 9

Symptomatic parasitic cysts are treated with splenectomy while avoiding spillage of cyst content to prevent anaphylactic shock.

Question 10

What is the most common cause of non-parasitic cysts in the spleen?

Answer 10

Dermoid, epidermoid, and epithelial cysts.

Question 11

How are non-parasitic splenic cysts managed if symptomatic?

Answer 11

Symptomatic non-parasitic cysts can be treated laparoscopically or surgically depending on the size, with excision and splenic preservation for small cysts.

Question 12

What is the mechanism of splenic artery aneurysms?

Answer 12

Splenic artery aneurysms arise from the middle to distal portion of the splenic artery, often due to trauma or other vascular abnormalities.

Question 13

What are the indications for treating a splenic artery aneurysm?

Answer 13

Presence of symptoms, pregnancy, intention to become pregnant, and presence of pseudoaneurysms with inflammatory processes.

Question 14

What is the management approach for a mid-splenic artery aneurysm?

Answer 14

Resection or ligation of the aneurysm, and splenectomy if the splenic artery is ligated.

Question 15

What is the cause of splenomegaly in portal hypertension?

Answer 15

Portal hypertension due to liver cirrhosis leads to splenomegaly and splenic congestion, causing sequestration and destruction of circulating cells in the spleen.

Question 16

How is sinistral hypertension, secondary to splenic vein thrombosis, treated?

Answer 16

Sinistral hypertension is curable with splenectomy.

Question 17

What are the components of Felty’s syndrome?

Answer 17

Felty’s syndrome is characterized by rheumatoid arthritis, splenomegaly, and neutropenia.

Question 18

What is the primary treatment for Felty’s syndrome?

Answer 18

Splenectomy and treatment for the underlying rheumatoid arthritis.

Question 19

What causes a wandering spleen?

Answer 19

A wandering spleen is caused by congenital problems, leading to a spleen that ‘floats’ inside the abdominal cavity without attachment to adjacent viscera.

Question 20

What complication can arise from a wandering spleen?

Answer 20

Splenic torsion and infarction, leading to severe abdominal pain and the need for splenopexy or splenectomy.

Question 21

What are the key preparations for a patient undergoing splenectomy?

Answer 21

Vaccination against pneumococcus, meningococcus, and Haemophilus, transfusion for anemic patients, and availability of cross-matched blood.

Question 22

How should an anemic patient be prepared before splenectomy?

Answer 22

Anemic patients should be transfused to a hemoglobin level of 10 g/dL before surgery.

Question 23

How are DVTs prevented in splenectomy patients?

Answer 23

DVT prophylaxis includes the use of sequential compression devices and subcutaneous heparin administration.

Question 24

What is the most common indication for open splenectomy (OS)?

Answer 24

Traumatic rupture of the spleen.

Question 25

Describe the surgical position for open splenectomy in traumatic cases.

Answer 25

A midline incision is typically used for traumatic cases, with exploratory laparotomy (ex-lap) done for rupture or massive splenomegaly.

Question 26

What is the procedure for an open splenectomy?

Answer 26

The blood vessels are ligated first, followed by removal of the ligaments, and the spleen is mobilized by dividing the ligamentous attachments.

Question 27

How is laparoscopic splenectomy typically performed?

Answer 27

Laparoscopic splenectomy is done for normal-sized spleens, using a few trocars for access and ensuring the spleen is extracted piecemeal with minimal spillage.

Question 28

What are the indications for partial splenectomy?

Answer 28

Partial splenectomy is indicated for children, lipid storage disorders (like Gaucher’s disease), and some blunt or penetrating splenic injuries.

Question 29

What are the common short-term complications after splenectomy?

Answer 29

Short-term complications include overwhelming postoperative infection (OPSI), pulmonary infection, deep vein thrombosis, and spleno-portal thrombosis.

Question 30

What is the most common fatal infection after splenectomy?

Answer 30

Overwhelming postoperative infection (OPSI) caused by encapsulated bacteria, particularly Streptococcus pneumoniae.

Question 31

What are the most common vaccines administered before splenectomy?

Answer 31

Pneumococcal, Haemophilus, and Meningococcal vaccines are given before splenectomy.

Question 32

What is the recommended antibiotic prophylaxis for children after splenectomy?

Answer 32

A single daily dose of penicillin or amoxicillin is given for the first 2 years after splenectomy.