spleen Flashcards
1
Q
intra or retro?
A
intraperitoneal encapsulated organ
2
Q
the spleen is encapsulated by the ________________
A
peritoneum||covers entire organ except hilum
3
Q
middle layer covering is ________________ and ____________ ______________ ______________ capsule and surrounds ENTIRE organ
A
fibroelastic and smooth muslce fiber||allows organ to expand and contract
4
Q
__________________ layer projects into organ forming partitions in pulp
A
inner
5
Q
______________________ ligament connects spleen to greater curvature of stomach
A
gastrosplenic
6
Q
_____________________ ligament connects spleen to L kidney
A
splenorenal
7
Q
situated obliquely in _____________ and ______________ portion of L hypochondriac region under _______th - _________ th ribs
A
posterior and lateral||9-11
8
Q
long axis of spleen runs parallel to ______ rib
A
1o
9
Q
splenic size
A
12 length x 8 thick x 4 width cm
10
Q
splenic volume index
A
L x W x H /27 = SVI
11
Q
normal SVI
A
Aug-35
12
Q
hilum where vessels enter and exit is located
A
lower medial portion
13
Q
______________ _________________ , ________________ __________, and _________________ ____________ are located anterior to splenic hilum
A
stomach fundus|lesser sac|pancreatic tail
14
Q
diaphragm is adjacent to the _________________ _______________ ______________ sides of the spleen
A
posterior lateral and superior
15
Q
spleen bordered posteriorly by ______________
A
lung
16
Q
the ______________ and _______________ _________ located anterior and medial to spleen
A
stomach and lesser sac
17
Q
the _______________ ______________ is located medial and slightly inferior
A
L kidney
18
Q
____________________ is medial and inferior to splenic hilum
A
splenic flexure of colon
19
Q
the tail of the pancreas lies _______________ to the stomach and _______________ to the splenic hilum
A
posterior |medial
20
Q
anatomic variant where the inferior portion of the spleen is located posterolateral to the upper pole of the L kidney and can mimic a mass
A
retrorenal spleen
21
Q
largest branch of celiac axis
A
splenic artery
22
Q
the SA follows a tortuous course ______________ and _______________ to the body and proximal tail of the pancreas
A
posterior and superior
23
Q
distal splenic artery CAN course _________________
A
anterior to pancreatic tail
24
Q
SA courses through _________________ ligament
A
splenorenal
25
SA supplies
spleen, pancreas, and fundus of stomach
26
SA resistance
low
27
SA branches into
superior and inferior splenic arteries
28
sup and inf splenic arteries give rise to
several segmental arteries||intrasegmental arteries DO NOT communicate w/ each other
29
lack of anastomoses in intrasplenic arterial circulation eliminates possibility of collateral formation when _______________ occurs
infarction
30
SV originates at splenic hilum and courses _________________ to pancreas body and tail
posteroinferior
31
SV:|Joins with the _________ to form the _________.
SMV / PV
32
SV drains
stomach, spleen, and pancreas
33
SV best seen
trans
34
normal diameter splenic vein
5-10 mm||diameter increases 50-100% w/ deep insp
35
splenic vein diameter increase of < _______ % w/ deep insp suggests portal hypertension
20%|(same w/ portal vein
36
PHYSIOLOGY
extramedullary hematopoiesis|fetal hematopoiesis and adult lymphopoiesis|immune response|phagocytosis|erythrocyte storage
37
blood cell production that occurs outside of bone marrow
extramedullary hematopoiesis
38
bld cell production primarily performed by bone marrow but spleen can also be onvolved during _______, __________, and ____________
fetal development|normal immune responses|pathological circumstances (anemia)
39
largest organ of RES
spleen
40
splenic tissue|______% red pulp|_______% white pulp
85% red|15% white
41
venous sinuses filled w/ blood and cords of splenic tissue
red pulp
42
another name for red pulp
cords of Billroth
43
clusters of lymphatic tissue called Malpighian corpuscles form a sheath around splenic artery and produce lymphocytes
white pulp
44
fetal hematopoiesis and adult lymphopoiesis
RBC and WBC production
45
immune response
white pulp responsible for defense
46
phagocytosis
red pulp breaks down hemoglobin
47
erythrocyte storage
stores large volume of blood
48
spleen not essential for life
post splenectomy fxns of spleen taken over by other RES organs ||increased risk of infection tho
49
an overactive spleen that removes too many blood cells from circulation
hypersplenism
50
complications of hypersplenism
reduction in infection response - too few WBC|anemia - bld not enough O2 carrying RBC|splenomegaly||cirrhosis, tuberculosis, Gaucher disease, and lymphoma
51
underperforming spleen
hyposplenism
52
causes of hyposplenism
sickle cell anemia and celiac disease
53
fxns of spleen 5
bld filtration : RES system removes various organisms from bld as passes thru splenic venous sinusoids||bld production : glucocytes and plasma cells||bld destruction : venous sinusoids w/ macrophages break down old RBC and platelets to release hemoglobin||*** hemoglobin for RBC passed to liver for storage and bile production||bld storage : main storehouse of bld 1/6 total bld in body||storage Fe
54
LABS
WBC|RBC|platelets|hematocrit
55
_________ controls antibodies and prevents infection
WBC
56
increased WBC count
leukocytosis
57
increased WBC usually indicates
infection
58
leukocytosis causes
infection|hemorrhage|malignancy |pregnancy
59
fewer WBC
leukopenia
60
leukopenia occurs w/
acute viral infections |chemo |radiation |lupus|HIV/AIDS|myelofibrosis|aplastic anemia
61
platelets
aka thrombocytes are the smallest blood cells produced in bone marrow for blood clotting
62
increased platelet count
thrombocytosis
63
increased platelet count can indicate
anemia (condition in which you lack enough healthy red blood cells to carry adequate oxygen to your body's tissues)||hemorrhage||myocardial infarction||hx splenectomy
64
decreased platelet count
thrombocytopenia
65
thrombocytopenia can indicate
internal hemorrhage
66
determines number/% RBC in blood
hematocrit
67
elevated hematocrit associated w/
dehydration|polycythemia vera (type of blood cancer. It causes your bone marrow to make too many RBCs. These excess cells thicken your blood, slowing its flow, which may cause serious problems, such as blood clots)
68
low hematocrit associated w/
anemia (condition in which you lack enough healthy red blood cells to carry adequate oxygen to your body's tissues)||bleeding (ulcers, colon cancer, leaking aneurysm) ||meds
69
hemoglobin is a protein in RBCs that carries O2||more RBCs = __________ hematocrit = __________ hemoglobin
increased increased
70
normal hematocrit levels men/women
41-50% men|36-48% women
71
normal hemoglobin levels men/women
13-18 g/dL men|12-16 g/dL women
72
indications for splenic US
LUQ pain|splenomegaly|anemia|traumatic disorders|congenital anomalies|focal defects|hematogenic and lymphogenic disorders|liver dx|mets
73
spleen probe
2.5 - 6.5 MHZ adult|4 - 8 MHZ pediatric
74
spleen echotexture
homogenous|isoechoic or slightly hypoechoic to liver|smooth well defined borders|highly vascular
75
best view to obtain long spleen
intercostal coronal or coronal oblique
76
normal arrangement of abdominal organs
situs solitus
77
organs are reversed in mirror image formation|liver on left|stomach and spleen on right
situs inversus
78
disorganzied rearrangement of abdominal organs
situs ambiguous (heterotaxia)
79
type of heterotaxia
asplenia and polysplenia
80
absence of spleen
asplenia
81
asplenia
rare|double right sidededness
82
asplenia anomalies
absent spleen|midline liver and GB|intestinal malrotation |right sided AO (reversed AO and IVC)|congenital heart defects |||duplicate IVC|horseshoe kidney
83
congenital heart defects are common w/
asplenia and polysplenia
84
formation of multiple spleens
polysplenia
85
Polysplenia is associated with
biliary atresia|absent GB|intestinal malrotation |interrupted IVC|congenital heart defects
86
most common congenital anomaly of the spleen
accessory spleen
87
an accessory spleen is found in the region of
pancreatic tail , splenic hilum
88
SA accessory spleen
round/oval solid structure|isoechoic to spleen|< 5 cm diameter
89
wandering spleen
ectopic spleen||can be mistaken for a mass|may undergo torsion and cause acute pain
90
cause of ectopic spleen
weak splenic ligament lead to migration
91
_______________ is characterized by premature red blood cell (RBC) destruction and anemia due to intrinsic RBC defects
Hereditary hemolytic anemia (HHA) ||anemia - condition in which you lack enough healthy RBCs to carry adequate oxygen to your body's tissues
92
sickle cell anemia
hereditary disorder of abnormal hemoglobin producing sickle-shaped erythrocytes and hemolysis
93
spleen processes abnormal RBCs that do not carry necessary normal _________________
hemoglobin
94
hereditary hemolytic anemia can cause
stroke|pulmonary HTN|blindess|priapism||risk cholelithiasis
95
both acquired and hereditary hemolytic anemia have an increased risk of cholelithiasis due to
accelerated breakdown of RBCs into bilirubin
96
HHA is more common in
african americans
97
homozygous sickle cell anemia
spleen enlarges early life as tries to keep up filtereing abnormal RBCs and then atrophies and shrinks later in childhood as get clogged
98
homozygous sickle cell anemia SA
difficult to see|bright w/ calcifications|autosplenctomy - fibrosis w/ fxn loss
99
splenomegaly w/ signs of infarction
heterozygous sickle cell anemia
100
acquired disorder caused by infection or medication of hypersplenism leading to excessive destruction of normal RBCs and causing release of hemoglobin
acquired hemolytic anemia
101
liver uses hemoglobin to produce ____________
bilirubin
102
increased _________________ _________________ hallmark sign of hemolytic anemia
indirect (unconjugated) bilirubin
103
LABS acquired hemolytic anemia
increased indirect bilirubin|decreased hemoglobin |decreased RBCs|decreased hematocrit||ALT/AST/ALP/AFP normal
104
acquired hemolytic anemia commonly seen in patients w/
AIDS
105
acquired hemolytic anemia - spleen enlarges or shrinks?
enlarges due to excessive processing of increased volume destroyed RBCs
106
body lacks specific enzyme and causes buildup of fat in organs like spleen and liver
Gaucher disease
107
gaucher disease is an
autosomal recessive disorder
108
less common areas Gaucher can affect
bone, spinal cord, brain
109
liver and spleen enlarge or shrink w/ Gaucher?
enlarge - splenomegaly (>18 cm) and hepatomegaly cause abdominal pain
110
SA Gaucher disease
spleno/hepatomegaly|hypo hetero nodules on spleen|diffuse nodule formation
111
Gaucher disease is associated w/
myeloma, leukemia, lymphoma
112
CYSTIC ABNORMALITIES OF SPLEEN
simple/primary cyst|autosomal dominant polycystic disease|parasitic|echinococcal |pseudocyst|infarct|peliosis|hematoma
113
filled w/ keratin substance that is echogenic
splenic epidermoid cysts
114
SA splenic epidermoid cyst
layers hypo hyper material|large > 10 cm|calcified walls
115
pancreatic pseudocyst
collection of debris, fluid, pancreatic enzymes, and blood as a complication of acute pancreatitis
116
most common type of abdominal branch aneurysm
splenic artery aneurysm||risk of rupture makes it critical finding
117
SA aneurysms are more common in
females
118
SA aneurysms are associated w/
pregnancy|pancreatic pseudocyst formation
119
SA aneurysm symptoms
asymptomatic|LUQ pain|abdominal bruit
120
sono app SA aneurysm
cystic mass |if calcified - hyperechoic shadowing foci
121
SV thrombosis is associated w/
chronic pancreatitis|pseudocysts|portal HTN
122
SV thrombosis may result in
upper GI bleeding from gastric varices (fatal complication)
123
blood collection forms between capsule and splenic pulp
subcapsular hematoma
124
subcapsular hematoma SA
capsule intact|appears in outer borders of spleen|varies w/ age
125
blood collection inside peritoneal cavity that occurs when splenic capsule ruptures
perisplenic hematoma (intraperitoneal)
126
SA perisplenic hematoma
FF outside spleen|varies in appearance w/ age
127
blood collection collection w/in parenchyma - capsule intact
intraparenchymal hematoma
128
SA intraparenchymal hematoma
may appear cystic, solid, or complex depending on age
129
symptoms include LUQ pain / decreasing hematocrit / hypotension
splenic rupture||critical finding
130
splenic rupture is usually caused by
trauma
131
SA splenic rupture
FF|absence normal spleen|irregular complex mass of tissue in LUQ||depends on AGE, AMOUNT, PHYSICAL STATE OF CLOT ||splenosis - small masses of homo splenic tissue
132
spontaneous rupture seen in patients w/
hep A|malaria|cytomegalovirus|mono|HIV
133
autotransplantation of splenic tissue in the peritoneal cavity when the spleen ruptures
splenosis
134
areas of tissue death when bld supply is cut off
splenic infarct
135
splenic infarcts found in patients w/
leukemia|sickle cell anemia|pancreatitis|bacterial endocarditis
136
SA acute splenic infarct
hypo wedge shaped in peripheral parenchyma||avascular
137
SA chronic splenic infarct
becomes more hyper and more wedge shaped |broad base and triangular base point toward hilum
138
hyperechoic linear shaped bands w/in splenic infarct lesions
Bright Band Sign
139
_______________ is caused by excessive pooling of blood in splenic tissues
congestive splenomegaly
140
another name for congestive splenomegaly
Banti syndrome
141
common causes of congestive splenomegaly
portal HTN|CHF|SV thrombosis
142
SA congestive splenomegaly
splenomegaly|splenic varices|increased resistance in SA w/ reduced or reversal diastolic flow
143
decrease in rate of bld flow thru liver will cause increased pressure in portal venous system
portal HTN
144
anatomical &/or fxnal obstruction to bld flow into PV system
portal HTN
145
caused by increase in total PV flow or increased resistance in PV system/liver
portal HTN
146
increased PV flow volume may develop as result congenital or acquired _______________ or _______________
fistula or shunt
147
portal HTN is the most common cause of
splenomegaly
148
results in varices at splenic hilum
portal HTN
149
3 categories of increased resistance to PV flow
prehepatic|intrahepatic|post hepatic (extrahepatic)
150
most likely to occur due to obstruction of extrahepatic PV
prehepatic
151
develops as result of hepatocellular disease (cirrhosis, hepatitis, fatty liver, diffuse metastatic disease)
intrahepatic
152
can occur secondary to CHF, constrictive pancreatitis, Budd-Chairi or suprahepatic IVC obstruction
post hepatic / extrahepatic
153
in later stage portal HTN - reversal of flow in PV occurs which produces ___________________ _________________
congestive splenomegaly
154
portal HTN may cause ________________ to develop w/ risk acute rupture and hemorrhage
submucosal varices
155
describe changes in MPV in patients w/ portal HTN
normal MPV changes w/ respiration||increased diameter w/ inspiration and decreased w/ expiration|DOES NOT OCCUR||MPV >13 mm diameter|SV or SMV > 1 cm diameter
156
overproduction of RBCs that causes hypercoagulability
polycythemia vera||type of blood cancer. It causes your bone marrow to make too many RBCs. These excess cells thicken your blood, slowing its flow, which may cause serious problems, such as blood clots
157
polycythemia vera causes ________________ PT and INR
decreased||slows bld clotting process|takes longer to clot
158
polycythemia vera associated w/
splenic infarcts|renal vein thrombosis|PV thrombosis|Budd Chiari||splenomegaly
159
splenomegaly
enlarged spleen > 13 cm length||spleen extends past L kidney lower pole
160
most frequent LUQ mass
splenomegaly
161
splenomegaly is most commonly caused by
portal HTN w/ cirrhosis
162
Asher Sign?
upper border of spleen extends past anterior AO by > 2 cm
163
causes splenomegaly
congestive vascular disorder (portal HTN)|lymphoma|schistosomiasis|leukemia|infection - AIDS , mono, Epstein-barr|hemolytic anemia|neoplasm/malig tumor|storage disease|collagen disease|extramedullary hematopoiesis|polycythemia vera
164
size splenomegaly
length >13 cm|thickness > 5cm
165
SA splenomegaly
hypo w/ malignancy|hyper w/ inflammatory processes
166
mild-moderate splenomegaly occurs w/
infection, portal HTN, AIDS
167
marked splenomegaly
hemtologic disorders, lymphoma, leukemia, myelofibrosis
168
massive splenomegaly
> 18 cm length|thalassemia major|myelofobrosis|lymphoma|Gaucher disease
169
inflammatory process that causes cell clumping in certain organs due to overactive immune system
sarcoidosis
170
the clumps of cells form splenic nodules called _______________
granulomas
171
SA sarcoidosis
multiple hypoechoic nodules thru spleen||healed granulomas - calcified||multiple echogenic foci w/ shadowing
172
spleen fix includes ____________ production and ____________________||splenic infection may be ________________ or __________________||mononucleosis -
WBC production and filtration||localized or imported||causes significant splenomegaly|associated Epstein- Barr -Epstein-Barr virus (EBV) is the most common cause of infectious mononucleosis
173
moderate splenomegaly occurs in _____________ % of patients w/ AIDS
50-70%
174
splenomegaly of AIDS patients more common w/
ST HIV than acquiring thru IV drug use
175
AIDS associated w/
hepatomegaly|hepatitis|candidiasis||pneumocystis carinii (mc infection of AIDS patients)||fatty infiltration ||Kaposi sarcoma - mc malig tumor of liver and spleen w/ AIDS)||cholangitis|acalculous cholecystitis |non-hodgkin lymphoma|hemolytic anemia
176
most common infection of AIDS patients
pneumocystis carinii
177
mc malig tumor of liver and spleen in AIDS patients
kaposi sarcoma
178
systemic fungal respiratory disease caused by bird bat and other animal droppings
granulomatous infections
179
most common cause of granulomatous infections
tuberculosis and histoplasmosis||also seen w/ sarcoidosis
180
SA granulomatous infections
multiple hyp nodules <1cm|heal become hyper foci in spleen and liver
181
organized foci of hemorrhage in spleen and liver w/ portal HTN
gamma-gandy
182
linear calcifications that follow course of a vessel
vascular calcifications
183
SA splenic calcifications
diffuse echogenic foci|w/ or w/out shadowing|twinkle
184
rare may be seen post splenectomy
splenic abscess
185
splenic abscess associated w/
general abdominal sepsis and trauma
186
splenic abscess symptoms
pain dizziness faintness
187
splenic abscess labs
decreased hematocrit|increased WBC
188
SA splenic abscess
complex fluid colleciton w/ internal echoes|irregular borders|septations/pleural effusion|dirty shadowing - gas producing organisms
189
BENIGN NEOPLASMS
benign neoplasms of spleen rare||cystic cavernous hemangioma|hamartoma|Gaucher disease||osteoma - bone disease|fibroma - fibrous tissues|chondroma - cartilaginous tumor|cystic lymphangioma - congenital defect in lymphatic vessels in spleen|granuloma - calcifications
190
most common benign tumor of spleen
cystic cavernous hemangioma
191
SA hemangioma
highly vascular
192
incidental finding of solitary mass
hamartoma
193
SA hamartoma
hypo homo solid masses hypervascular
194
mulptiple well define hypoechoic nodules w/ massive splenomegaly
Gaucher disease
195
most common splenic malignancy
lymphoma||tumor of lymphatic system commonly involves spleen||hodgkin and nonhodgkin
196
hodgkin lymphoma||most commonly occurs in patients age ________|average age|labs|treatable
15-24 and >60|60|elevated LDH
197
SA lymphoma
diffuse / marked splenomegaly / patchy inhomogeneity||mulpt small hypo lesions||mult large lesions 1-10 cm||single bulky solid mass
198
cancer of WBCs
leukemia
199
leukemia symptoms
night sweats|fatigue|unintentional weight loss|painless, swollen lymph nodes|liver and/or spleen enlargement
200
2 type leukemia
myelogenous - cancer of immature WBCs ||lymphocytic - cancer of lymphocytes
201
leukemia labs
elevated ALP||decreased RBC |increased WBC
202
primary malig neoplasm of sleen
angiosarcoma
203
very rare aggressive malig w/ high rate of mets and poor prognosis
angiosarcoma
204
which neoplasm has has incidence of splenic rupture
angiosracoma
205
symptoms agiosarcoma
LUQ pain|malaise|fever|weight loss
206
SA angiosarcoma
splenomegaly|hetero|complex mass w/ cystic and solid|hypervascular
207
most likely primary cancer to spread to spleen
melanoma
208
most common primary carcinomas seen w/ splenic mets
lung and breast
209
SA spleen mets
hypoechoic bulls eye|cystic or hyperechoic
