Spleen Flashcards
The splenic vessels run in which ligament?
the splenorenal
The short gastrics run in which ligament?
the gastrosplenic
T-cells take what architecture in the spleen?
periarterial lymphatic sheaths (PALS)
Howell-Jolly bodies are made of what?
nuclear remnants
What are pappenheimer bodies?
iron deposits in RBCs found in post-splenectomy patients
What are target cells?
immature RBCs
What are Heinz bodies?
intracellular denatured hemoglobin seen on a post-splenectomy blood smear
If you don’t find Howell-Jolly bodies after a splenectomy, what does this suggest?
the presence of an accessory spleen
What is the most reliable finding post-splenectomy on a blood smear?
Howell-Jolly bodies made up of nuclear remnants
Which hematologic disorders are indications for splenectomy?
ITP and spherocytosis
Angiographic intervention for splenic trauma should be considered for which patients?
- those with greater than a grade 3 injury
- those with a contrast blush
- those with moderate hemoperitoneum
Describe the etiology and management of ITP.
- thought to be secondary to glycoprotein IIb/IIIa auto-antibodies
- initially managed medically with steroids and IVIG
- can perform splenectomy for medically refractory patients, especially those with a good response to steroids
When do you transfuse platelets in a patient with ITP undergoing splenectomy?
after ligating the splenic artery if you can wait to prevent consumption
Describe the etiology, presentation, and treatment of hereditary spherocytosis.
- due to an AD defect in cell membrane proteins like spectrum which make them less deformable and more likely to be culled by the spleen
- presents with anemia and splenomegaly
- splenectomy is indicated for symptomatic patients older than 6
- often require cholecystectomy at the same time
Describe the etiology and management of splenic abscesses.
- most due to IVDU, endocarditis, sickle cell disease, and infection of a traumatic pseudocyst
- perc drains are appropriate for unilocular and thick walled lesions in stable patients
- multi-locular and thin walled abscesses are suspicious for echinococal abscess and are indications for splenectomy
What is a well-defined hypodense splenic lesion most likely to be?
a splenic cyst
What are the two types of splenic cysts?
- pseudocysts (post-traumatic)
- true cysts (parasitic, congenital, or neoplastic)
How are splenic cysts managed?
laparoscopic resection or fenestration is indicated for cysts >5cm and those that are symptomatic
What is the most common splenic tumor?
a hemangioma
How are splenic hemangiomas managed?
with splenectomy if they become symptomatic
What is the most common malignant tumor of the spleen?
angiosarcoma
Angiosarcomas of the spleen are associated with what exposures?
vinyl chloride and thorium dioxide
What is the most common lymphoma of the spleen, how is it managed surgically?
- most common is CLL
- indications for splenectomy are anemia and thrombocytopenia
How are splenic artery aneurysms managed?
- treated with >2cm and in all women of childbearing age given the high risk of rupture during pregnancy
- typically treated endovascularly with coil embolization or covered stent
