spleen

Question 1

Congenital abnormalities(Spleen)

Answer 1

accessory spleens (splenunculi)
congenital asplenia or polysplenia

Question 2

Hypersplenism definition

Answer 2

the term is applied to an association between a
peripheral blood pancytopaenia and splenic
enlargement

Question 3

Signs of Primary hypersplenism

Answer 3

marked and massive splenomegaly
and pancytopaenia

Question 4

Treatment of Hypersplenism

Answer 4

splenectomy

Question 5

Causes of splenomegaly

Answer 5

• congestion
• infection
• immune disorders
• red blood cell abnormalities
• primary or metastatic neoplasms
• storage disorders
• amyloidosis

Question 6

Causes of a grossly enlarged spleen

Answer 6

• Chronic myeloid leukemia
• Myelofibrosis
• Malaria
• Gaucher’s disease

Question 7

Moderately enlarged splenomegaly

Answer 7

• Congestion
• Amyloidosis
• Haemolytic anemia
• Chronic lymphocytic leukemia

Question 8

Mildly enlarged

Answer 8

• Any of the above
• Infection
• Autoimmune disease
• Felty’s disease

Question 9

Causes of Congestive splenomegaly(pre/post/hepatic)

Answer 9

Pre-hepatic: thrombosis of the extrahepatic portion of the portal vein or splenic vein

Hepatic: cirrhosis

Post-hepatic: raised pressure in the inferior vena cava.
* transmitted to the spleen via the portal system
* usually associated with ascites and hepatomegaly
* usual causes - decompensated right heart failure and
pulmonary or tricuspid disease

Question 10

Morphology of Congestive splenomegaly(capsule and cut surface)

Answer 10

Capsule- thickened and fibrotic
Cut Surface: beefy-red color with inconspicuous white pulp
– contains scattered firm brown nodules – Gamna
Gandy bodies - represent areas of healed infarction -composed of fibrous and elastic tissue with abundant haemosiderin and dystrophic calcification

Question 11

Splenomegaly due to systemic infection

Answer 11

–may cause moderate splenomegaly
–characterized by congestion and
macrophage hyperplasia
–white pulp- usually prominent

Question 12

Splenomegaly due to bacterial infection

Answer 12

–in response to infections e.g. bacterial
endocarditis or localized abscesses
–neutrophils can accumulate in the
sinuses and medullary cords
–if extreme – ‘acute septic splenitis’
–becomes soft because of proteolytic
enzyme action

Question 13

Splenomegaly due to viral infection

Answer 13

–especially infectious mononucleosis
–may produce more severe splenomegaly
–susceptible to rupture

Question 14

Splenomegaly due chronic malarial infection

Answer 14

–may lead to massive splenomegaly
–splenic capsule – thickened and fibrotic
–cut surface – slate grey color due to
abundant malarial pigment

Question 15

granulomatous inflammation that causes Splenomegaly

Answer 15

–bacteria : Tuberculosis
–fungi: Histoplasmosis, Cryptococcus
–protozoal: Toxoplasmosis

Question 16

Immune disorders that cause Splenomegaly

Answer 16

-Rheumatoid arthritis, splenomegaly, and Neutropenia – Felty’s syndrome
-Systemic lupus erythematosus

Question 17

Red blood cell abnormalities that cause Splenomegaly

Answer 17

Sickle cell anemia
Hereditary spherocytosis

Question 18

Neoplasms that cause Splenomegaly

Answer 18

• haemangioma
• acute and chronic leukemia
• myeloproliferative disorders
• Hodgkin’s lymphoma
• Non-Hodgkin’s lymphoma

Question 19

Storage disorders that result in splenomegaly plus morphology

Answer 19

• Niemann Pick disease
• Gaucher’s disease
• Mucopolysaccharidoses

Morphology: Marked red pulp expansion by macrophages whose cytoplasm is distended with the abnormal storage product

Question 20

causes of splenic infarction

Answer 20

• follows occlusion of the splenic artery or its
  branches
• usually secondary to emboli that arise in the
  heart
• may be due to local thrombosis as in:
  -sickle cell anemia
  -myeloproliferative disorders
  -malignant infiltrates

Question 21

Causes and treatment of rupture of the spleen

Answer 21

caused by blunt abdominal trauma
spontaneous rupture –e.g. with infectious
mononucleosis
Treatment – emergency splenectomy

Question 22

Causes of Splenic atrophy

Answer 22

*sickle cell disease – multiple splenic infarcts -
the spleen is greatly reduced in size and function.
*may occur in association with intestinal
malabsorption states such as coeliac disease -
the spleen is small and weighs less than 50g