spleen Flashcards
blood supply spleen
splenic artery (from coeliac axis) // splenic vein (joins with SMV –> portal vein)
causes MASSIVE splenomegaly
myelofibrosis // CML // malaria // Gaucher // leishmanias
other causes splenomegaly
portal hypertension // lymphoproliferative (CLL, hodgkins) // haemolytic anaemia // infection (hep, EBV, endocarditis) // feltys (RA)
features hypersplenism
splenomegaly + fall in one of: RBC, WBC, platelet, plasma // (hypersplenism is consequence of splenomegaly)
what can cause hyposplenism
splenectomy // sickle cell // coealic // graves // SLE // amyloid
blood film hyposplenism
howell-jolly // siderocytes
what infections are more common following splenectomy
pneumococcus, haemophilis, meningococus, Capnocytophaga (CAPSULATED organisms)
what vaccines should a patient ideally have before splenectomy
Hib // meningitis A+C // annual flue // pneucomoccal vaccine 5 years
what abx prophylaxis is given in splenectomy patients and for how long
pen V - at least 2 years, maybe life long
indications splenectomy
trauma // rupture (EBV) // hypersplenism // lymphoma, leukaemia // splenic cyst, abscess
complications splenectomy
bleeding // pancreatic fistula // thrombocytosis // infection
what happens to blood film + following a splenectomy
raised target cells, siderocytes, reticulocyes // granulocytosis (mainly neutrophils) // may be high platelets
what blood thinner may some patients need post-splenectomy and why
raised platelets –> antiplatelet
what would indicate conservative mx in splenic rupture
subcapsular haematoma // minimal abdo blood // hilar intact
what would indicate laparotomy + conservation mx in splenic rupture
increased abdo blood // haemodynamically unstable // tears <50%
