Spleen Flashcards
The short gastric run in which ligament?
the gastrosplenic
The splenic vessels run in which ligament?
the splenorenal
What are the four major ligaments of the spleen?
- splenophrenic
- splenocolic
- splenorenal
- gastrosplenic
What is the relationship of the splenic vessels to the pancreas?
- artery runs superior to the pancreas
- vein runs posterior or within the pancreas
What is erythrocyte pitting?
the spleen removing intracellular products to “re-energize” erythrocytes
Describe the architecture of the splenic white pulp.
- lymphoid follicles containing B-cells
- periarterial lymphatic sheaths containing T-cells
What are the two key proteins for opsonization in the spleen?
tuftsin and properdin
What do the following blood smear findings suggest:
- Howell-Jolly bodies
- pappenheimer body
- target cell
- heinz body
- spur cell
- Howell-Jolly: nuclear remnants suggestive of asplenia
- pappenheimer body: iron deposits
- target cell: immature RBC
- heinz body: intracellular denatured hemoglobin
- spur cell: deformed membrane
What re the two most common hematologic indications for splenectomy?
ITP and spherocytosis
What are the indications for splenic embolization in trauma?
- grade III injury or higher
- moderate hemoperitoneum
- contrast blush
- any signs of ongoing bleed
Describe the pathophysiology and management of ITP.
- due to autoantibodies against GP IIb-IIIa
- treat with steroids and IVIG
- consider splenectomy for refractory or recurrent cases
- good response to steroids predicts a favorable response to splenectomy
For patients with ITP, what predicts a good response to splenectomy?
a good response to steroids
When should platelets be given during splenectomy for ITP?
after the splenic artery is ligated if possible
What is hereditary spherocytosis?
an anemia caused by an autosomal dominant defect in a cell membrane protein, spectrum, causing RBCs to be deformed and culled by the spleen
Describe the treatment of hereditary spherocytosis.
- splenectomy for symptomatic patients older than 6 (give them time to develop an immune system)
- consider cholecystectomy at the same time
When are splenectomies indicated for hereditary spherocytosis and ITP.
- for ITP if refractory to steroids/IVIG or if recurrent
- for hereditary spherocytosis as first line therapy for those > 6 years old
What are the four most common causes of splenic abscess?
- IV drug use
- endocarditis
- infection of traumatic pseudocyst
- sickle cell disease
How are splenic abscesses managed?
- unilocular with thick wall: perc drainage
- multilocular or thin-walled: splenectomy (suspect echinococal abscess)
What are three kinds of splenic cysts?
- congenital
- neoplastic
- infectious
How should splenic cysts be managed?
- imaging and serology can usually identify a simple cyst
- in these cases, would only consider cyst fenestration if > 5cm or symptomatic
What is the most common type of splenic tumor?
hemangioma
How is a splenic hemangioma managed?
can perform splenectomy if symptomatic
Describe the risk factors and management of splenic hemangiosarcoma.
- risk: vinyl chloride or thorium dioxide
- treat with splenectomy
When is splenectomy indicated for non-Hodgkin’s lymphoma?
for anemia or thrombocytopenia
What is the most common visceral artery aneurysm?
splenic artery
What are the indications of intervention of a splenic artery aneurysm?
- all pregnant women or women of child bearing age
- greater than 3cm
Why do splenectomy patients have a heightened risk of infection?
decreased IgM and IgG lead to increased susceptibility to encapsulated organisms
Splenectomy patients are most at risk for infection with which organisms?
- S. pneumoniae (MC)
- N. meningitidis
- H. influenza
Which splenectomy patients are at even higher risk of infection?
children with hematologic diseases
Which splenectomy patients should be considered for OPSI prophylaxis?
children under 10 years old
What is the most common location of an accessory spleen?
the splenic hilum
What causes a floating spleen?
failure of fusion of the dorsal mesogastrium, leading to an abscence of splenic ligaments
What is the treatment for a floating spleen?
splenectomy if infarcted; otherwise, splenopexy
What is the most common source of post-splenectomy bleeding?
short gastrics
