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BTK Review 2024 > Spleen > Flashcards

Spleen Flashcards

1
Q

The short gastric run in which ligament?

A

the gastrosplenic

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2
Q

The splenic vessels run in which ligament?

A

the splenorenal

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3
Q

What are the four major ligaments of the spleen?

A
  • splenophrenic
  • splenocolic
  • splenorenal
  • gastrosplenic
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4
Q

What is the relationship of the splenic vessels to the pancreas?

A
  • artery runs superior to the pancreas
  • vein runs posterior or within the pancreas
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5
Q

What is erythrocyte pitting?

A

the spleen removing intracellular products to “re-energize” erythrocytes

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6
Q

Describe the architecture of the splenic white pulp.

A
  • lymphoid follicles containing B-cells
  • periarterial lymphatic sheaths containing T-cells
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7
Q

What are the two key proteins for opsonization in the spleen?

A

tuftsin and properdin

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8
Q

What do the following blood smear findings suggest:
- Howell-Jolly bodies
- pappenheimer body
- target cell
- heinz body
- spur cell

A
  • Howell-Jolly: nuclear remnants suggestive of asplenia
  • pappenheimer body: iron deposits
  • target cell: immature RBC
  • heinz body: intracellular denatured hemoglobin
  • spur cell: deformed membrane
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9
Q

What re the two most common hematologic indications for splenectomy?

A

ITP and spherocytosis

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10
Q

What are the indications for splenic embolization in trauma?

A
  • grade III injury or higher
  • moderate hemoperitoneum
  • contrast blush
  • any signs of ongoing bleed
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11
Q

Describe the pathophysiology and management of ITP.

A
  • 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
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12
Q

For patients with ITP, what predicts a good response to splenectomy?

A

a good response to steroids

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13
Q

When should platelets be given during splenectomy for ITP?

A

after the splenic artery is ligated if possible

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14
Q

What is hereditary spherocytosis?

A

an anemia caused by an autosomal dominant defect in a cell membrane protein, spectrum, causing RBCs to be deformed and culled by the spleen

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15
Q

Describe the treatment of hereditary spherocytosis.

A
  • splenectomy for symptomatic patients older than 6 (give them time to develop an immune system)
  • consider cholecystectomy at the same time
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16
Q

When are splenectomies indicated for hereditary spherocytosis and ITP.

A
  • for ITP if refractory to steroids/IVIG or if recurrent
  • for hereditary spherocytosis as first line therapy for those > 6 years old
17
Q

What are the four most common causes of splenic abscess?

A
  • IV drug use
  • endocarditis
  • infection of traumatic pseudocyst
  • sickle cell disease
18
Q

How are splenic abscesses managed?

A
  • unilocular with thick wall: perc drainage
  • multilocular or thin-walled: splenectomy (suspect echinococal abscess)
19
Q

What are three kinds of splenic cysts?

A
  • congenital
  • neoplastic
  • infectious
20
Q

How should splenic cysts be managed?

A
  • imaging and serology can usually identify a simple cyst
  • in these cases, would only consider cyst fenestration if > 5cm or symptomatic
21
Q

What is the most common type of splenic tumor?

A

hemangioma

22
Q

How is a splenic hemangioma managed?

A

can perform splenectomy if symptomatic

23
Q

Describe the risk factors and management of splenic hemangiosarcoma.

A
  • risk: vinyl chloride or thorium dioxide
  • treat with splenectomy
24
Q

When is splenectomy indicated for non-Hodgkin’s lymphoma?

A

for anemia or thrombocytopenia

25
Q

What is the most common visceral artery aneurysm?

A

splenic artery

26
Q

What are the indications of intervention of a splenic artery aneurysm?

A
  • all pregnant women or women of child bearing age
  • greater than 3cm
27
Q

Why do splenectomy patients have a heightened risk of infection?

A

decreased IgM and IgG lead to increased susceptibility to encapsulated organisms

28
Q

Splenectomy patients are most at risk for infection with which organisms?

A
  • S. pneumoniae (MC)
  • N. meningitidis
  • H. influenza
29
Q

Which splenectomy patients are at even higher risk of infection?

A

children with hematologic diseases

30
Q

Which splenectomy patients should be considered for OPSI prophylaxis?

A

children under 10 years old

31
Q

What is the most common location of an accessory spleen?

A

the splenic hilum

32
Q

What causes a floating spleen?

A

failure of fusion of the dorsal mesogastrium, leading to an abscence of splenic ligaments

33
Q

What is the treatment for a floating spleen?

A

splenectomy if infarcted; otherwise, splenopexy

34
Q

What is the most common source of post-splenectomy bleeding?

A

short gastrics

35
Q
A

BTK Review 2024 (19 decks)

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