Spleen Flashcards
1
Q
Although the spleen is located near the stomach it plays no part in _____.
A
digestion
2
Q
The spleen is elongate-_____ in shape and of a dull _____ color.
A
oval
purplish
3
Q
The spleen is a _____ organ that lies _____ the stomach, high up on the left side of the abdomen, on a level with the 9 to 11 ribs.
A
lymphatic
behind
4
Q
The spleen is similar to a _____ in shape and structure but is much _____.
A
lymph node
larger
5
Q
The spleen is the largest _____ organ in the body.
A
lymphatic
6
Q
The spleen is a _____ organ that filters damaged cells and delivers _____ to the immune system.
A
peritoneal
antigens
7
Q
The spleen of an adult human:
1) Weighs about _____ (_____)
2) Is ___-___ ( ___- ___ ) long
3) Is _____ (_____) wide
4) Is _____ (_____) thick.
A
170 grams (6 ounces)
13-15 cm (5-6 inches) long*
7.5 cm (3 inches) wide
4cm (1.5 inches) thick
*Jennifer says up to 12 cm is the common healthy size
8
Q
The _____ brings blood to the spleen from the heart.
A
splenic artery
9
Q
The splenic artery enters the spleen through a fissure called the _____ and divides into numerous branches, assuming an appearance rather like a _____; they are sometimes called the _____ arteries.
A
hilum
brush
brush
10
Q
Blood leaves the spleen through the _____, which becomes part of the _____ that carries the blood to the liver.
A
splenic vein
MPV
11
Q
The spleen consists of two types of tissue called _____ and _____.
A
white pulp
red pulp
12
Q
The white pulp of the spleen is lymphatic tissue consisting mainly of _____ around the _____.
A
lymphocytes
arteries
13
Q
The red pulp consists of venous _____ (cavities) filled with blood and cords of _____ cells, such as _____ and _____.
A
sinuses
lymphatic
lymphocytes
macrophages
14
Q
The normal spleen:
_____ (increases/decreases) in size and weight with advancing age.
_____ (increases/decreases) in volume while digestion is in progress, and returns to its normal size when it’s finished.
The size can vary in size in accordance with the _____ status of the body.
A
decreases
increases
nutritional
15
Q
The spleen filters blood in much the way that the lymph nodes filter _____. Lymphocytes in the spleen react to _____ in the blood and attempt to destroy them. _____ then engulf the resulting debris, the damaged _____, and the other large particles.
A
lymph
pathogens
macrophages
cells
16
Q
The spleen, along with the liver, removes old and damaged _____ from the circulating blood.
A
erythrocytes (RBCs)
17
Q
The spleen can also, like _____, produce new red blood cells. It can accordingly be regarded both as a _____ and as a _____ organ.
A
bone marrow
hemolytic
hemopoietic
18
Q
The terms hemolytic and hemopoietic come from the Greek: hema: _____; luein: _____; poiein: _____.
A
blood
to dissolve/destroy
to produce
19
Q
T or F? The spleen is removable.
A
true
20
Q
In healthy people, the spleen plays a role in immunity against _____.
A
bacterial infections
21
Q
The shape of the spleen is _____ (adjective).
A
variable
22
Q
The spleen consists of 2 components at the hilum:
A
superomedial component
inferolateral component
23
Q
In the TRV plane, the superior part of the spleen has a typical fat _____ shape.
A
comma
24
Q
In the coronal plane, the spleen has a _____ shape.
A
inverted comma
25
Why do we scan the spleen coronally?
Because the stomach is anterior to the spleen and is full of air, which makes it impossible to see through.
26
The diaphragm cradles the spleen _____, _____, and _____.
posteriorly
superiorly
laterally
27
If the _____ lobe of the liver is large, it may extend into the LUQ, _____ to the spleen.
left
| superior
28
The fundus of the stomach is _____ and _____ to the splenic hilum.
medial
| anterior
29
The pancreas tail lies _____ to the stomach and is also _____ and _____ to the splenic hilum.
posterior
medial
anterior
30
What are the 3 organs/parts that are medial and anterior to the splenic hilum?
stomach
pancreatic tail
lesser sac
31
The left kidney generally lies _____ and _____ to the spleen.
medial
| inferior
32
Why perform an ultrasound on the spleen? (4)
To demonstrate:
- existence of a mass and its composition
- disruption of splenic texture or outline
- spleen size
- progressive changes in masses
33
Enlargement of the spleen is >_____.
12cm
34
What does splenomegaly demonstrate?
it is not a disease in itself but a sign of an underlying disorder
35
Mild-to-moderate splenomegaly is usually caused by: (3)
infection
portal HTN
AIDS
36
Marked splenomegaly is usually the result of: (3)
leukemia
lymphoma
infectious mononucleosis
37
Massive splenomegaly is seen in _____.
myelofibrosis
38
What is myelofibrosis?
the body making too much scar tissue
39
What is the most frequently observed abnormality of the spleen?
splenomegaly
40
What are 5 common causes of splenomegaly?
```
congestive
hematologic
infiltrative
metabolic
trauma
```
41
The congestive (can't keep up with its job in the body) cause of splenomegaly is secondary to _____ due to _____. An example is _____.
portal HTN
cirrhosis
anemia
42
The main hematologic cause of splenomegaly is
polycythemia vera
43
What is a blood disorder that results in uncontrollable RBC production?
polycythemia vera
44
Besides splenomegaly, what else does polycythemia vera cause? (2)
hyperviscosity
| hypercoagulation
45
The infiltrative cause of splenomegaly is due to _____ and both types of _____ ( _____ and _____).
leukemia
| lymphoma (Hodgkins and non-Hodgkins)
46
The splenic parenchyma is extremely _____ (homogeneous/heterogeneous) with uniform mid-to-low level _____. It is generally considered that the liver is more _____ (echogenicity) than the spleen, but the spleen parenchyma actually has a _____ echogenicity than the liver (due to its _____ content) or may be _____ (echogenicity) to the liver.
```
homogeneous
echoes
echogenic
higher
water
isoechoic
```
47
_____ is a common primary malignancy of the spleen, usually appearing as diffuse _____ organ _____. Less common forms include a round _____ mass or multiple _____. Splenic involvement is more common with _____ lymphoma than with _____ lymphoma.
```
lymphoma
homogeneous
enlargement
focal
small nodules
non-Hodgkin
Hodgkin
```
48
The metabolic cause of splenomegaly is caused by _____ disease and _____ disease.
Gaucher's
| Niemann-Pick
49
What is Gaucher's disease?
a disease where there is a missing fat enzyme
50
What is the disease that means the body has too much sphingomyelin?
Niemann-Pick
51
Gaucher's Disease
It is _____ (inherited/not inherited).
It means the body is missing a _____ enzyme.
_____ is one of the earliest signs.
inherited
fat
splenomegaly
52
Niemann-Pick Disease
It is _____ (inherited/not inherited).
It means the body has too many deposits of _____.
inherited
| sphingomyelin
53
What are the signs and symptoms of splenomegaly?
LUQ pain
| pressure on adjacent organs
54
What causes LUQ pain with splenomegaly?
the stretching of the capsule or ligament of the spleen
55
This mass appears as an echo-free areas with smooth, sharp borders and acoustic enhancement.
cyst
56
The 4 categories of cysts on the spleen are
infectious
post-traumatic
primary congenital (born with it)
intrasplenic pancreatic pseudocyst
57
Infection or parasitic cysts may be caused by _____ or _____.
hydatid cysts
| echinococcus
58
How is an infectious or parasitic cyst identified among the different kinds of cysts?
calcification in the wall
59
What is needed to be diagnostic for infectious/parasitic cysts? (2)
percutaneous aspiration
| history and background info
60
Hydatid cysts result from a _____.
parasitic tapeworm
61
If you open up a hydatid cyst, what does it look like?
a honeycomb
62
With hydatid parasitic cysts, ____ form the cysts and the cysts multiply, creating _____ cysts.
parasites
| daughter
63
What are post-traumatic cysts caused by?
usually due to hematoma due to trauma
64
Post-traumatic cysts are referred to as _____ (type of cyst) and ____ (have/don't have) a cellular lining.
pseudocysts
| don't have
65
This kind of cyst differs from a post-traumatic cyst in that it has a cellular lining.
primary congenital cysts
66
Another term for primary congenital cysts is ____, which means "_____."
epidermoid cysts
| "true cyst"
67
T or F? Primary congenital cysts are rare.
True
68
_____ cysts can be due to polycystic disease. The walls may become _____ or may contain low level _____ that can be _____ or debris.
Primary congenital
calcified
echoes
cholesterol crystals
69
These cysts extend into the spleen and are associated with pancreatitis features.
pancreatic pseudocysts
70
This pancreatic pseudocyst is uncommon, but associated with a high mortality rate.
splenic abscess
71
Fever + infection =
abscess!
72
This kind of pancreatic pseudocyst commonly occurs due to spread of infection, especially from infective endocarditis or most commonly from streptococcus.
splenic abscess
73
Fever + infection + underlying issue =
splenic abscess!
74
Fever, pain, leukocytosis*** and a LUQ mass is a sign of
a splenic abscess
75
How does a splenic abscess appear sonographically?
variable
76
This is a traumatic abnormality of the spleen and is associated with rib fractures.
hematoma
77
What is the choice modality for a hematoma?
CT
78
How does a hematoma appear sonographically?
variable
79
This kind of splenic mass is uncommon but can be caused by a number of diseases.
solid focal lesion
80
This is the most common solid focal lesion and it results from previous _____ infections, which are seen as a _____, bright, _____ lesion with or without shadowing.
granulomatous
focal
echogenic
81
What are the most common causes of granulomas? (2)
histoplasmosis
| TB
82
What is the disease that is spread by the inhalation of bird/bat poop?
histoplasmosis
83
Granulomas may occur in patients with _____.
sarcodosis
84
What is sarcodosis?
inflammation of the lymph nodes
85
With granulomatous disease, calcification in the _____ is common.
splenic artery
86
Granulomas are clusters of _____ cells.
immune
87
Primary malignancies of the spleen are very rare, but if there is one, it is probably _____.
lymphoma
88
Splenic metastasis occurs most commonly with malignant _____.
melanoma
89
After melanoma, the next 2 most common splenic mets comes from the _____ and the _____.
breast
| lung
90
This is the most common benign neoplasm of the spleen.
hemangioma
91
A hemangioma is usually isolated with variable appearance, sonographically. But mostly, they look like _____.
liver hemangiomas
92
What is a common cause of focal splenic lesions?
splenic infarctions
93
The appearance of a splenic infarction typically appears as a _____, _____, _____ lesion (3)
peripheral
wedge-shaped
HYPOechoic
94
With splenic infarctions, when it becomes chronic, the wedge-shaped characteristic becomes _____.
HYPERechoic
95
Any wedge-shaped lesion in the spleen will be an _____. So if, on the boards, you see ANY wedge-shaped image, pick _____, whether it’s hypoechoic or hyperechoic.
infarct
96
The most common cause of a splenic infarct is
bacterial endocarditis
97
Besides bacterial endocarditis, what are other causes of splenic infarcts? (4)
leukemia
lymphoma
tumor emboli
sickle cell anemia
98
Splenic nodules are present with these 3 conditions:
Gauchers Disease
Schistosomiasis
Candidiasis (wheel within a wheel)
99
What is the choice diagnostic imaging modality for splenic trauma? Why? What is the modality that may be used for follow-up?
CT
because more upper abdominal pathology can be identified with one exam
ultrasound
100
T or F? Subcapsular or perisplenic hematomas are seen with ultrasound with high accuracy.
True
101
Inside capsule =
subcapsular
102
Outside capsule =
perisplenic
103
This is a hematoma that occurs with splenic trauma in which the splenic capsule remains intact.
subcapsular (AKA intraparenchymal)
104
Another term for subcapsular is
intraparenchymal
105
How does a subcapsular hematoma look sonographically?
crescent-shaped fluid collection, inferior to the diaphragm
106
This appears as a crescent-shaped fluid collection, inferior to the diaphragm.
subcapsular hematoma
107
This hematoma occurs with splenic trauma in which the splenic capsule ruptures.
perisplenic hematoma (AKA intraperitoneal)
108
Another term for perisplenic hematoma is
intraperitoneal
109
T or F? A ruptured spleen is a serious condition. Without emergency treatment, a ruptured spleen can cause life-threatening bleeding. An enlarged spleen may rupture spontaneously.
True
110
What are the classic symptoms of a ruptured spleen? (2-ish)
abdominal pain and tenderness
111
What are possible more severe symptoms of a ruptured spleen? (4-ish)
internal bleeding could cause blood pressure to drop, may become lightheaded or confused, with blurred vision and fainting
112
This can cause severe hemorrhage and shock (in splenic rupture).
tearing of splenic vessels
113
If tearing of the splenic vessels happens with splenic rupture, what is a really bad possible outcome?
death can occur within minutes (even in the best situations, death cannot be prevented)
114
This refers to when blood collects due to splenic injury, it irritates the diaphragm, causing referred pain to the shoulder tip.
Kehr's Sign
115
A ruptured spleen is typically caused by a blow to the _____ (area) abdomen or the left lower _____. Sporting mishaps, fist fights and car accidents are common causes. An injured spleen may rupture soon after the abdominal trauma or, in some cases, days or even _____ after the injury.
left upper
chest
weeks
116
An enlarged spleen, which may be caused by various underlying problems — from mononucleosis and other infections, to liver disease and blood cancers — may sometimes rupture with _____.
trauma to the abdomen
117
How can the spleen rupture during 3rd trimester pregnancies?
Large abdomen pushes the LLL anteriorly to the spleen
118
What is the most significant complication of mononucleosis?
ruptured spleen
119
What is the splenic rupture sign that refers to fluid in the lesser and greater sacs on both sides of the gastrosplenic ligament?
Butterfly sign
120
The Butterfly sign refers to fluid in the ____ and ____ on both sides of the ____ ligament.
lesser sac
greater sac
gastrosplenic
121
This occurs when the splenic vascular supply, parenchyma, or capsule has been disrupted.
splenic rupture
122
The appearance of this ranges from a cystic, hypoechoic mass to a complex area in the periphery of the splenic parenchyma.
splenic rupture
123
Splenic rupture can appear as a cystic, _____ (echogenicity) mass.
HYPOechoic
124
A splenic rupture can appear as a _____ area in the _____ of the splenic parenchyma.
complex
| periphery
125
_____ is the autotransplantaion of splenic tissue, following splenic injury.
splenosis
126
If a rupture is small, how is it treated?
surgical repair
127
If a rupture is bad (typically, it is) how is it treated?
splenectomy
128
This might be needed with splenectomy surgery if the patient has lost a large amount of blood in the trauma that caused the rupture of the spleen.
transfusions
129
This is a slender tube equipped with a camera lens and light, used for splenectomy surgery.
laparoscope
130
A person can live an active life without a spleen, but they are more likely to contract serious or life-threatening _____. If the spleen is removed, the doctor may recommend _____ and _____ vaccines. _____ may be recommended as well, especially if there are any other conditions that increase the risk of serious infections.
infections
pneumonia
flu
antibiotics
131
What is the condition in which the spleen ruptures and splenic cells implant through the peritoneal cavity, resulting in "ectopic spleens?"
post-traumatic splenosis
132
What is the most common finding in patients with AIDS in a splenic ultrasound? (50-70% of patients)?
moderate splenomegaly
133
Moderate splenomegaly is noted to be more frequent in _____-transmitted HIV infection, than in _____-transmitted HIV infection.
sexually
| IV drug
134
Focal splenic lesions may cause opportunistic infections such as (5):
```
candida
pneumocystis carini
mycobacterium avium
Kaposi's sarcoma
lymphoma
```
135
Congenital anomalies:
A normal variant which may be confused with enlarged lymph nodes around the spleen, or with masses in the pancreas tail.
accessory spleen (AKA splenunculi)
136
____% of people have an accessory spleen.
25
137
Another term for accessory spleen is
splenunculi
138
Splenunculi (AKA accessory spleen) is easy to recognize as small, round masses <____, located near the splenic _____, with echogenicity identical to the _____.
5cm
hilum
spleen
139
From where does an accessory spleen get blood supply?
splenic artery
140
What vessel drains an accessory spleen?
splenic vein
141
This represents nodules of normal spleen tissue.
accessory spleen
142
T or F? After a splenectomy, an accessory spleen can enlarge and take the place and function of the original spleen.
True
143
This is an abnormal inferior displacement of the spleen.
splenic ptosis
144
What are some causes of splenic ptosis? (3) and why?
extreme weight loss
weak ab muscles
splenomegaly
They cause the splenic ligaments to become dysfunctional.
145
This congenital anomaly is found in unusual locations. It may be mistaken for a mass that could undergo torsion, which would result in acute abdominal pain.
wandering spleen
146
With a wandering spleen, the cause is the long ____ mesentery of the ____ mesentery failed to fuse with the _____ peritoneum.
mobile
dorsal
posterior
147
This means "absent spleen"...
asplenia
148
What is asplenia?
When the spleen is absent OR not fully developed (hypoplastic).
149
This term means "multiple spleens"....
polysplenia
150
What does hypoplastic mean?
not fully developed
