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Surgery > Spleen > Flashcards

Spleen Flashcards

1
Q

What ligaments are attached to the spleen?

A

Splenorenal, gastrosplenic, splenocolic

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2
Q

What goes from the spleen to the greater curve of the stomach and carries the short gastric vessels?

A

Gastrosplenic ligament

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3
Q

What is the blood supply for the spleen?

A

Mostly from the splenic artery – but some from the short gastrics

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4
Q

What is the spleen’s immmune function?

A

Filters encapsulated bacteria like S. pneumonia, H. influenza, N. meningitides

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5
Q

What is hypersplenism?

A

diffuse enlargement of the spleen

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6
Q

What disorders can cause hypersplenism?

A

Neoplastic disorders
Hematopoietic disorders
Metabolic or storage disorders

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7
Q

What diseases are associated with secondary hypersplenism (7)?

A 
Portal HTN
Splenic vein thrombosis
Leukemias/lymphoma
SLE
Gaucher disease
Mononucleosis
Felty syndrome
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8
Q

When is splenectomy indicated?

A

primary hypersplenism

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9
Q

What is the treatment for splenic vein thrombosis with bleeding gastric varices with chronic pancreatitis?

A

Splenectomy

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10
Q

What is a hemangioma of the spleen?

A

benign but requires splenectomy for tissue diagnosis

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11
Q

What are hamartomas of the spleen?

A

benign but may need splenectomy for diagnosis

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12
Q

What are lymphangiomas of the spleen?

A

may lead to hypersplenism. Splenectomy for diagnosis

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13
Q

What are angiosarcomas of the spleen?

A

very rare and malignant. Splenectomy for diagnosis and treatment

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14
Q

What should be done in regard to the spleen for Hodgkin’s disease?

A

may need splenectomy for staging

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15
Q

What should be done in regard to the spleen for hairy cell leukemia?

A

splenectomy if splenomegaly and failed medical management

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16
Q

What is acquired hemolytic anemia?

A

Acute RBC destruction 2° complement fixation of antibiodies bound to the surface of the erythrocyte

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17
Q

What is the onset for hemolytic anemia?

A

Sudden onset

18
Q

Hemolytic anemia is most commonly seen in whom?

A

Women > men

Age 50

19
Q

How does hemolytic anemia present?

A

Palpable splenomegaly in 50%
fatigue
Associated with certain medications such as PCN and quinidine

20
Q

What is the first line treatment for acquired hemolytic anemia?

A

glucocorticoid

21
Q

When is splenectomy indicated in hemolytic anemia?

A

patients with warm antibodies that fail high-dose corticosteroid treatment or have a contraindication to corticosteroids

22
Q

What is Immune/Idiopathic thrombocytopeniaPurpura (ITP)?

A

Antibodies to platelet antigens
No splenomegaly
Presence of antiplatelet antibodies

23
Q

How dies ITP present?

A
  • No splenomegaly
  • Petechiae, ecchymosis, epistaxis and easy bruising
  • Thrombocytopenia (platelets always below 100,000/uL and often < 50,000/uL) and
  • Prolonged bleeding time
24
Q

What should never be given for ITP?

A

Platelets

25
Q

What is the initial treatment for ITP?

A

Glucocorticoids

26
Q

When is splenectomy indicated in ITP?

A

Failure of steroids

27
Q

What is the most common congenital hemolytic anemia?

A

Hereditary spherocytosis

28
Q

What is deficient in the RBCs in hereditary spherocytosis?

A

spectrin which makes erythrocytes more susceptible to destruction

29
Q

What are the sx of hereditary spherocytosis?

A

Splenomegaly, abdominal discomfort, jaundice

30
Q

What is the treatment for hereditary spherocytosis?

A

Splenectomy after age 6

31
Q

What should occur with splenectomy when pt also has gallstones?

A

Cholecystectomy indicated at time of splenectomy

32
Q

What is the congenital abnormality with hereditary elliptocytosis?

A

Low level of spectrin

33
Q

How do erythrocytes appear with hereditary elliptocytosis?

A

Elliptical

34
Q

How is hereditary elliptocytosis treated?

A

Splenectomy depending on severity

35
Q

When is splenectomy indicated for splenic cysts?

A

If cyst persists or becomes symptomatic

36
Q

What is overwhelming postsplenectomy sepsis?

A

Relatively rare condition that may follow a splenectomy. Infection is with encapsulated organisms (S pneumonia, H influenza, N meningitidis)

37
Q

What vaccines should be given pre-splenectomy?

A

Pneumo, haemophilus, and Meningococcus

38
Q

What is an accessory spleen?

A

A small nodule of splenic tissue found apart from the main body of the spleen

39
Q

What are the most common locations for accessory spleens?

A

hilum of the spleen and adjacent to the tail of the pancreas

40
Q

Why are accessory spleens important?

A

If splenectomy is performed for conditions in which blood cells are sequestered in the spleen, failure to remove accessory spleens may result in the failure of the condition to resolve

Surgery (10 decks)

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