Spleen Flashcards
What ligaments are attached to the spleen?
Splenorenal, gastrosplenic, splenocolic
What goes from the spleen to the greater curve of the stomach and carries the short gastric vessels?
Gastrosplenic ligament
What is the blood supply for the spleen?
Mostly from the splenic artery – but some from the short gastrics
What is the spleen’s immmune function?
Filters encapsulated bacteria like S. pneumonia, H. influenza, N. meningitides
What is hypersplenism?
diffuse enlargement of the spleen
What disorders can cause hypersplenism?
Neoplastic disorders
Hematopoietic disorders
Metabolic or storage disorders
What diseases are associated with secondary hypersplenism (7)?
Portal HTN Splenic vein thrombosis Leukemias/lymphoma SLE Gaucher disease Mononucleosis Felty syndrome
When is splenectomy indicated?
primary hypersplenism
What is the treatment for splenic vein thrombosis with bleeding gastric varices with chronic pancreatitis?
Splenectomy
What is a hemangioma of the spleen?
benign but requires splenectomy for tissue diagnosis
What are hamartomas of the spleen?
benign but may need splenectomy for diagnosis
What are lymphangiomas of the spleen?
may lead to hypersplenism. Splenectomy for diagnosis
What are angiosarcomas of the spleen?
very rare and malignant. Splenectomy for diagnosis and treatment
What should be done in regard to the spleen for Hodgkin’s disease?
may need splenectomy for staging
What should be done in regard to the spleen for hairy cell leukemia?
splenectomy if splenomegaly and failed medical management
What is acquired hemolytic anemia?
Acute RBC destruction 2° complement fixation of antibiodies bound to the surface of the erythrocyte
What is the onset for hemolytic anemia?
Sudden onset
Hemolytic anemia is most commonly seen in whom?
Women > men
Age 50
How does hemolytic anemia present?
Palpable splenomegaly in 50%
fatigue
Associated with certain medications such as PCN and quinidine
What is the first line treatment for acquired hemolytic anemia?
glucocorticoid
When is splenectomy indicated in hemolytic anemia?
patients with warm antibodies that fail high-dose corticosteroid treatment or have a contraindication to corticosteroids
What is Immune/Idiopathic thrombocytopeniaPurpura (ITP)?
Antibodies to platelet antigens
No splenomegaly
Presence of antiplatelet antibodies
How dies ITP present?
- No splenomegaly
- Petechiae, ecchymosis, epistaxis and easy bruising
- Thrombocytopenia (platelets always below 100,000/uL and often < 50,000/uL) and
- Prolonged bleeding time
What should never be given for ITP?
Platelets
What is the initial treatment for ITP?
Glucocorticoids
When is splenectomy indicated in ITP?
Failure of steroids
What is the most common congenital hemolytic anemia?
Hereditary spherocytosis
What is deficient in the RBCs in hereditary spherocytosis?
spectrin which makes erythrocytes more susceptible to destruction
What are the sx of hereditary spherocytosis?
Splenomegaly, abdominal discomfort, jaundice
What is the treatment for hereditary spherocytosis?
Splenectomy after age 6
What should occur with splenectomy when pt also has gallstones?
Cholecystectomy indicated at time of splenectomy
What is the congenital abnormality with hereditary elliptocytosis?
Low level of spectrin
How do erythrocytes appear with hereditary elliptocytosis?
Elliptical
How is hereditary elliptocytosis treated?
Splenectomy depending on severity
When is splenectomy indicated for splenic cysts?
If cyst persists or becomes symptomatic
What is overwhelming postsplenectomy sepsis?
Relatively rare condition that may follow a splenectomy. Infection is with encapsulated organisms (S pneumonia, H influenza, N meningitidis)
What vaccines should be given pre-splenectomy?
Pneumo, haemophilus, and Meningococcus
What is an accessory spleen?
A small nodule of splenic tissue found apart from the main body of the spleen
What are the most common locations for accessory spleens?
hilum of the spleen and adjacent to the tail of the pancreas
Why are accessory spleens important?
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
