Spleen 2 Flashcards
About 70% of splenic abscess spread via what route?
hematogenously
endocarditis, osteomeylitis, IV drug abuse
Treatment of splenic abscesses depends on what?
if they’re unilocular vs multilocular
How do we treat unilocular splenic abscesses?
percutaneous drainage + antibiotics
75- 90% success rate
How do we treat multilocular splenic abscesses?
splenectomy
drainage of LUQ + antibiotics
WHat % of abscesses are multilocular vs unilocular in adults and kids?
adults; 1/3 multilocular
kids; 1/3 unilocular
After splenectomy, most pts are susceptible to encapsulated organisms such as?
strept pneumo
h. flu
neisseria meningitidis
Vaccines for encapsulated bacteria are recommended to be given when?
within 2 weeks before a scheduled surgery
2 weeks after emergent splenectomy
** most infections occur after 2 years and 40% occur after 5 yrs after splenectomy
Major bugs causing OPSI?
strept pneumo h. flu n. meningitidis strept pyogenes capnocytophaga canimorsus
Most common organism to cause OPSI after a splenectomy after a dog bite is?
capnocytophaga canimorsus
Long, thing, gram negative, faculatively anaerobic bacillus seen in dog bites that causes OPSI?
capnocytophaga canimorsus
What is the most common cause of splenic vein thrombosis?
chronic pancreatitis
Risk of OPSI is highest in children less than 4 years old, and is also more commonly seen in those undergoing splenectomy for what?
b-thal
sickle cell dx
Cysts of the spleen can be categorized as parasitic vs non-parasitic, how do we treat parasitic cysts?
total vs partial splenectomy
70 to 80% of non-parasitic cysts are what?
pseudocysts (seen in those w/hx of trauma)
cysts < 4 cm do not need tx, involute over time
Common cause of parasitic cysts of spleen?
echinococcus causing hydatid cysts
What’s the concern with echinococus hydatid cysts of spleen?
rupture and spillage causes anaphylactic shock and intraperitoneal spillage of contents
Where do the splenic artery and splenic vein lie in relation to the pancreas?
splenic artery–> superior to pancreas
splenic vein–> posterior or within pancreas
Most common cause of iatrogenic splenic trauma?
forceful retraction of omentum for exposure causing tearing of splenic capsule
What are some common symptoms of hypersplenism?
hypotension
abd tenderness
splenomegaly
Risk of cyst recurrence after deroofing?
30-45%
deroofing only an option for cysts close to the capsule
IgG antibodies against platelets seen in what disorder?
ITP
Does sideroblastic anemia respond to splenectomy?
No
If partial splenectomy performed, do pts need post-op vaccines?
if 1/3 of splenic function remains after partial splenectomy, no vaccines needed post-op
Wandering spleen commonly seen in pregnant women, why?
hormonal changes
abdominal laxity
splenic pedicle usually long and prone to torsion
What do we see on CT of suspected wandering spleen?
spleen outside normal anatomic position
whorled appearance of splenic pedicle
a non-contrasted spleen
Three most common locations for accessory spleens?
hilum 54%
pedicle 25%
greater omentum 12%
Pt with known ITP, s/p splenectomy 5 yrs prior, presents with bleeding gums and thrombocytopenia, what do we do?
radionucleotide scan looking for accessory spleen
if blood smear shows Howell Jolly bodies, means no spleen is present, and will guide you away from accessory spleen
This is a relative contraindication for partial splenectomy;
cirrhosis
**these pts are at high risk of recurrent hemorrhage from the raw splenic surface
This bacteria responsible for 50% of post-splenectomy sepsis:
strept. pneumo
How do pts with sequestration crisis from sickle cell dx present?
lethargic, LUQ pain, lightheadedness
tachy, hypotensive
normal O2 sat, anemic
Any pt who develops LUQ pain, fever, leukocytosis following splenectomy should have a CT or US to look for?
fluid collections
dx of pancreatic fistula can be made by sampling the fluid and seeing amylase-rich fluid
cultures should also be sent to rule out abscess
What are some triggers that cause hemolysis in pts with G-6-P dehydrogenase deficiency?
recent infection fava beans antimalarials nitrofurantoin sulfonamides
How do we manage simple splenic cysts in pregnant pts?
the same as in non-pregnant pts
if symptomatic–> need tx
if > 4 cm–> may need tx
