Spleen 2

Question 1

About 70% of splenic abscess spread via what route?

Answer 1

hematogenously

endocarditis, osteomeylitis, IV drug abuse

Question 2

Treatment of splenic abscesses depends on what?

Answer 2

if they’re unilocular vs multilocular

Question 3

How do we treat unilocular splenic abscesses?

Answer 3

percutaneous drainage + antibiotics

75- 90% success rate

Question 4

How do we treat multilocular splenic abscesses?

Answer 4

splenectomy

drainage of LUQ + antibiotics

Question 5

WHat % of abscesses are multilocular vs unilocular in adults and kids?

Answer 5

adults; 1/3 multilocular

kids; 1/3 unilocular

Question 6

After splenectomy, most pts are susceptible to encapsulated organisms such as?

Answer 6

strept pneumo
h. flu
neisseria meningitidis

Question 7

Vaccines for encapsulated bacteria are recommended to be given when?

Answer 7

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

Question 8

Major bugs causing OPSI?

Answer 8

strept pneumo
h. flu
n. meningitidis
strept pyogenes
capnocytophaga canimorsus

Question 9

Most common organism to cause OPSI after a splenectomy after a dog bite is?

Answer 9

capnocytophaga canimorsus

Question 10

Long, thing, gram negative, faculatively anaerobic bacillus seen in dog bites that causes OPSI?

Answer 10

capnocytophaga canimorsus

Question 11

What is the most common cause of splenic vein thrombosis?

Answer 11

chronic pancreatitis

Question 12

Risk of OPSI is highest in children less than 4 years old, and is also more commonly seen in those undergoing splenectomy for what?

Answer 12

b-thal

sickle cell dx

Question 13

Cysts of the spleen can be categorized as parasitic vs non-parasitic, how do we treat parasitic cysts?

Answer 13

total vs partial splenectomy

Question 14

70 to 80% of non-parasitic cysts are what?

Answer 14

pseudocysts (seen in those w/hx of trauma)

cysts < 4 cm do not need tx, involute over time

Question 15

Common cause of parasitic cysts of spleen?

Answer 15

echinococcus causing hydatid cysts

Question 16

What’s the concern with echinococus hydatid cysts of spleen?

Answer 16

rupture and spillage causes anaphylactic shock and intraperitoneal spillage of contents

Question 17

Where do the splenic artery and splenic vein lie in relation to the pancreas?

Answer 17

splenic artery–> superior to pancreas

splenic vein–> posterior or within pancreas

Question 18

Most common cause of iatrogenic splenic trauma?

Answer 18

forceful retraction of omentum for exposure causing tearing of splenic capsule

Question 19

What are some common symptoms of hypersplenism?

Answer 19

hypotension
abd tenderness
splenomegaly

Question 20

Risk of cyst recurrence after deroofing?

Answer 20

30-45%

deroofing only an option for cysts close to the capsule

Question 21

IgG antibodies against platelets seen in what disorder?

Answer 21

ITP

Question 22

Does sideroblastic anemia respond to splenectomy?

Answer 22

No

Question 23

If partial splenectomy performed, do pts need post-op vaccines?

Answer 23

if 1/3 of splenic function remains after partial splenectomy, no vaccines needed post-op

Question 24

Wandering spleen commonly seen in pregnant women, why?

Answer 24

hormonal changes
abdominal laxity

splenic pedicle usually long and prone to torsion

Question 25

What do we see on CT of suspected wandering spleen?

Answer 25

spleen outside normal anatomic position

whorled appearance of splenic pedicle

a non-contrasted spleen

Question 26

Three most common locations for accessory spleens?

Answer 26

hilum 54%
pedicle 25%
greater omentum 12%

Question 27

Pt with known ITP, s/p splenectomy 5 yrs prior, presents with bleeding gums and thrombocytopenia, what do we do?

Answer 27

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

Question 28

This is a relative contraindication for partial splenectomy;

Answer 28

cirrhosis

**these pts are at high risk of recurrent hemorrhage from the raw splenic surface

Question 29

This bacteria responsible for 50% of post-splenectomy sepsis:

Answer 29

strept. pneumo

Question 30

How do pts with sequestration crisis from sickle cell dx present?

Answer 30

lethargic, LUQ pain, lightheadedness

tachy, hypotensive

normal O2 sat, anemic

Question 31

Any pt who develops LUQ pain, fever, leukocytosis following splenectomy should have a CT or US to look for?

Answer 31

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

Question 32

What are some triggers that cause hemolysis in pts with G-6-P dehydrogenase deficiency?

Answer 32

recent infection
fava beans
antimalarials
nitrofurantoin 
sulfonamides

Question 33

How do we manage simple splenic cysts in pregnant pts?

Answer 33

the same as in non-pregnant pts

if symptomatic–> need tx
if > 4 cm–> may need tx