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Surgical Recall > Spleen > Flashcards

Spleen Flashcards

1
Q

Which arteries supply the spleen?

A

Splenic artery (a branch of the celiac trunk) and the short gastric arteries that arise for the gastroepiploic arteries

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2
Q

What is the venous drainage of the spleen?

A

Portal vein, via the splenic vein and the left gastroepiploic vein

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3
Q

What is said to tickle the spleen?

A

Tail of the pancreas

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4
Q

What percentage of people have an accessory spleen?

A

20%

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5
Q

What percentage of the total body platelets are stored in the spleen?

A

33%

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6
Q

What are the main functions of the spleen?

A

Filters abnormal RBCs, stores platelets, produces tuftsin and properdin (opsins), produces antibodies (especially IgM) and is site of phagocytosis

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7
Q

What is delayed splenic rupture?

A

Subcapsular hematoma or pseudoaneurysm may rupture some time after blunt trauma.
Rupture classically occurs about 2 weeks after the injury and presents with shock and abdominal pain.

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8
Q

What are the signs and symptoms of ruptured or injured spleen?

A

Hemoperitoneum and Kehr’s sign, LUQ abdominal pain, Ballance’s sign

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9
Q

What is Kehr’s sign?

A

Left shoulder pain seen with splenic rupture

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10
Q

What is Ballance’s sign?

A

LUQ dullness to percussion

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11
Q

What is Seagesser’s sign?

A

Phrenic nerve compression causing neck tenderness in splenic rupture

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12
Q

How is a spleen injury diagnosed?

A

If the patient is stable: abdominal CT.

If not, DPL or FAST exam.

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13
Q

What is the treatment for a spleen injury?

A
  1. Non-operative in a stable patient with an isolated splenic injury without hilar involvement or complete rupture.
  2. If patient is unstable, DPL/FAST laparotomy with splenorrhaphy or splenectomy.
  3. Embolization is an option in selected patients.
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14
Q

What is a splenorrhaphy?

A

Splenic salvage operation wrapping vicral mesh, aid of topical hemostatic agents or partial splenectomy, sutures (buttressed)

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15
Q

For which malignant diseases is a splenectomy indicated?

A

Hodgkin’s staging not conclusive by CT (rare); splenic tumors (primary/metastatic); hypersplenism caused by other leukemias/non-Hodgkin’s lymphomas

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16
Q

For which anemic conditions is a splenectomy indicated?

A

Medullary fibrosis with myeloid metaplasia; hereditary elliptocytosis; sickle cell anemia (rare, most autosplenectomize); pyruvate kinase deficiency; autoimmune hemolytic anemia; hereditary spherocytosis; thalassemias

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17
Q

For which thrombocytopenic conditions is a splenectomy indicated?

A

ITP, TTP

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18
Q

What are some miscellaneous conditions for which a splenectomy is indicated?

A

Variceal bleeding with splenic vein thrombosis, Gaucher’s disease, splenic abscess, refractory splenic cysts, hypersplenism, Felty’s syndrome

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19
Q

Is G6PD deficiency an indication for splenectomy?

A

No

20
Q

What are the possible post-splenectomy complications?

A

Thrombocytosis, subphrenic abscess, atelectasis, pancreatitis gastric dilation, OPSS

21
Q

What is OPSS?

A

Overwhelming Post-Splenectomy Sepsis

22
Q

What causes OPSS?

A

Increased susceptibility to fulminant bacteremia, meningitis, or pneumonia because of loss of splenic function

23
Q

What is the incidence of OPSS in adults?

A

< 1%

24
Q

What is the incidence and overall mortality of OPSS in children?

A

1-2% with 50% mortality

25
Q

What is the typical presentation of OPSS?

A

Fever, lethargy, common cold, sore throat, URI followed by confusion, shock, and coma with death ensuing within 24 hours in up to 50% of patients

26
Q

What are the common organisms associated with OPSS?

A

Encapsulated (e.g. Strep pneumo, Neisseria meningitides, H. flu)

27
Q

What is the most common bacteria in OPSS?

A

Streptococcus pneumoniae

28
Q

What is the preventative treatment of OPSS?

A

Vaccinations for pneumococcus, H. flu, and meningococcus; prophylactic penicillin for all minor infections/illnesses and immediate medical care if febrile illness develops

29
Q

What is the best time to give immunizations to splenectomy patients?

A

Preoperatively, if at all possible.

If emergent, then 2 weeks post-operatively.

30
Q

What lab tests are abnormal after splenectomy?

A

WBC count increases by 50% over the baseline; marked thrombocytosis occurs; RBC smear is abnormal

31
Q

What are the findings on post-splenectomy RBC smear?

A

Peripheral smear will show Pappenheimer bodies, Howell-Jolly bodies, and Heinz bodies

32
Q

When and how should thrombocytosis be treated?

A

When platelet count is > 1 million, most surgeons will treat with aspirin

33
Q

What is the most common cause of splenic vein thrombosis?

A

Pancreatitis

34
Q

What opsonins does the spleen produce?

A

Properdin, tuftsin

Think: PROfessionally TUF spleen

35
Q

What is the most common cause of isolated gastric varices?

A

Splenic vein thrombosis (usually from pancreatitis)

36
Q

What is the treatment of gastric varices caused by splenic vein thrombosis?

A

Splenectomy

37
Q

Which patients develop hyposplenism?

A

Patients with UC

38
Q

What vaccinations should every patient with a splenectomy receive?

A

Pneumococcus; meningococcus; H. flu type B

39
Q

What is hypersplenism?

A

Can include:

  1. Hyperfunctioning spleen
  2. Documented loss of blood elements (WBC, Hct, platelets)
  3. Large spleen (splenomegaly)
  4. Hyperactive bone marrow (trying to keep up with loss of blood elements)
40
Q

What is splenomegaly?

A

Enlarged spleen

41
Q

What is ITP?

A

Idiopathic Thrombocytopenic Purpura:

Autoimmune (IgG) platelet destruction leading to troublesome bleeding and purpura

42
Q

What is the most common cause of failure to correct thrombocytopenia after splenectomy for ITP?

A

Missed accessory spleen

43
Q

What are the “I’s” of ITP?

A

Immune etiology (IgG anti-platelet antibodies)
Immunosuppressive treatment (steroids)
Immune globulin
Improvement with splenectomy

44
Q

What is TTP

A

Thrombotic Thrombocytopenic Purpura

45
Q

What is the treatment for TTP?

A

Plasmapheresis (splenectomy is a last resort)

46
Q

What is the most common physical finding of portal hypertension?

A

Splenomegaly

Surgical Recall (68 decks)

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