Spleen Flashcards by abbie anderson

where is the spleen located?

what covers it?

what ligaments? what do they attach?

which capsule is it in?

Lt. hypochondrium
Intraperitoneal
•
Peritoneum covering entire organ, except hilum
Peritoneal ligaments
•
Attach spleen to the stomach and kidney
–
True capsule

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is the hilum in direct contact w/ the peritoneum?

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what is the avg adult size of spleen in long and AP?

12-13 cm in long, 7-8cm in AP

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describe the spleens shape and texture.

which surface in convex? concave?

Variable shape: Ovid, Triangular

Smooth surface

Convex superior surface
Concave inferior surface

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What surface is this?

inferior. notice the hilum

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where is the spleen in relation to the pancreas? stomach? kidney?

superior and lateral to the pancreas

lateral to the stomach

anterior and slighly superior to the kidney

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what ligaments extend from the spleen?

gastrosplenic ligament

lienorenal ligament

phrenicocolic ligament

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Why is the spleen subject to infarction?

because of lack of anastomoses between the intra-parenchymal vessels

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describe the splenic artery

from Celiac Axis
–
tortuous vessel
–
travels horizontally along superior border of pancreas
–
divides and enters the spleen at its hilum

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what does the splenic vein join and form?

joins superior mesenteric vein to form the portal vein at head of pancreas

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describe teh splenic vein

forms in splenic hilum
–
travels medially toward pancreatic head
–

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________ also exit the spleen at the hilum

Lymph vessels

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what type of pulp does the spleen have?

white and red

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what are the functions of the spleen (4) as an organ of the reticulendothelial system?

production of lymphocytes and plasma cells

production of antibodies

storage of iron

storage of other metabolites

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what are the functions and characteristics of the spleen (6)?

maturation of the surface of erthrocytes

reservoir

culling (keeping #s when we need them, killing excess)

pitting function

disposal of senescent or abnormal erthrocytes

functions related to platelet and leukocyte life span

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what is the funciton of the spleen in the fetus?

erythropoiesis - RBC production

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Splenic Protocol

–
Longitudinal with measurements in longest axis and 90o to long axis
–
Transverse with measurement in this planes longest dimension

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splenic sonographic appearance

what can make it hard to visualize?

homogenous texture, smooth surface, calcifcations no uncommon

lung, stomach, gas in colon

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what type of calcification are not uncommon to find in the spleen? what are they and why do they become calcified?

Granulomas-spherical mass of immune cells that forms when the body attempts to wall off substances that it perceives as foreign but is unable to eliminate. The body then places calcium around it.

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what landmarks are important to find when looking for the spleen? where should you look?

diaphragm and lt kidney

posterior and superior

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what are the dimensions of this spleen?

is this normal?

long 10.25cm

AP 4.22 cm

a bit small perhaps

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what plane was this image taken in?

transverse

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which plane are each of these spleens in? how can you tell?

lt long, rt trans

look for the hilum.

(same below)

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What is it called when the spleen is larger than normal?

splenemegaly

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what is the absence of the spleen called? is it congenital?

asplenia yes

what is polyspelenia? is it commmon? what else can it be associated with? what do you need to be careful not to mistake this for when ruling out this anomaly?

multiple spleens rare cardiac or broncopulmonary the lt liver lobe

what is the congenital variant called?

wandering spleen (rt line pointing to the bladder) color example below

what is this an example of?

wandering spleen

what is one or two little spleen close to the bain spleen alled? what can they look like?

accessory spleen (splenials, satellite spleens...) looks exactly like the spleen and should NOT be coming of the pancreas. can be mistaken for pancreatic tail mass

which image has a pseudo-accessory spleen and which has a real accessory spleen?

what is increased number of RBC's called? WBC's?

polycythemia leukocytosis

what is a decreased number of RBC's called? WBC's?

anemia leukopenia

what is the proportion of blood volume that is occupied by red blood cells?

Hematocrit –

what indications are may be present to cause you to do a splenic exam?

palpable spleen, abnormal labs, LUQ pain, infectious disease (mono affects spleen - making it bigger as its functioning and working hard. have to keep looking at it w/ US b/c it can burst. goes down on its own)

patient prep? Td? positions? image? compared to liver?

none vector or curve supline, RLD, upright homogenous low to md level echoes. \*iso or slightly hyperechoic to live

what must you be aware of when doing a splenic exam?

Watch out for left lobe of liver. • Some people will have their left liver lobe right adjacent to the spleen and it can easily be mistake for part of the spleen when you are first beginning to scan.

what is the best acoustic window to image the spleen?

lt lateral intercostal approach

is the spleen found in the retroperitoneum?

the vascular supply feeding the spleen comes from \_\_\_. which arises from \_\_\_\_. this vessels characteristic feature is \_\_\_\_\_.

splenic artery, celiiac axis, torturous

the venous drainage of the spleen is via \_\_\_\_. it drains blood into the _____ and joins \_\_\_\_\_.

splenic vein, liver, SMV

what organ typically sits anterior to the splenic vein?

pancreas

What confluence is made by the junction of the splenic v and superior mesenteric v?

portal confluence

What specific anatomy sits directly anterior to this confluence?

pancreatic neck

If a sonographer is looking for the spleen from a lt. lateral approach , and sees the lt. kidney on the screen what direction should the probe be moved?

move more superior

What can the sonographer do to try and help visualize the tail of the pancreas if the anterior approach is blocked with gas and the pt. is unable to drink H20?

try lt lateral approach and use the spleen as an acoustic window

In relationship to the pancreatic body/tail area, where would you look for the splenic artery?

superior to the pancreas

What relationship does the lt. kidney have with the spleen, according to HA?

lt kidney is found along the medial surface of the spleen

What relationship does the splenic flexure of the colon have with the spleen, according to HA?

splenic flexure is found along the medial surface of the spleen

According to HA, what congenital variant results from an anomaly of the supporting ligaments of the spleen?

wandering spleen

What symptomatology may a patient experience when they have a wandering spleen, according to HA?

abdominal mass, pelvic mass, intermittent pain

What tool can the sonographer use to help evaluate the spleen when torsion is suspected; in a case of a wandering spleen?

color doppler to check perfusion of th espleen

what is another term for an accessory spleen?

splenule

Describe the sonographic appearance of a splenule.

round, smooth borders, homogenous and same echogenicity as the spleen

What do both of these images have in common?

splenules

These small clusters of tissue found within the normal spleen are what? The area surrounding these clusters, making up the majority of the splenic tissue is known as what?

white pulp red pulp

where would you put calipers to measure in long?

the following are functions of what system? Production of lymphocytes Production of antibodies Storage of RBC’s

reticuloendothelial system.

isthe spleen the largest organ of the reticuloendothelial system.?

yes

Production of lymphocytes is handled by what specific portion of the splenic parenchyma?

white pulp

Ability to digest cellular debris is handle by what specific portion of the splenic parenchyma?

red pulp

Production of antibodies is handled by what specific portion of the splenic parenchyma?

white pulp

The spleen has the ability to remove old, worn out \_\_\_

RBC's

Splenomegaly is an enlarged spleen. All of the following are causes of splenomegaly except. A. Sequestering too many RBC’s B. A systemic infection, such as mononucleosis C. Renal failure D. Portal hypertension; when PV blood can’t freely enter the liver 2o to liver disease

The process of destroying RBC’s which are abnormal or old is called \_\_\_\_\_.

culling

The process of fixing/removing imperfection from RBC’s without destroying them is called \_\_\_\_\_.

pitting

The spleen is of concern whenever the abdomen in involve in blunt force trauma. Why is this of concern?

spleen serves as a reservoir for blood therefore it can lose a lot of blood quickly if it sustains a laceration or rupture

US is sometimes called upon to inspect the spleen after a blunt force trauma. What type of splenic injury would the sonographer be looking for?

splenic laceration or rupture aka splenic fracture