Spleen Flashcards
Location: left hypochondriac region, anterior to ribs 9,10 &11
Does not extend below the costal margin (not easily palpable)
- palpated with patient on R lateral decubitus with the leg flexed
Spleen
Attachment and its contents
To the stomach: gastrosplenic ligament
- short gastric artery & vein
- left gastroepiploic artery & vein
To the kidney: splenorenal ligament
- 5 terminal branches of the splenic artery
- tributaries of splenic vein
- tail of pancreas
Usually near the hilum, tail of pancreas or within the gastrosplenic ligament
Accessory spleen
Functions of spleen
Removal of old or abnormal RBC
Removal of inclusion bodies from RBC
- e.g. Howell-Jolly bodies (nuclear remnants), Pappenheimer bodies (iron granules) or Heinz bodies (denatured Hgb)
Removal of poor opsonized pathogens
IgM production by plasma cells
Storage of platelets
Protection from infection
The largest branch of celiac trunk
Splenic artery
Branches of splenic artery
Dorsal pancreatic artery
Great pancreatic artery
Caudal pancreatic artery
Short gastric artery
Left gastroepiploic artery
5 terminal branches:
- supply individual segments of the spleen
- no anastomosis between them (end arteries)
- obstruction results in splenic infarction
Joins the superior mesenteric vein to form the portal vein
Splenic vein
Nearby structures that may be injured during splenectomy
Gastric wall (if short gastric artery are compromised)
Tail of pancreas (is caudal pancreatic artery are compromised during manipulation of splenorenal ligament)
Left kidney (manipulation of splenorenal ligament)
MC complication: atelectasis of left lower lobe of the lung
Post op: thrombocytosis, abnormal RBCs, Howell-Jolly bodies
Splenectomy
Due to ⬇️ opsonic production, ⬇️ IgM, ⬇️ bacterial clearance from the blood
S. Pneumonia, H. Influenzae, N. Meningitidis
Overwhelming postsplenectomy sepsis
Abnormal RBCs –> multiple infarcts –> autosplenectomy
Sickle cell anemia
Spectrum protein deficiency caused by mutation in the gene for ankyrin
Anisocytosis (RBC size variation) & spherocytes
SSX: jaundice, pigmented gall stones, splenomegaly
Tx: splenectomy
Hereditary spherocytosis
IgG against a platelet-associated antigen –> rapid platelet destruction
SSX: ⬇️ platelet count, ⬆️ megakaryocyte count, easy bruising, petechiae, mucosal bleeding
Tx: steroids, platelet transfusion, plasmapheresis
Splenectomy only when steroid is ineffective
Immune thrombocytopenic purpura (ITP)
Associated with pancreatitis
SSX: gastric varices, upper GI bleeding
Splenic vein thrombosis
