SPLEEN

Question 1

Indications for splenectomy in patients with ITP

Answer 1

Fail to four – six weeks of medical therapy

toxic doses of immunosuppressive medication

relapse following an initial response to steroids

Massive bleeding

Question 2

Suspensory ligaments of the screen

Answer 2

splenophrenic
splenocolic
splenorenal
gastrosplenic

Question 3

Steps for laparoscopic splenectomy

Answer 3

Position: 45° modified right lateral decubitus

FIRST look for accessories (because hard to find once blood staining)

Question 4

Where are accessories spleens found

Answer 4

14%

Around the splenic hilum

Gastrocolic lig

Omentum

LEFT Gonadal vessels

Question 5

How are blood products administered for ITP perioperatively

Answer 5

Platelets are cross matched preoperatively
Decision to administer platelets is based clinically on whether clot formation is demonstrated during the operation.

Splenic ARTERY ligated FIRST

then

Platelets administered

(this way, that immunoglobulin antibody does not have a chance to attack the administered platelets)

For administration after this week if there is failure clot formation

Question 6

Preoperative Consideration for patient who is going to undergo laparoscopic splenectomy and who has ITP

Answer 6

Two weeks prior immunization is given
Pneumovax - pneumococcus
I’m off list influenza
Neisseria meningitidis

SCDs

Crossmatch platelets
Cross matched blood

If patient has been on steroids over six months stress dose 100 mg hydrocortisone in preop holding