Spleen

Question 1

Which surface does the spleen have impressions on?

Answer 1

Medial surface

Question 2

What are the impressions on the medial surface of the spleen?

Answer 2

Gastric impression

Renal impression

Colic impression

Question 3

Where does the spleen lie in relation to the stomach?

Answer 3

Lies behind the stomach

Question 4

Where does the spleen lie in relation to the kidneys and colon?

Answer 4

Lies above the kidneys and colon

Question 5

What is the blood supply of the spleen?

Answer 5

Aorta
coeliac trunk branches off aorta
splenic artery branches off coeliac trunk

Question 6

What is the blood drainage of the spleen?

Answer 6

Splenic vein
exits spleen
feeds into hepatic portal vein

Question 7

Where do blood vessels enter and leave the spleen?

Answer 7

Hilum located on medial surface

Question 8

What is the spleen made up of?

Answer 8

Red pulp

White pulp

Question 9

What is red pulp made up of?

Answer 9

Sinuses - large capillaries, gaps in their endothelium
endothelium is lined by macrophages
and cords of connective tissue

Question 10

What is white pulp made up of?

Answer 10

Similar structure to lymphoid follicles

so germinal centre, B cells etc.

Question 11

Which parts of the spleen do the different blood components pass through?

Answer 11

Red cells preferentially pass through red pulp

White cells and plasma preferentially pass through white pulp

Question 12

What are the four main functions of the spleen?

Answer 12

Macrophages remove old, damaged, abnormal red blood cells from blood
destroy them by phagocytosis

Pooling of blood

Extramedullary haemopoiesis

Immunological function

Question 13

What is the use of pooling of blood in the spleen?

Answer 13

Platelets and red cells can be rapidly mobilised during bleeding

Question 14

When does extramedullary haemopoiesis occur?

Answer 14

Bone marrow fails

Cells are dying quickly

Question 15

How does the spleen have an immunological function?

Answer 15

Contains significant amount of body’s T cells and B cells

Question 16

What is splenomegaly?

Answer 16

Enlarged spleen

Question 17

How do you examine for splenomegaly?

Answer 17

Palpate at right iliac fossa

move hand diagonally upwards, palpate at regular intervals

Question 18

What are the results of an examination if there actually is splenomegaly?

Answer 18

Can palpate spleen below the costal margin

which is always abnormal

Question 19

How does the spleen move during inspiration? Why?

Answer 19

Moves downwards as lungs expand and diaphraghm moves downwards

Question 20

What can cause splenomegaly?

Answer 20

Over working red pulp

Over working white pulp

Extramedullary haemopoiesis

Infiltration

Question 21

What might cause an over-working red pulp?

Answer 21

Haemolytic anaemia

defective red blood cells being removed from blood

Question 22

What might cause an over-working white pulp?

Answer 22

Infection

Question 23

What can infiltrate the spleen?

Answer 23

Cancer cells of blood origin e.g. leukaemia, lymphoma

Cancer metastases

Sarcoidosis - granulomas

Question 24

Splenomegaly due to infiltration by leukaemia, lymphoma cells involves expansion of which part of the spleen specfically?

Answer 24

White pulp

Question 25

How is splenomegaly classified?

Answer 25

Massive Moderate Mild

Question 26

What are the causes of massive splenomegaly?

Answer 26

Myelofibrosis Chronic malaria

Question 27

What are the causes of moderate splenomegaly?

Answer 27

Lymphoproliferative disorders myeloproliferative disorders Portal hypertension Infections e.g. EBV

Question 28

How does portal hypertension lead to splenomegaly?

Answer 28

Increased blood pressure in portal vein blood backs up in splenic vein raised hydrostatic pressure, less reabsorption of fluid oedema in spleen

Question 29

What are the causes of mild splenomegaly?

Answer 29

Infections e.g. hepatitis Infiltration e.g. sarcoidosos Autoimmune diseases

Question 30

What are the complications of splenomegaly?

Answer 30

Hypersplenmism Rupture Infarction

Question 31

What is hypersplenism?

Answer 31

Blood pools in the enlarged spleen more than usual

Question 32

What can hypersplenism lead to?

Answer 32

Thrombocytopenia Pancytopenia

Question 33

Why is the spleen more prone to rupture with splenomegaly?

Answer 33

No longer entirely protected by ribcage

Question 34

What happens if the spleen ruptures?

Answer 34

Haematoma - large blood clot forms Anaemia - loss of red cells from blood Hypotension - reduced blood volume reduces pressure

Question 35

Why is the spleen more prone to infarction with splenomegaly?

Answer 35

Spleen demands more blood because it's enlarged if demand not met, ischaemia and infarction occur

Question 36

What do splenic infarctions look like?

Answer 36

White Wedge-shaped

Question 37

What do multiple splenic infarctions lead to?

Answer 37

Hyposplenism | Spleen shrinks

Question 38

What is hyposplenism?

Answer 38

Lack of functioning splenic tissue reduced spleen function overall

Question 39

What are the causes of hyposplenism?

Answer 39

Splenoctomy - surgical removal of spleen Sickle cell disease

Question 40

How can sickle cell disease lead to hyposplenism?

Answer 40

Sickle cells block capillaries in spleen | lead to ischaemia, multiple infarcts, healing by fibrosis

Question 41

What is seen on a blood film of someone with hyposplenism?

Answer 41

Howell-Jolly bodies

Question 42

What are Howell-Jolly bodies?

Answer 42

Remnants of DNA in red blood cells

Question 43

Why do Howell-Jolly bodies show up with hyposplenism?

Answer 43

Spleen would normally remove and destroy red blood cells with DNA remnants But in hyposplenism, this isn't happening such cells remain in the blood

Question 44

What is the cause of Howell-Jolly bodies?

Answer 44

Errors of erythropoiesis

Question 45

What are patients with hyposplenism at risk of?

Answer 45

Overwhelming sepsis | particularly by encapulsated bacteria

Question 46

What are some examples of encapsulated bacteria that people with hyposplenism are at risk of?

Answer 46

Strep. pneumoniae Neisseria meningitidis Haemophilus influenzae