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Haematology > Spleen > Flashcards

Spleen Flashcards

1
Q

Which surface does the spleen have impressions on?

A

Medial surface

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2
Q

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

A

Gastric impression

Renal impression

Colic impression

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3
Q

Where does the spleen lie in relation to the stomach?

A

Lies behind the stomach

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4
Q

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

A

Lies above the kidneys and colon

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5
Q

What is the blood supply of the spleen?

A

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

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6
Q

What is the blood drainage of the spleen?

A

Splenic vein
exits spleen
feeds into hepatic portal vein

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7
Q

Where do blood vessels enter and leave the spleen?

A

Hilum located on medial surface

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8
Q

What is the spleen made up of?

A

Red pulp

White pulp

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9
Q

What is red pulp made up of?

A

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

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10
Q

What is white pulp made up of?

A

Similar structure to lymphoid follicles

so germinal centre, B cells etc.

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11
Q

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

A

Red cells preferentially pass through red pulp

White cells and plasma preferentially pass through white pulp

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12
Q

What are the four main functions of the spleen?

A

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

Pooling of blood

Extramedullary haemopoiesis

Immunological function

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13
Q

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

A

Platelets and red cells can be rapidly mobilised during bleeding

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14
Q

When does extramedullary haemopoiesis occur?

A

Bone marrow fails

Cells are dying quickly

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15
Q

How does the spleen have an immunological function?

A

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

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16
Q

What is splenomegaly?

A

Enlarged spleen

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17
Q

How do you examine for splenomegaly?

A

Palpate at right iliac fossa

move hand diagonally upwards, palpate at regular intervals

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18
Q

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

A

Can palpate spleen below the costal margin

which is always abnormal

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19
Q

How does the spleen move during inspiration? Why?

A

Moves downwards as lungs expand and diaphraghm moves downwards

20
Q

What can cause splenomegaly?

A

Over working red pulp

Over working white pulp

Extramedullary haemopoiesis

Infiltration

21
Q

What might cause an over-working red pulp?

A

Haemolytic anaemia

defective red blood cells being removed from blood

22
Q

What might cause an over-working white pulp?

A

Infection

23
Q

What can infiltrate the spleen?

A

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

Cancer metastases

Sarcoidosis - granulomas

24
Q

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

A

White pulp

25
Q

How is splenomegaly classified?

A

Massive

Moderate

Mild

26
Q

What are the causes of massive splenomegaly?

A

Myelofibrosis

Chronic malaria

27
Q

What are the causes of moderate splenomegaly?

A

Lymphoproliferative disorders

myeloproliferative disorders

Portal hypertension

Infections e.g. EBV

28
Q

How does portal hypertension lead to splenomegaly?

A

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

29
Q

What are the causes of mild splenomegaly?

A

Infections e.g. hepatitis

Infiltration e.g. sarcoidosos

Autoimmune diseases

30
Q

What are the complications of splenomegaly?

A

Hypersplenmism

Rupture

Infarction

31
Q

What is hypersplenism?

A

Blood pools in the enlarged spleen more than usual

32
Q

What can hypersplenism lead to?

A

Thrombocytopenia

Pancytopenia

33
Q

Why is the spleen more prone to rupture with splenomegaly?

A

No longer entirely protected by ribcage

34
Q

What happens if the spleen ruptures?

A

Haematoma - large blood clot forms

Anaemia - loss of red cells from blood

Hypotension - reduced blood volume reduces pressure

35
Q

Why is the spleen more prone to infarction with splenomegaly?

A

Spleen demands more blood because it’s enlarged

if demand not met, ischaemia and infarction occur

36
Q

What do splenic infarctions look like?

A

White

Wedge-shaped

37
Q

What do multiple splenic infarctions lead to?

A

Hyposplenism

Spleen shrinks

38
Q

What is hyposplenism?

A

Lack of functioning splenic tissue

reduced spleen function overall

39
Q

What are the causes of hyposplenism?

A

Splenoctomy - surgical removal of spleen

Sickle cell disease

40
Q

How can sickle cell disease lead to hyposplenism?

A

Sickle cells block capillaries in spleen

lead to ischaemia, multiple infarcts, healing by fibrosis

41
Q

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

A

Howell-Jolly bodies

42
Q

What are Howell-Jolly bodies?

A

Remnants of DNA in red blood cells

43
Q

Why do Howell-Jolly bodies show up with hyposplenism?

A

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

44
Q

What is the cause of Howell-Jolly bodies?

A

Errors of erythropoiesis

45
Q

What are patients with hyposplenism at risk of?

A

Overwhelming sepsis

particularly by encapulsated bacteria

46
Q

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

A

Strep. pneumoniae

Neisseria meningitidis

Haemophilus influenzae

Haematology (12 decks)

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