SPLEEN Flashcards
1
Q
blood supply to spleen
A
#1 splenic artery cephalad #2 splenic vein caudad (inferior mesenteric vein) #3 short gastrics ( from the left gastroepiploic artery) #4 left gastroepiploic artery #5 right gastroepiploic artery (off gastroduodenal artery) #6
2
Q
where our accessory spleens found
A
#1 splenic hilum #2 splenocolic ligament #3 gastrocolic ligament #4 splenorenal ligament #5 greater omentum #6 Tail pancreas #7 mesentery #8 gonadal: left ovary and testicular area
3
Q
asplenia Iver Marks syndrome
A
right arterial isomerism
double right side!
Central liver big
4
Q
polysplenia
A
double left-sided anatomy
5
Q
general of B cells
A
makes antibodies
6
Q
general of T cells
A
cellular immunity
7
Q
Howell-Jolly bodies
A
remnants of red blood cells
8
Q
Heinz bodies
A
the major hemoglobin
9
Q
nonspecific immune mechanisms of spleen
A
# antibody #2 opsonin #3 Tuftsin #4 largest producer IgM (IgM equals of immediate) #5 fibronectin
10
Q
white pulp
A
#1 T cells #2 macrophage
11
Q
red pulp
A
Red = Reticular
Removal of particular matter
12
Q
where should splenic abscess be drained external landmarks
A
below the 11th rib
13
Q
indications for splenectomy
A
#1 hereditary sohgericytosis #2 splenic artery aneurysm ( first choice with thrombosis and aneurysm is endovascular)
14
Q
workup for missed accessory spleen
A
look up
15
Q
indications for trauma splenectomy
A
#1 developed hemodynamic instability regardless of transfusion history #2 transfusion 40 cc per kilogram
16
Q
hereditary spherocytosis
A
#1 Spectrin #2 autosomal dominant #3 osmotic fragility test #4 treatment SPLENECTOMY
17
Q
sickle cell anemia
A
#1 beta chain of hemoglobin a #2 most follows normal recessive #3 auto infarct spleen #4 pigmented gallstones get cholecystectomy #5 Salmonella-> osteomyelitis with
18
Q
Splenectomy vaccinations
A
Encapsulated organisms: #1 Streptococcus pneumonia: Most common-75% #2 Haemophilus influenza the second most common #3 Neisseria meningitidis #4 beta-hemolytic Streptococcus #5 Staphylococcus aureus #6 Escherichia coli viral infections: Herpes zoster Parasite:
19
Q
ITP
A
Idiopathic thrombocytopenic purpura FAT RN: #1 steroids #2 gammaglobulin #3 RhoGAM #4 monoclonal-up Rituxan (chemotherapy) #5 splenectomy 75-85 response rate (Drops to 60% if failed medical management) Transfuse if platelets less than 20,000 After splenic artery ligation
20
Q
TTP
A
Thrombotic thrombocytopenic purpura #1 multilevel organ syndrome- Renal Neuro #2 treat with PLASMA PHERESIS #3 NO splenectomy
21
Q
HIV-associated thrombocytopenia
A
#1 resistant to medical therapy #2 splenectomy recommended in does not appear at maxillary conversion rate AIDS
22
Q
Immunization post trauma splenectomy
A
Immunization before he leaves the hospital
23
Q
Treatment of elevated platelet count status post splenectomy
A
700,000-1,000,000 and to quietly with aspirin
Greater than 1 million anticoagulate Cameron (Cameron)
24
Q
Congestive splenomegaly
A
#1 caused by lives at liver failure portal hypertension #2 the treat by dressing portal hypertension #3 NO splenectomy (this would preclude possible future splenorenal shunt) Ultimately lead to portal vein thrombosis and complicate potential liver transplantation
25
Felty's syndrome
```
The #1 rheumatoid arthritis #2 splenectomy controversial
#3 methotrexate steroids
```
26
Hodgkin's disease
RARELY splenectomy for staging anymore
| Treatment chemotherapy
27
Non-Hodgkin's lymphoma
RARELY splenectomy except for massive splenomegaly symptoms
28
Name vaccinations for postsplenectomy
Polyvalent pneumococcal polysaccharide
(Children younger than 2 years old not effectively immunized in parentheses
H. influenzae vaccination type B
Neisseria meningitidis vaccination
Caution: Children less than 6 oral penicillin prophylaxis
29
relationship of superior mesenteric artery and superior mesenteric vein
superior mesenteric ARTERY is to the LEFT
Superior mesenteric VEIN is to be RIGHT
(CAREFUL:This is reversed in malrotation)
30
most common place to find accessory spleen
```
Splenic hilum/vascular pedicle
#1 gastrocolic ligament
#2 tail of pancreas
#3 greater omentum
#4 greater curvature stomach
#5 splenocolic ligament
#6 small large bowel mesentery
#7 left broad ligament and uterus in women
#8 left spermatic cord and men
```
31
Most common cause a spontaneous splenic rupture worldwide
MALARIA
UNITED STATES: Mononucleosis!
Other causes: Plasmodium vivax infection Other
32
Hypersplenism
```
#1 sickle cell
#2 radiation
#3 celiac disease
#4 malignancy
#5 ulcerative colitis
#6 alcoholism/drug addiction
#7 tropical sprue
#8 lupus
#9 anemia
#10 HIV
#11 splenic trauma
#12 amyloidosis
```
33
Highest risk for postsplenectomy sepsis
HEMATOLOGIC:
THALASSEMIA MAJOR
SICKLE CELL
Children higher than adult
34
Optimal timing for pneumococcal vaccination post trauma splenectomy
14 days
35
Felty's syndrome triad
```
#1 rheumatoid arthritis
#2 splenomegaly
#3 neutropenia
```
Methotrexate/steroids
Leg ulcers
36
Indications for splenectomy with Felty's syndrome
```
#1 transfusion-dependent anemia
#2 profound thrombocytopenia
```
Splenectomy response excellent-80% durable increase in white blood cell count
Immediate neutrophil count improvement
37
ectopic wandering spleen
```
#1 lack of peritoneal attachments
#2 multiparous women
#3 most asymptomatic
#4 provided spleen is not infarcted treat with splenopexy
```
38
cell findings after splenectomy
```
#1 target cells
#2 Howell-Jolly bodies
#3 Heinz bodies
#4 Pappenheimer bodies
#5 prolonged leukocytosis
```
39
time course of WBC findings post splenectomy
WBC count increasing within one day
| may remain elevated prolonged several months and
40
most common source for splenic abscess
```
#1-most common hematogenous spread
- infective endocarditis
- typhoid fever
- malaria
-- urinary tract infection
- osteomyelitis
#2 contiguous infection
#3 hemoglobinopathy
#4 immunosuppression
#5 trauma
```
41
medical treatment of hairy cell leukemia
Leustatin (cladribine)
42
splenectomy indication hairy cell leukemia
early satiety
| Cell counts fell to increase
