Spleen

Question 1

Ligaments of spleen?

Answer 1

-	Gastrosplenic
o	Contains short gastric aa
-	Splenorenal
o	Contains splenic vessels + tail of pancreas
-	Splenocolic
-	Splenophrenic

Question 2

Red pulp and white pulp of spleen

Answer 2

Red pulp (RBCs, most pre-dominant) and white pulp (WBCs)

Question 3

s/p splenectomy blood smear

Answer 3

o	Howel-Jolly bodies: nuclear remnants
o	Pappenhemier body: Iron deposits
o	Target cells: immature RBC
o	Heinz bodies:  intracellular denatured hemoglobin
o	Spur cells: deformed membraned

Question 4

Indications for splenectomy

Answer 4

Unstable trauma patient (especially penetrating)
ITP
Splenic abscesses
Symptomatic cysts
Primary malignancies

Question 5

Trauma patient splenectomy considerations

Answer 5

Blunt trauma
“ HDS, no peritonitis í watch
“ Angiography: >grade III splenic injury + stable or contrast blush

Penetrating trauma: go for splenectomy

Question 6

ITP

Answer 6

autoantibodies to G23Pa

tx: IVIG, steroids, refractory -> splenectomy

Question 7

Splenic abscess tx

Answer 7

Unilocular with thick wall, stable patient
“ Perc drain
Multilocular with thin wall, unstable
“ Splenectomy

Question 8

Splenic cysts tx

Answer 8

o Well-defined hypodense lesion without enhancing rim
o False cysts: post-traumatic
o If asx: do nothing
o >5 cm or sx: lap cyst excision

Question 9

Splenic artery aneurysm when to treat?

Answer 9

Women, pregnant or child-bearing
>2 cm in men or non child-bearing women
“ Coil embolize
“ Splenectomy for distal aneurysm

Question 10

Increased susceptibility to what type of organism after splenectomy?

Answer 10

Susceptibility to encapsulated organisms (loss of opsonization, reduction in IgM)
o	Strep pneumo
o	Neisseria meningitides
o	H flu
loss of opsonization, reduction in IgM

Question 11

When to vaccinate for splenectomy?

Answer 11

o 2 weeks prior to elective splenectomy

o Emergent splenectomy -> prior to hospital discharge

Question 12

OPSI

Answer 12

overwhelming post-splenectomy infection
o Greatest risk in children, beta-thalassemia
o MC organism: Strep pneumo
o Tx: broad spectrum antibiotics

Question 13

MC source of bleeding post-splenectomy

Answer 13

short gastric aa

Question 14

TTP

Answer 14

AMS, fevers, anemia, purpura, renal failure

• ADAMTS13 defect
• Causes platelet aggregation
• Tx: plasmapheresis

Question 15

Wandering spleen

Answer 15

no splenic ligaments, risk of splenic torsion and infarction

- Tx: splenoplexy or splenectomy if there is infarction