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QUESTION NOTES > SPLEEN > Flashcards

SPLEEN Flashcards

1
Q

Vascular vs. avascular ligaments of spleen

A

vascular: splenorenal (hilar vessels + panc tail), gastrosplenic (short gastrics)
avascular: splenocolic, splenophrenic

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2
Q

What are: Howell-Jolley bodies

A

nuclear remnant; most reliable to detect asplenic smear

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3
Q

What are: target cells

A

immature RBC (target is nucleus)

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4
Q

What are: Pappenheimer bodies

A

iron granules

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5
Q

What are: Heinz bodies

A

intracellular denatured Hgb

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6
Q

What are: Spur cells

A

deformed RBC membranes

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7
Q

For splenectomy, what do you ligate first: splenic vein vs. artery?

A

artery

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8
Q

Patho: idiopathic thrombocytopenic purpura

A

Ab to glycoproteins GP2b3A and GP1A2A

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9
Q

Patho: hereditary spherocytosis

A

autosomal defect in cell membrane (spectrin)

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10
Q

Prophylactic mgmt children w/ hereditary spherocystosis

A

splenectomy for symptomatic children >6yo (time to develop immunity) + 2-wk pre-op vaccinations

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11
Q

Anemia + splenomegaly in child, suspect…?

A

hereditary spherocytosis

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12
Q

MCC hereditary reason for splenectomy that is not structure-related

A

pyruvate kinase def: hemolytic anemia 2/2 defect in glucose metabolism

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13
Q

Mgmt for splenic cysts

A

if symptomatic or >5cm -> laparoscopic cyst excision or fenestration

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14
Q

Mgmt: splenic artery aneurysm

A

> 2cm -> repair

female of child-bearing age of ANY size -> repair (coil embolize, covered stent)

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15
Q

Mgmt splenic artery aneurysm at distal hilum of spleen

A

splenectomy

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16
Q

Sxs splenic artery aneurysm rupture

A

“double rupture sign” = acute abdominal pain, but stabilize (bc tamponade by lesser sac) -> lesser sac ruptures -> intraperitoneal blood

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17
Q

Splenectomy population most at risk of OPSI

A

children, particularly if splenectomy 2/2 beta-thalassemia

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18
Q

MC location accessory spleen

A

hilum

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19
Q

MC organism responsible for OPSI

A

strep pneumo

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20
Q

Hypotensive + tender abdominal exam post-splenectomy, suspect…?

A

short gastric bleed

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21
Q

Fluid collection s/p splenectomy, concern for…?

A

pancreatic leak from tail

22
Q

Patho: TTP (thrombotic thrombocytopenic purpura)

A

ADAMTS13 metalloproteinase defect -> cannot break down wWF -> platelet aggregation in microvasculature

23
Q

Sxs TTP

A
24
Q

MC primary splenic neoplasm

A

non-Hodgkin’s lymphoma

25
Q

When give platelets intra-op splenectomy for ITP?

A

after ligating splenic artery, unless bleeding and need to give for hemostasis

26
Q

What else do you need to check for in pts with hereditary spherocytosis that you would have to intervene for?

A

gallstones from hemolysis; may do cholecystectomy at time of splenectomy

27
Q

MC visceral artery aneurysm

A

splenic artery

28
Q

Mgmt splenic hemangioma

A

if symptomatic -> splenectomy

29
Q

Splenic hemangiosarcoma associated with … exposure?

A

vinyl chloride and thorium dioxide

30
Q

First step in child w/ fever + hx splenectomy

A

immediate broad spectrum Abx (high mortality)

31
Q

Mgmt TTP

A

emergency plasmaphoresis

32
Q

s/p sleeve gastrectomy + CT w/ infarcted superior pole of spleen

A

normal after takedown of short gastrics - non-op mgmt, pain mgmt, will resolve spontaneously

33
Q

Spleen in RLQ + abd US shows no flow in splenic vein… suspect?

A

wandering spleen 2/2 failure of fusion of dorsal mesogastrium -> lack of splenic ligaments

34
Q

Mgmt wandering spleen

A

increased risk splenic torsion/infarction -> splenopexy (unless infarcted, then need splenectomy)

35
Q

If isolated gastric varices, suspect…?

A

splenic vein thrombosis

36
Q

Isolated gastric varices 2/2 retrograde flow through…?

A

short gastric and posterior gastric veins

37
Q

Dx splenic vein thrombosis

A

abdominal ultrasound

38
Q

Mgmt nonparasitic splenic cysts

A

obs, most asymptomatic. if symptomatic, relief with aspiration (often recur) suggests benefit of operative mgmt

39
Q

Mgmt splenic abscess

A

perQ drain + IV Abx (high mortality rate)

40
Q

The most consistent predictor of response to splenectomy from ITP is…?

A

young age

41
Q

DVT prophylaxis during non-op mgmt spleen lac

A

early use of LWMH (<3d) does NOT increase failure rate for non-op mgmt of spleen lac - must have trauma pts on DVT ppx

42
Q

After non-op spleen lac, child should be kept on bed rest until what criteria is fulfilled?

A
  • Hct stabilizes

- abdominal pain resolves

43
Q

After non-op spleen lac, how long before can return to full activity?

A

Grade of splenic injury + 2 weeks

44
Q

Etiology of popliteal artery entrapment syndrome

A

MC 2/2 congenital anomaly where medial/lateral gastrocnemius head shifted to artery -> compression during knee flexion

45
Q

Popliteal entrapment causes ?? pathology of popliteal artery that -> parasthesia and complete occlusion or thrombosis of artery

A

popliteal artery fibrosis

46
Q

Mgmt splenic injury by grade + unstable, or requiring continued transfusions

A

Grade 1 = topical hemostatic agents, cautery
2/3 = splenorrhaphy with suture or absorbable mesh repair (or omentum
4/5 = splenectomy required

47
Q

How to mobilize spleen?

A

Must medialize spleen.

  • ligate splenorenal ligament (contains splenic vessels)
  • ligate splenocolic ligament
  • divide splenophrenic ligament (avascular)
48
Q

Should drain be placed after splenectomy?

A

Not routinely (associated with devel of abscess) - only if coexisting injury to pancreatic tail or renal collecting duct

49
Q

Mgmt splenic injury by grade + unstable, or requiring continued transfusions

A

Grade 1 = topical hemostatic agents, cautery
2/3 = splenorrhaphy with suture or absorbable mesh repair (or omentum
4/5 = splenectomy required

50
Q

How to mobilize spleen?

A

Must medialize spleen.

  • ligate splenorenal ligament (contains splenic vessels)
  • ligate splenocolic ligament
  • divide splenophrenic ligament (avascular)
51
Q

Should drain be placed after splenectomy?

A

Not routinely (associated with devel of abscess) - only if coexisting injury to pancreatic tail or renal collecting duct

QUESTION NOTES (28 decks)

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