Spleen Flashcards
Which arteries supply the spleen?
Splenic artery (a branch of the celiac trunk) and the short gastric arteries that arise for the gastroepiploic arteries
What is the venous drainage of the spleen?
Portal vein, via the splenic vein and the left gastroepiploic vein
What is said to tickle the spleen?
Tail of the pancreas
What percentage of people have an accessory spleen?
20%
What percentage of the total body platelets are stored in the spleen?
33%
What are the main functions of the spleen?
Filters abnormal RBCs, stores platelets, produces tuftsin and properdin (opsins), produces antibodies (especially IgM) and is site of phagocytosis
What is delayed splenic rupture?
Subcapsular hematoma or pseudoaneurysm may rupture some time after blunt trauma.
Rupture classically occurs about 2 weeks after the injury and presents with shock and abdominal pain.
What are the signs and symptoms of ruptured or injured spleen?
Hemoperitoneum and Kehr’s sign, LUQ abdominal pain, Ballance’s sign
What is Kehr’s sign?
Left shoulder pain seen with splenic rupture
What is Ballance’s sign?
LUQ dullness to percussion
What is Seagesser’s sign?
Phrenic nerve compression causing neck tenderness in splenic rupture
How is a spleen injury diagnosed?
If the patient is stable: abdominal CT.
If not, DPL or FAST exam.
What is the treatment for a spleen injury?
- Non-operative in a stable patient with an isolated splenic injury without hilar involvement or complete rupture.
- If patient is unstable, DPL/FAST laparotomy with splenorrhaphy or splenectomy.
- Embolization is an option in selected patients.
What is a splenorrhaphy?
Splenic salvage operation wrapping vicral mesh, aid of topical hemostatic agents or partial splenectomy, sutures (buttressed)
For which malignant diseases is a splenectomy indicated?
Hodgkin’s staging not conclusive by CT (rare); splenic tumors (primary/metastatic); hypersplenism caused by other leukemias/non-Hodgkin’s lymphomas
For which anemic conditions is a splenectomy indicated?
Medullary fibrosis with myeloid metaplasia; hereditary elliptocytosis; sickle cell anemia (rare, most autosplenectomize); pyruvate kinase deficiency; autoimmune hemolytic anemia; hereditary spherocytosis; thalassemias
For which thrombocytopenic conditions is a splenectomy indicated?
ITP, TTP
What are some miscellaneous conditions for which a splenectomy is indicated?
Variceal bleeding with splenic vein thrombosis, Gaucher’s disease, splenic abscess, refractory splenic cysts, hypersplenism, Felty’s syndrome