Spleen

Question 1

Spleen and Rib fractures

-Total / Subtotal splenectomy

Answer 1

Close proximity of spleen to rib cage.

left rib fracture - sharp end rapture spleen .

Spleen very vascular organ so bleeds heavily without stopping - treated seriously.

0 Splenectomy indicated with life threatening damage to spleen and haemorrhage 
    ( can 
    remove 
    spleen or 
    using tubes 
    / wires to 
    block of 
    arteries 
    which are 
    bleeding - 
    in case of 
    catastropic 
    bleed)

Subtotal splenectomy

Splenic a. reaches spleen and splits into 5 branches which don’t anastomose - create 5 vascular segments - one can be removed without effecting the other ( Subtotal Splenectomy )

Total Splenectomy - removal of whole spleen.

Question 2

Anatomical position of Liver ?

Answer 2

Upper left quadrant of abdomen , under diaphragm.

Covered by ribcage and diaphragm - so can usually be palpated unless enlarged ( SPLENOMEGALY - superior border moves inferomedially.
0 2 Surfaces -
- Diaphragmatic surface - in contact with diaphragm & ribcage
- Visceral surface - in contact with abdominal viscera.

Intraperitoneal.

Attach to greater curvature of stomach by - Gastrosplenic ligament

Attach to left kideny by Splenorenal ligament

Both ligaments are part of the Greater omentum.

0 left kidney , tail of pancreas medial to spleen

0 Stomach anterior to S

0 Splenic flexure inferior to S

0 Diaphragm , left lung , ribs 9 -12 posterior to S

Question 3

Lymphatic drainage of the Spleen ?

Answer 3

Drain into pancreaticosplenic lymph nodes ———-> coeliac nodes.

Question 4

Consequence of Spleen removal

Answer 4

Need life long antibiotics - more susceptible to bacterial infections.

• even though liver and bone marrow take some of its function.

Question 5

Function of Spleen ?

Answer 5

0 Blood filter

0 remove old RBC

0 role in cell mediated and humoral immune responses.

Question 6

Causes of Splenomegaly ?

Answer 6

Congestion
Infiltration
Proliferation

( CIP)

Congestion

Question 7

Causes of Splenomegaly ?

Answer 7

Congestion
Infiltration
Proliferation

( CIP)

Congestion - increased pressure in splenic vein (occlusion - thrombosis , pathology that causes portal hypertension e.g cirrhosis , right sided heart failure ?
)——–> leads to congestion ——— > lead t hyperplasia and fibrosis of spleen

If Cirrhosis likely to see:

0 Jaundice
0 Varices
0 Spider angiomas

Infiltration - prone to invasion by maligant and non maligant causes.

Maligancies

0 Lymphomas
0 Leukemias
0 Metastatic Solid Tumours * if spleen palpable 8cm below costal margin likely to be something to do with cancer or proliferation.

Amyliodosis
Sarcoidosis

Proliferation - - Infection can cause Spleen to become Hyperfunctioning
0 Viral - HIV , EBV (Epstein- Barr virus ) , CMV
0 Bacterial TB
0 Fungal - Histoplasmosis - chronic infection - similar symptoms to pneumonia or non - specific chronic illness.
0 Parasitic
- Malaria
- Visceral
Leishmaniasis

Question 8

Consquences of Splenomegaly ?

Answer 8

Hypersplenism - cytopenia (reduction in mature blood cells caused by splenomegaly )

Splenomagly —— > increased blood filtering + destrcution of RBC , WBC and platelets.

• compensatory bone hyperplasia occurs in those cell lines.

Hypersplenism - suspected in splenomegaly patients with anemias or cytopenias

Diagnosis -

0 full blood count
0 Physical exam 0 Ultrasound - if needed

Question 9

Treatment of Splenomegaly ?

Answer 9

Treat underlining cause

Splenectomy

Vaccination + prophylatic antibodies for patients with removed spleen.

Splenic Ablation ( destroying splenic tissue ) -

radiofrequency ablation (RFA) of spleen - heat used to destroy splenic tissue ]
Different forms 

introduction on emobilising agent into splenic arterial branches - causes ischemia necrosis of areas supplied by this

Question 10

fever + unexplained splenomegaly -

Answer 10

fever + unexplained splenomegaly - indicative of non - Hodgkin’s’

consider suspected cancer referral - within 2 week