Spleen and Splenectomy, C60 P458-463 Flashcards

1
Q

Which arteries supply the
spleen?
P458

A
Splenic artery (a branch of the celiac
trunk) and the short gastric arteries that
arise from the gastroepiploic arteries
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the venous drainage
of the spleen?
P458

A

Portal vein, via the splenic vein and the

left gastroepiploic vein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is said to “tickle” the
spleen?
P459

A

Tail of the pancreas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What percentage of people
have an accessory spleen?
P459

A

≈20%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What percentage of the total
body platelets are stored in
the spleen?
P459

A

33%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the functions of
the human spleen?
P459

A
Filters abnormal RBCs (does NOT store
RBCs like canine spleen!), stores platelets,
produces tuftsin and properdin (opsins),
produces antibodies (especially IGM) and
is site of phagocytosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is “delayed splenic
rupture”?
P459

A
Subcapsular hematoma or
pseudoaneurysm may rupture some time
after blunt trauma, causing “delayed
splenic rupture”; rupture classically
occurs about 2 weeks after the injury and
presents with shock/abdominal pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the signs/symptoms
of ruptured/injured spleen?
P459

A

Hemoperitoneum and Kehr’s sign, LUQ

abdominal pain, Ballance’s sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is Kehr’s sign?

P459

A

Left shoulder pain seen with splenic

rupture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is Ballance’s sign?

P459

A

LUQ dullness to percussion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is Seagesser’s sign?

P459

A

Phrenic nerve compression causing neck

tenderness in splenic rupture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How is a spleen injury
diagnosed?
P459

A

Abdominal CT, if the patient is stable;
DPL or FAST exam if the patient is
unstable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the treatment?

P459

A
1. Nonoperative in a stable patient with
    an isolated splenic injury without hilar
    involvement/complete rupture
2. If patient is unstable, DPL/FAST
    laparotomy with splenorrhaphy or
    splenectomy
3. Embolization is an option in selected
    patients
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is a splenorrhaphy?

P460

A

Splenic salvage operation: wrapping vicral
mesh, aid of topical hemostatic agents or
partial splenectomy, sutures (buttressed)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the other
indications for splenectomy:
Malignant diseases?
P460

A
Hodgkin’s staging not conclusive by CT
    scan (rare)
Splenic tumors (primary/metastatic/
    locally invasive)
Hypersplenism caused by other
    leukemias/non-Hodgkin’s lymphomas
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the other
indications for splenectomy:
Anemias?
P460

A
Medullary fibrosis with myeloid
    metaplasia
Hereditary elliptocytosis
Sickle cell anemia (rare, most
    autosplenectomize)
Pyruvate kinase deficiency
Autoimmune hemolytic anemia
Hereditary spherocytosis
Thalassemias (e.g., 	ℬ-thalassemia major
    a.k.a. Cooley’s)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the other
indications for splenectomy:
Thrombocytopenia?
P460

A

ITP (Idiopathic Thrombocytopenic
Purpura)
TTP (Thrombotic Thrombocytopenic
Purpura)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the other
indications for splenectomy:
Miscellaneous indications?
P460

A

Variceal bleeding with splenic vein
thrombosis, Gaucher’s disease, splenic
abscess, refractory splenic cysts,
hypersplenism, Felty’s syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Is G6PD deficiency an
indication for splenectomy?
P460

A

NO

20
Q

What are the possible
postsplenectomy
complications?
P460

A

Thrombocytosis, subphrenic abscess,
atelectasis, pancreatitis gastric dilation,
and Overwhelming PostSplenectomy
Sepsis (OPSS)

21
Q

What causes OPSS?

P460

A

Increased susceptibility to fulminant
bacteremia, meningitis, or pneumonia
because of loss of splenic function

22
Q

What is the incidence of
OPSS in adults?
P461

A

< 1%

23
Q

What is the incidence and
overall mortality of OPSS in
children?
P461

A

1% to 2% with 50% mortality rate

24
Q

What is the typical
presentation of OPSS?
P461

A

Fever, lethargy, common cold, sore
throat, URI followed by confusion, shock,
and coma with death ensuing within 24
hours in up to 50% of patients

25
Q

What are the common
organisms associated with
OPSS?
P461

A

Encapsulated: Streptococcus
pneumoniae, Neisseria meningitides,
H. influenzae

26
Q

What is the most common
bacteria in OPSS?
P461

A

Streptococcus pneumoniae

27
Q

What is the preventive
treatment of OPSS?
P461

A
Vaccinations for pneumococcus,
    H. influenzae, and meningococcus
Prophylactic penicillin for all minor
    infections/illnesses and immediate
    medical care if febrile illness develops
28
Q

What is the best time to
give immunizations to
splenectomy patients?
P461

A

Preoperatively, if at all possible
If emergent, then 2 weeks
postoperatively

29
Q

What lab tests are abnormal
after splenectomy?
P461

A

WBC count increases by 50% over
the baseline; marked thrombocytosis
occurs; RBC smear is abnormal

30
Q

What are the findings on
postsplenectomy RBC
smear?
P461

A

Peripheral smear will show
Pappenheimer bodies, Howell-Jolly
bodies, and Heinz bodies

31
Q

When and how should
thrombocytosis be treated?
P461

A

When platelet count is > 1 million, most

surgeons will treat with aspirin

32
Q

What is the most common
cause of splenic vein
thrombosis?
P461

A

Pancreatitis

33
Q

What opsonins does the
spleen produce?
P461

A

PROperdin, TUFtsin (Think:

“PROfessionally TUF spleen”)

34
Q

What is the most common
cause of ISOLATED
GASTRIC varices?
P462

A

Splenic vein thrombosis (usually from

pancreatitis)

35
Q

What is the treatment of
gastric varices caused by
splenic vein thrombosis?
P462

A

Splenectomy

36
Q

Which patients develop
hyposplenism?
P462

A

Patients with ulcerative colitis

37
Q

What vaccinations should
every patient with a
splenectomy receive?
P462

A

Pneumococcus
Meningococcus
Haemophilus influenzae type B

38
Q

Define hypersplenism.

P462

A
Hyperfunctioning spleen
Documented loss of blood elements
    (WBC, Hct, platelets)
Large spleen (splenomegaly)
Hyperactive bone marrow (trying to keep
    up with loss of blood elements)
39
Q

Define splenomegaly.

P462

A

Enlarged spleen

40
Q

What is idiopathic
thrombocytopenic
purpura (ITP)?
P462

A

Autoimmune (antiplatelet antibodies IgG
in 90% of patients) platelet destruction
leading to troublesome bleeding and
purpura

41
Q
What is the most common
cause of failure to correct
thrombocytopenia after
splenectomy for ITP?
P462
A

Missed accessory spleen

42
Q

What are the “I’s” of ITP?

P462

A
Immune etiology (IgG antiplatelets ABs)
Immunosuppressive treatment (initially
    treated with steroids)
Immune globulin
Improvement with splenectomy (75% of
    patients have improved platelet counts
    after splenectomy)
43
Q

What is TTP?

P462

A

Thrombotic Thrombocytopenic Purpura

44
Q

What is the treatment of
choice for TTP?
P463

A

Plasmapheresis (splenectomy reserved as

a last resort—very rare)

45
Q

What is the most common
physical finding of portal
hypertension?
P463

A

Splenomegaly