Spleen and Splenectomy, C60 P458-463 Flashcards
Which arteries supply the
spleen?
P458
Splenic artery (a branch of the celiac trunk) and the short gastric arteries that arise from the gastroepiploic arteries
What is the venous drainage
of the spleen?
P458
Portal vein, via the splenic vein and the
left gastroepiploic vein
What is said to “tickle” the
spleen?
P459
Tail of the pancreas
What percentage of people
have an accessory spleen?
P459
≈20%
What percentage of the total
body platelets are stored in
the spleen?
P459
33%
What are the functions of
the human spleen?
P459
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
What is “delayed splenic
rupture”?
P459
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
What are the signs/symptoms
of ruptured/injured spleen?
P459
Hemoperitoneum and Kehr’s sign, LUQ
abdominal pain, Ballance’s sign
What is Kehr’s sign?
P459
Left shoulder pain seen with splenic
rupture
What is Ballance’s sign?
P459
LUQ dullness to percussion
What is Seagesser’s sign?
P459
Phrenic nerve compression causing neck
tenderness in splenic rupture
How is a spleen injury
diagnosed?
P459
Abdominal CT, if the patient is stable;
DPL or FAST exam if the patient is
unstable
What is the treatment?
P459
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
What is a splenorrhaphy?
P460
Splenic salvage operation: wrapping vicral
mesh, aid of topical hemostatic agents or
partial splenectomy, sutures (buttressed)
What are the other
indications for splenectomy:
Malignant diseases?
P460
Hodgkin’s staging not conclusive by CT scan (rare) Splenic tumors (primary/metastatic/ locally invasive) Hypersplenism caused by other leukemias/non-Hodgkin’s lymphomas
What are the other
indications for splenectomy:
Anemias?
P460
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)
What are the other
indications for splenectomy:
Thrombocytopenia?
P460
ITP (Idiopathic Thrombocytopenic
Purpura)
TTP (Thrombotic Thrombocytopenic
Purpura)
What are the other
indications for splenectomy:
Miscellaneous indications?
P460
Variceal bleeding with splenic vein
thrombosis, Gaucher’s disease, splenic
abscess, refractory splenic cysts,
hypersplenism, Felty’s syndrome