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
patientsWhat 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 lymphomasWhat 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
Is G6PD deficiency an
indication for splenectomy?
P460
NO
What are the possible
postsplenectomy
complications?
P460
Thrombocytosis, subphrenic abscess,
atelectasis, pancreatitis gastric dilation,
and Overwhelming PostSplenectomy
Sepsis (OPSS)
What causes OPSS?
P460
Increased susceptibility to fulminant
bacteremia, meningitis, or pneumonia
because of loss of splenic function
What is the incidence of
OPSS in adults?
P461
< 1%
What is the incidence and
overall mortality of OPSS in
children?
P461
1% to 2% with 50% mortality rate
What is the typical
presentation of OPSS?
P461
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
What are the common
organisms associated with
OPSS?
P461
Encapsulated: Streptococcus
pneumoniae, Neisseria meningitides,
H. influenzae
What is the most common
bacteria in OPSS?
P461
Streptococcus pneumoniae
What is the preventive
treatment of OPSS?
P461
Vaccinations for pneumococcus,
H. influenzae, and meningococcus
Prophylactic penicillin for all minor
infections/illnesses and immediate
medical care if febrile illness developsWhat is the best time to
give immunizations to
splenectomy patients?
P461
Preoperatively, if at all possible
If emergent, then 2 weeks
postoperatively
What lab tests are abnormal
after splenectomy?
P461
WBC count increases by 50% over
the baseline; marked thrombocytosis
occurs; RBC smear is abnormal
What are the findings on
postsplenectomy RBC
smear?
P461
Peripheral smear will show
Pappenheimer bodies, Howell-Jolly
bodies, and Heinz bodies
When and how should
thrombocytosis be treated?
P461
When platelet count is > 1 million, most
surgeons will treat with aspirin
What is the most common
cause of splenic vein
thrombosis?
P461
Pancreatitis
What opsonins does the
spleen produce?
P461
PROperdin, TUFtsin (Think:
“PROfessionally TUF spleen”)
What is the most common
cause of ISOLATED
GASTRIC varices?
P462
Splenic vein thrombosis (usually from
pancreatitis)
What is the treatment of
gastric varices caused by
splenic vein thrombosis?
P462
Splenectomy
Which patients develop
hyposplenism?
P462
Patients with ulcerative colitis
What vaccinations should
every patient with a
splenectomy receive?
P462
Pneumococcus
Meningococcus
Haemophilus influenzae type B
Define hypersplenism.
P462
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)Define splenomegaly.
P462
Enlarged spleen
What is idiopathic
thrombocytopenic
purpura (ITP)?
P462
Autoimmune (antiplatelet antibodies IgG
in 90% of patients) platelet destruction
leading to troublesome bleeding and
purpura
What is the most common cause of failure to correct thrombocytopenia after splenectomy for ITP? P462
Missed accessory spleen
What are the “I’s” of ITP?
P462
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)What is TTP?
P462
Thrombotic Thrombocytopenic Purpura
What is the treatment of
choice for TTP?
P463
Plasmapheresis (splenectomy reserved as
a last resort—very rare)
What is the most common
physical finding of portal
hypertension?
P463
Splenomegaly
