Spleen and tonsils

Question 1

What type of structure is the spleen?

Answer 1

Secondary/Peripheral lymphoid organ

Question 2

What are the 2 key aspects of the spleen?

Answer 2

Diaphragmatic surface
Visceral surface

Question 3

What structures are in contact with the visceral surface of the spleen?

Answer 3

Left kidney
Gastric fundus
Tail of pancreas
Splenic flexure of colon

Question 4

What is the main arterial supply to the spleen?

Answer 4

Splenic artery (Branch of coeliac trunk)

Question 5

What is the main venous drain of the spleen?

Answer 5

Splenic vein

Question 6

What are the 2 types of tissue within the spleen?

Answer 6

Red pulp
White pulp

Question 7

What does the red pulp of the spleen contain?

Answer 7

Sinusoids
Cords of Bilroth

Question 8

Describe the structure of splenic sinusoids

Answer 8

They are fenestrated sinusoids, lined by epithelial cells and supported by hoops of reticulin
They become engorged with blood, hence red pulp

Question 9

What is contained in the white pulp?

Answer 9

Peri-arteriolar lymphoid sheath (PALS) containing CD4+ lymphoid cells

Lymphoid follicles containing B cells

Question 10

How do antigens reach the white pulp?

Answer 10

In the blood stream via APCs

Question 11

What are the cords of Bilroth made up of?

Answer 11

Macrophages
Fibroblasts
Cells in transit (RBC, WBC, PC and some CD8+)

Question 12

What are the 3 main features of hypersplenism?

Answer 12

• Splenomegaly
• Fall in one or more blood components (Cytopenia)
• Correction of cytopenia by splenectomy

Question 13

What is splenomegaly?

Answer 13

Enlargement of the spleen

Question 14

What are some types of causes of splenomegaly?

Answer 14

• Infection
• Congestion
• Haematological disease
• Inflammatory disorders
• Others

Question 15

What are some infections that can cause splenomegaly?

Answer 15

• EBV
• Malaria
• TB
• Typhoid
• Brucellosis
• Leishmaniasis

Question 16

What are some causes of splenic congestion?

Answer 16

Portal hypertension in hepatic cirrhosis and cardiac failure

Question 17

What are some haematological diseases that can cause splenomegaly?

Answer 17

Lymphoma
Leukaemia
Haemolytic anaemia
Myeloproliferative disorders

Question 18

What are some inflammatory disorder that can cause splenomegaly?

Answer 18

Rheumatoid arthritis
SLE

Question 19

What are some ‘other’ diseases that can cause splenomegaly?

Answer 19

• Gaucher’s (Storage disease)
• Niemann-Pick disease (Storage disease)
• Amyloid
• Tumours
• Cysts

Question 20

How will splenomegaly present?

Answer 20

Dragging sensation and discomfort in the LUQ, with possible eating pain in infarction and early satiety

Question 21

What are some causes of splenic atrophy?

Answer 21

• Splenectomy
• Coeliac disease
• Sickle cell disease
• Sarcoidosis

Question 22

What is the most common feature of splenic atrophy?

Answer 22

Reduced red pulp amount and function

Question 23

What will blood film show in splenic atrophy?

Answer 23

• Howell-Jolly bodies
• Basophilic nuclear remnants
• Other red cell abnormalities
• Possible immune deficiency (Especially in childhood splenectomy)

Question 24

What are tonsils?

Answer 24

Tonsils are like lymph nodes without a capsule

They contain germinal centres and follicles, but the capsule is replaced by stratified squamous epithelium with crypts