Spleen Disorders Flashcards
Diaphragmatic surface of the spleen ?
It is convex directed laterally and
related to diaphragm which separates it from lower part of left pleura, left lung , ribs & intercostal muscles.
Visceral surface of the spleen ?
It is directed medially and shows the hilum &
4 impressions:
Colic impression: anterior to the hilum , near lateral end &related to left colic flexure.
Pancreatic impression: just below the lateral end of the hilum , related to the tail of pancreas.
Renal impression: below hilum, related to front of left kidney.
Gastric impression: above the hilum & related to the fundus of the stomach.
Superior and inferior border of the spleen
Surface anatomy
It lies opposite left 9, 10, 11 ribs, its medial end
lies 1.5 inch from midline posterior & its lateral end in the left mid-axillary line.
Arterial supply
Splenic artery (arises from the coeliac trunk,
tortuous, runs on the upper border of pancreas) .
Venous drainage?
Splenic vein (runs behind the body of pancreas &
joins the superior mesenteric vein to form the portal vein ).
Peritoneum
nearly completely covered with. peritoneum & related to:
Gastro-splenic ligament: contains short gastric & left
gastroepiploic vessels , splenic lymph nodes , autonomic plexus and extraperitoneal fat.
Spleno-renal (Lieno-renal) ligament: contains tail of
pancreas & splenic vessels ,lymph nodes , autonomic plexus and extraperitoneal fat.
Phreno-colic ligament : between left colic flexure and
diaphragm , support the spleen from below. This ligament direct the enlarged spleen towards the right iliac fossa.
Hypersplenisim
This is a syndrome of splenomegaly combined with destruction of formed blood elements leading to one or more of the following:
• Anaemia;
• Leukopenia < 4-5 x 109/L;
• Thrombocytopenia < l00 X 109/L.
Hyposplenism
Hyposplenism is confirmed by the appearance of defective red cells in the peripheral circulation.
• The most frequent cause is surgical splenectomy.
Causes of splenomegaly
Infection
• Bacterial: Typhoid fever, endocarditis, septicemia, abscess
• Viral:E-B virus, CMV, and others
• Protozoal: Malaria, toxoplasmosis • Hematologic processes
• Hemolytic anemia: Congenital, acquired
• Extramedullary hematopoiesis: thalassemia, osteopetrosis, myelofibrosis
• Neoplasms
• Malignant: Leukemia, lymphoma, histiocytoses, metastatic tumors
• Benign: Hemagioma, hamartoma • Metabolic diseases
• Lipidosis: Niemann-Pick, Gaucher disease
• Mucopolysaccharidosis infiltration: Histiocytosis
• Cirrhosis
• Cysts
Causes of hyposplenism
• Splenectomy
• Splenic agenesis
• Coeliac disease
• Inflammatory bowel disease Systemic amyloidosis
• Old age
• Sickle cell anemia
• Systemic lupus erythematosus
Etiology of splenic abscess
• Hematogenic spread
• Infected trauma Infected splenic infarction
• Alcoholism
• DM
• Immunosuppression
• Drug abuser
Clinical features of splenic abscess
• Fever
• Abdominal Pain(maximum in the left hypochondria )
• Shoulder pain (Involvement of the diaphragmatic pleura )
• Pleuritic chest pain
• General malaise
• Dyspeptic symptoms
Imaginings investigations
Pyogenic splenic on axial CECT
- US
- CT
-MRI
Treatment of splenic abscess
• Splenectomy for most cases • Percutaneous drainage