Splenectomy Flashcards
Emergency splenectomy indications?
1) Trauma
2) rupture (e.g. EBV infection)
3) hypersplenism (hereditary spherocytosis)
4) malignancy (lymphoma or leukaemia
5) splenic cyst, hyatid cyst, splenic abscess
Elective splenectomy indications?
1) haemolytic anaemia (hereditary or immune)
2) idiopathic thrombocytopenic purpura (ITP)
What organisms are post-splenectomy patients susceptible to?
Encapsulated organisms:
- haemophilus
- pneumococcus (highest risk)
- meningococcus
- Capnocytophaga canimorsus
What vaccines are given to post-splenectomy patients?
1) pneumococcal vaccine - boosters every 5 years
2) influenza - yearly
3) Hib - one-off
4) meningitis - one-off
Other prophylactic management?
Antibiotics: typically amoxicillin or penicillin V (erythromycin if allergic)
Optimal time to give pneumococcal vaccine if patient undergoes elective splenectomy?
2 weeks before surgery (BNF)
When are splenectomy patients most at risk of infection?
First 2 years post-splenectomy
Blood film findings post-splenectomy/hyposplenism?
- Howell Jolly bodies
- Siderocytes (granules)
- Target cells
- Pappenheimer bodies
- acanthocytes
Hyposplenism is commonly associated with what condition?
Coeliac disease
What is infectious mononucleosis?
Glandular fever –> viral infection caused by EBV (HHV-4)
How is infectious mononucleosis transmitted?
Saliva (‘kissing disease’)
Presentation of glandular fever?
- Mild in young children
- Young adults (classic triad):
- -> Fever
- -> Sore throat
- -> Enlarged lymph nodes in neck
–> fatigue - lasts months
Other signs:
- pharyngitis, enlarged tonsils w/ pus
- petechiae palate
- splenomegaly (50%)
- hepatitis (transient rise ALT)
- lymphocytosis / haemolytic anaemia
Potential complications of glandular fever?
splenomegaly, hepatomegaly
Management of EBV?
Supportive - hydrate, rest, analgesia (paracetamol)
Advice to prevent ruptured spleen?
Avoid heavy lifting & contact sports for 1 month
Antibiotic to avoid?
Amoxicillin (EBV maculopapular rash)
Infectious causes of widespread maculopapular rash?
Enterovirus and echovirus infection (e.g. hand foot and mouth disease) Parvovirus B19 infection (erythema infectiosum) Roseola infantum Epstein Barr virus infection Cytomegalovirus (CMV) infection HIV seroconversion illness Secondary syphilis Acute hepatitis B/C infection Measles Rubella Meningococcemia Scarlet fever Staphylococcal scalded skin syndrome Kawasaki disease Juvenile onset or adult onset Still disease
Diagnosis of EBV?
- Clinical
- NICE recommends heterophil antibody test (Monospot test) + FBC in 2nd week to confirm diagnosis
How is lymphadenopathy different fro EBV vs. tonsillitis?
Tonsillitis - typically ONLY upper anterior cervical chain
EBV - possible in anterior and posterior triangle of neck
