Splenic Disorders Flashcards
The spleen has red and white pulp. What 3 things make up the white pulp?
Marginal zone
PALS
Primary follicles
What does the red pulp in the spleen do?
Network that filters RBCs and platelets
What does the marginal zone (part of the white pulp) in the spleen do?
Macrophages that clear debris
What does the PALS (part of the white pulp) in the spleen contain?
T cells
What does the primary follicles (part of the white pulp) in the spleen contain and make?
B cells that make antibodies
Splenomegaly
Enlarged spleen
Enlarged spleen
Splenomegaly
What is a type of splenomegaly that is a pathologic condition?
Hypersplenism
Hypersplenism
Pathologic splenomegaly where blood cells are removed by the spleen
Hypersplenism
Pathologic splenomegaly where blood cells are removed by the spleen
3 examples of diseases where Hypersplenism occurs?
Sickle Cell Disease
Hereditary Spherocytosis
ITP (immune thrombocytopenic purpura)
With Hypersplenism, splenomegaly is a result of?
Blood cells being removed/degraded by the spleen
Physical exam to evaluate the spleen?
Castell’s point
If the pre-test probability of splenomegaly is LOW, should you perform palpation and percussion?
NO
- They are not sensitive enough to rule in/out splenomegaly
If the pre-test probability of splenomegaly is LOW, what imaging should you obtain?
Ultrasound
On an ultrasound of the spleen, what should you NOT see?
Dark fluid around the spleen
If the pre-test probability of splenomegaly is HIGH, should you perform palpation and percussion?
Yes, start there
Most common reason for splenic rupture?
Trauma
2 reasons for splenic rupture that are not trauma related?
Splenomegaly
Surgical trauma
With a splenic rupture, where will the pain most likely be?
LUQ
What is Kehr’s sign?
- irritation of the phrenic nerve due to splenic rupture bleeding beneath the diaphragm
- causes left shoulder pain
= pain is elicited in lateral recumbant position with legs raised
What is Kehr’s sign?
- irritation of the phrenic nerve due to splenic rupture bleeding beneath the diaphragm
- causes left shoulder pain
= pain is elicited in lateral recumbant position with legs raised
If the Kehr’s sign is positive, what does that indicate?
Splenic rupture
With the Kehr’s sign, where will the pain elicited be?
Left shoulder
In what position does the patient have to be in to elicit pain with the Kehr’s sign?
Lateral recumbant with legs raised
2 things that put children at risk for splenic rupture?
Mono
Sports
What is the timeline to return to activities after splenomegaly with non-contact and contact sports?
Non-contact = 3 weeks from onset of symptoms Contact = 4 weeks from onset of symptoms
Order of things to do with a splenectomy?
- Take down ligaments
- Ligate splenic artery and then the splenic vein
What should you make sure to avoid during a splenectomy?
Pancreatic tail
What is a possible complication after a patient has a splenectomy?
OPSI
overwhelming post-splenectomy infection
What type of bacteria can cause OPSI’s?
Encapsulated bacteria that are resistant to opsonization
Describe the symptoms cascade that occurs with OPSI
Vague illness
*2-3 days later
Fulminant (severe) sepsis
When are patients at highest risk for OPSI?
3 years after splenectomy
When are patients at highest risk for OPSI?
3 years after splenectomy
After your patient has a splenectomy, they need to be vaccinated against what 3 encapsulated bacteria?
- Streptococcus Pneumoniae
- Neisseria Meningitidis
- Haemophilus Influenzae B
After your patient has a splenectomy, they need to be vaccinated against what 3 encapsulated bacteria?
- Streptococcus Pneumoniae
- Neisseria Meningitidis
- Haemophilus Influenzae B
If your patient is not vaccinated against the 3 recommended bacteria after a splenectomy, what can occur?
OPSI
After your patient has a splenectomy, what will likely be seen in RBCs?
Howell-jolly bodies
What are Howell-jolly bodies and when will you see them?
DNA inclusions in RBCs
- Seen after someone has a splenectomy
What usually removes Howell-jolly bodies (DNA inclusions in RBCs)?
Spleen
- Thus they will be present after someone has a splenectomy!
