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SBL > Splenic Disorders > Flashcards

Splenic Disorders Flashcards

1
Q

The spleen has red and white pulp. What 3 things make up the white pulp?

A

Marginal zone
PALS
Primary follicles

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2
Q

What does the red pulp in the spleen do?

A

Network that filters RBCs and platelets

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3
Q

What does the marginal zone (part of the white pulp) in the spleen do?

A

Macrophages that clear debris

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4
Q

What does the PALS (part of the white pulp) in the spleen contain?

A

T cells

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5
Q

What does the primary follicles (part of the white pulp) in the spleen contain and make?

A

B cells that make antibodies

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6
Q

Splenomegaly

A

Enlarged spleen

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7
Q

Enlarged spleen

A

Splenomegaly

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8
Q

What is a type of splenomegaly that is a pathologic condition?

A

Hypersplenism

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9
Q

Hypersplenism

A

Pathologic splenomegaly where blood cells are removed by the spleen

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10
Q

Hypersplenism

A

Pathologic splenomegaly where blood cells are removed by the spleen

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11
Q

3 examples of diseases where Hypersplenism occurs?

A

Sickle Cell Disease
Hereditary Spherocytosis
ITP (immune thrombocytopenic purpura)

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12
Q

With Hypersplenism, splenomegaly is a result of?

A

Blood cells being removed/degraded by the spleen

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13
Q

Physical exam to evaluate the spleen?

A

Castell’s point

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14
Q

If the pre-test probability of splenomegaly is LOW, should you perform palpation and percussion?

A

NO

- They are not sensitive enough to rule in/out splenomegaly

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15
Q

If the pre-test probability of splenomegaly is LOW, what imaging should you obtain?

A

Ultrasound

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16
Q

On an ultrasound of the spleen, what should you NOT see?

A

Dark fluid around the spleen

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17
Q

If the pre-test probability of splenomegaly is HIGH, should you perform palpation and percussion?

A

Yes, start there

18
Q

Most common reason for splenic rupture?

19
Q

2 reasons for splenic rupture that are not trauma related?

A

Splenomegaly

Surgical trauma

20
Q

With a splenic rupture, where will the pain most likely be?

21
Q

What is Kehr’s sign?

A
  • 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
22
Q

What is Kehr’s sign?

A
  • 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
23
Q

If the Kehr’s sign is positive, what does that indicate?

A

Splenic rupture

24
Q

With the Kehr’s sign, where will the pain elicited be?

A

Left shoulder

25
Q

In what position does the patient have to be in to elicit pain with the Kehr’s sign?

A

Lateral recumbant with legs raised

26
Q

2 things that put children at risk for splenic rupture?

A

Mono

Sports

27
Q

What is the timeline to return to activities after splenomegaly with non-contact and contact sports?

A 
Non-contact = 3 weeks from onset of symptoms
Contact = 4 weeks from onset of symptoms
28
Q

Order of things to do with a splenectomy?

A
  • Take down ligaments

- Ligate splenic artery and then the splenic vein

29
Q

What should you make sure to avoid during a splenectomy?

A

Pancreatic tail

30
Q

What is a possible complication after a patient has a splenectomy?

A

OPSI

overwhelming post-splenectomy infection

31
Q

What type of bacteria can cause OPSI’s?

A

Encapsulated bacteria that are resistant to opsonization

32
Q

Describe the symptoms cascade that occurs with OPSI

A

Vague illness
*2-3 days later
Fulminant (severe) sepsis

33
Q

When are patients at highest risk for OPSI?

A

3 years after splenectomy

34
Q

When are patients at highest risk for OPSI?

A

3 years after splenectomy

35
Q

After your patient has a splenectomy, they need to be vaccinated against what 3 encapsulated bacteria?

A
  1. Streptococcus Pneumoniae
  2. Neisseria Meningitidis
  3. Haemophilus Influenzae B
36
Q

After your patient has a splenectomy, they need to be vaccinated against what 3 encapsulated bacteria?

A
  1. Streptococcus Pneumoniae
  2. Neisseria Meningitidis
  3. Haemophilus Influenzae B
37
Q

If your patient is not vaccinated against the 3 recommended bacteria after a splenectomy, what can occur?

38
Q

After your patient has a splenectomy, what will likely be seen in RBCs?

A

Howell-jolly bodies

39
Q

What are Howell-jolly bodies and when will you see them?

A

DNA inclusions in RBCs

- Seen after someone has a splenectomy

40
Q

What usually removes Howell-jolly bodies (DNA inclusions in RBCs)?

A

Spleen

- Thus they will be present after someone has a splenectomy!

SBL (48 decks)

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