Splenic Disorders

Question 1

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

Answer 1

Marginal zone
PALS
Primary follicles

Question 2

What does the red pulp in the spleen do?

Answer 2

Network that filters RBCs and platelets

Question 3

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

Answer 3

Macrophages that clear debris

Question 4

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

Answer 4

T cells

Question 5

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

Answer 5

B cells that make antibodies

Question 6

Splenomegaly

Answer 6

Enlarged spleen

Question 7

Enlarged spleen

Answer 7

Splenomegaly

Question 8

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

Answer 8

Hypersplenism

Question 9

Hypersplenism

Answer 9

Pathologic splenomegaly where blood cells are removed by the spleen

Question 10

Hypersplenism

Answer 10

Pathologic splenomegaly where blood cells are removed by the spleen

Question 11

3 examples of diseases where Hypersplenism occurs?

Answer 11

Sickle Cell Disease
Hereditary Spherocytosis
ITP (immune thrombocytopenic purpura)

Question 12

With Hypersplenism, splenomegaly is a result of?

Answer 12

Blood cells being removed/degraded by the spleen

Question 13

Physical exam to evaluate the spleen?

Answer 13

Castell’s point

Question 14

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

Answer 14

NO

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

Question 15

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

Answer 15

Ultrasound

Question 16

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

Answer 16

Dark fluid around the spleen

Question 17

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

Answer 17

Yes, start there

Question 18

Most common reason for splenic rupture?

Answer 18

Trauma

Question 19

2 reasons for splenic rupture that are not trauma related?

Answer 19

Splenomegaly

Surgical trauma

Question 20

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

Answer 20

LUQ

Question 21

What is Kehr’s sign?

Answer 21

• 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

Question 22

What is Kehr’s sign?

Answer 22

• 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

Question 23

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

Answer 23

Splenic rupture

Question 24

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

Answer 24

Left shoulder

Question 25

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

Answer 25

Lateral recumbant with legs raised

Question 26

2 things that put children at risk for splenic rupture?

Answer 26

Mono | Sports

Question 27

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

Answer 27

``` Non-contact = 3 weeks from onset of symptoms Contact = 4 weeks from onset of symptoms ```

Question 28

Order of things to do with a splenectomy?

Answer 28

- Take down ligaments | - Ligate splenic artery and then the splenic vein

Question 29

What should you make sure to avoid during a splenectomy?

Answer 29

Pancreatic tail

Question 30

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

Answer 30

OPSI | overwhelming post-splenectomy infection

Question 31

What type of bacteria can cause OPSI's?

Answer 31

Encapsulated bacteria that are resistant to opsonization

Question 32

Describe the symptoms cascade that occurs with OPSI

Answer 32

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

Question 33

When are patients at highest risk for OPSI?

Answer 33

3 years after splenectomy

Question 34

When are patients at highest risk for OPSI?

Answer 34

3 years after splenectomy

Question 35

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

Answer 35

1. Streptococcus Pneumoniae 2. Neisseria Meningitidis 3. Haemophilus Influenzae B

Question 36

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

Answer 36

1. Streptococcus Pneumoniae 2. Neisseria Meningitidis 3. Haemophilus Influenzae B

Question 37

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

Answer 37

OPSI

Question 38

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

Answer 38

Howell-jolly bodies

Question 39

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

Answer 39

DNA inclusions in RBCs | - Seen after someone has a splenectomy

Question 40

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

Answer 40

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