Splenic infarct

Question 1

What is splenic infarct?

Answer 1

• Occlusion of splenic artery resulting in tissue necrosis

Question 2

What ar ethe arterial supplies to spleen?

Answer 2

• Splenic artery (from celiac trunk)
• short gastric artery (from left gastroepiploic artery)

Question 3

What predisposing condition increases rate of splenic infarct?

Answer 3

• Chronic Myelogenous Leukaemia

Question 4

What causes splenic infarct?

Answer 4

• Haematological disorders
  
  • Chronic Myeloid Leukaemia
  • SCD
  • Lymphohma
  • Polycythaemia Rubera Vera
• Embolic disorder
  
  • endocrditis
  • AF
  • infected aneurysm graft

Question 5

What are the clinical features of splenic infarct?

Answer 5

• LUQ pain - radiate to left shoulder
• fever
• N&V
• LUQ tenderness
  *

Question 6

What are the differential diagnosis for splenic infarct?

Answer 6

• PUD
• Pyelonephritis
• Ureteric colic
• Left sided basal pneumonia

Question 7

What Ix would you order for splenic infarct?

Answer 7

• Routine bloods
• Coagulation screen
• CT abdomen c contrast (gold standard)

Question 8

How would you Mx splenic infarct?

Answer 8

• Analegesia
• IV fluids
• Mx underlying cause
• Splenectomy - if sx persist
• Vaccination against s.pneumoniae, h.influenza, n.meningitidis
• long term low dose penicillin V cover

Question 9

Why is splenectomy avoided in splenic infarct?

Answer 9

• risk of overwhelming post splenectomy infection (OPSI)
• Should be delayed until pt >10yrs - ensure appropriate immune response has developed

Question 10

What are the complications of splenic infarct?

Answer 10

• splenic rupture
• splenic abcsess
• pseudocyst formation

Question 11

What is the main cause of splenic abcess?

Answer 11

• from non sterile embolus such as infective endocarditis

Question 12

What is autosplenectomy?

Answer 12

• repeated splenic infarctions > fibrosis and atrophy of spleen > asplenism

Question 13

What is the most common cause of autosplenectomy?

Answer 13

• SCA