Splenic infarct and rupture Flashcards
Pathophysiology of splenic infarct
Occlusion of the splenic artery causing necrosis
Blood supply to spleen
Splenic artery - from the coeliac axis
Short gastric arteries - from left gastroepiploic artery
Infarction is often not complete due to collateral circulation
Predisposing condition for infarction
Haematological:
- CML
- Sickle cell disease
- Polycythaemia
- Lymphoma
Embolic:
- endocarditis
- AF
- post MI mural thrombus
- infected aneurysm grafts
Clinical features of splenic infarction
LUQ abdominal pain - radiate to the left shoulder.
Less common symptoms:
- fever
- nausea or vomiting
- pleuritic chest pain
Can be completely asymptomatic
On examination:
LUQ tenderness
Investigations for splenic infarct
Routine bloods
Obs
Gold standard: CT abdo with contrast
Management of splenic infarction
No specific treatment - monitor regularly for haemodynamic stability
Prophylactic vaccination
Vaccinated against:
S. pneumoniae
N. mengitidis
H. influenza
When hyposplenic
With low dose penicillin cover
Complications of splenic infarction
Splenic abscess - if due to infective endocarditis
Auto splenectomy - asplenism
Causes of splenic rupture
Commonly due to abdominal trauma
Can be due to:
Iatrogenic cause
EBV
Clinical features of splenic rupture
Abdominal pain
Hypovolaemic shock
May have LUQ tenderness +/- peritonism
Radiating left shoulder pain
When is immediate laparotomy required
Haemodynamically unstable with peritonism
Haemodynamically stable with suspected abdominal injury Ix
Urgent CT chest-abdomen-pelvis with IV contrast
Mx of splenic rupture
ATLS
Grade 5 (a shattered spleen or major hilar vascular injury): - urgent laparotomy
Haemodynamically stable patients with grade 1–3 injuries:
- treated conservatively on HDU
- bed rest and have a repeat CT scan at 1-week post-injury
Kehr’s sign
Left shoulder pain due to ruptured spleen
