Splenomegaly Flashcards
The outside is a (1) capsule and the inside has (2)
- fibrous
2. reddish areas known as red pulp and whitish areas known as white pulp.
In general, the red pulp is the (1) filled region which tests the age and viability of (1); and the white pulp has (2) and (3)
- RBC
- lymphoid nodules for B lymphocytes
- periarteriolar lymphatic sheath for T lymphocytes.
Closed areas of the red pulps have (1) which are separated by (2) which create a functional filter for deforming and testing red cells leading to removal of?
- numerous thin walled vascular discontinuous sinusoids
- splenic cords of Bilroth
- removal of abnormal RBCs
Red blood cells have about a (1) life span but gradually become less deformable with aging and are eliminated by (2).
- 120 day
2. the spleen
The white pulp is a location for (1)
- immune responses against blood-borne infections.
(1) are present in lymphoid nodules which become (2) following antigen stimulation.
- B lymphocytes
2. germinal center
Antigen stimulation: a specific antigen reacts with activated B cells expressing (1) which migrates from the site of infection to a (2) and proliferate within the (3)
- a surface immunoglobulin
- follicle
- germinal center.
Following antigen stimulation, the monoclonal expansion then becomes (1) because of (2) of the light and heavy chain sequences that create some diversity of clones within the (3).
- polyclonal
- somatic hypermutations
- germinal center
Following antigen stimulation, although all still react with the same antigen they no longer all have the same (1) and there is some selection for improving antibody binding to the antigen by complex processes: (2) provide survival signals to prevent (3) from apoptosis but allow (4) to apoptose.
- avidity
- follicular dendritic cells
- high affinity antibodies
- lower affinity antibodies
The IgM antibody present prior to class switching is important for (1); this process actively occurs in the (2)
- opsonization
2. spleen.
(1) of (2) organisms marks them for destruction by the immune system and this loss of (1) may explain why patients with splenectomy are at much higher risks of infection with (2) organsms
- Opsonization
2. encapsulated
Class switching also occurs as the initial IgM antibodies can become (1) based on further heavy chain DNA recombinations which occur based on interactions with (2)
- IgD, IgA, or IgG
2. helper T cells.
Following class switching, the B cells become either (1) or (2) which produce large amounts of antibody which is then secreted into the circulation.
- antigen reactive memory cells
2. plasma cells
Why are patients who have splenectomy given vaccines?
Given vaccines against bacterial encapsulated organisms
such as pneumococcus or menigococcus, because opsonization which marks encapsulated bacteria for destruction occurs in the spleen
Although the spleen is highly vascular, splenic infarcts are seen on occasion, and are (1) shaped
- wedge
The recent splenic infarcts tend to be (1) whereas the older more fibrotic infarcts tend to be (2) in color.
- red due to hemorrhage
2. pale gray or white
Microscopically the recent splenic infarcts show (1)
- coagulative necrosis with cell outlines lacking nuclei
Most patients with sickle cell anemia have had so many (1) that their spleens appear (2). This situation is referred to as (3)
- splenic infarcts
- small and fibrotic and are not functional.
- autosplenectomy
Infections of (1) or other infections which spread through the blood can lead to acute inflammation of the spleen with (2) which is known as acute splenitis.
- heart valves (endocarditis)
2. abundant neutrophils
Acute splenitis can progress to a (1) if the neutrophils are walled off by (2) and inflammation.
- splenic abcess
2. fibroblasts
Like any abcess the fibrous wall can make (1) treatment very difficult.
- antibiotic
(1) is a fairly common disorder in which there can be very large spleens. It is caused by the (2) virus and produces (3)
- Infectious mononucleosis
- Epstein-Barr
- atypical B lymphocytes.
Other symptoms of mononucleosis
headache, sore throat, fever, tonsillitis, hepatitis, lymphadenopathy, nausea, vomiting, and a generalize fatigue.
The splenomegaly can lead to rupture which is a potential abdominal emergency and often treated surgically
infectious mononucleosis
Some of the largest spleens seen in benign conditions are seen in (1) which has a diagnostic triad of (2)
- Felty syndrome
2. rheumatoid arthritis, splenomegaly and granulocytopenia
These patients have (1) sequestration and antibodies to (2) which inhibit (3) maturation.
- WBC
- G-CSF
- granulocyte
refers to Felty syndrome
They can often have cutaneous ulcers particularly of the malleoli of the feet.
Felty syndrome
Another inflammatory disease which can affect the spleen is (1) which usually presents a (2) within the spleen if the spleen is affected.
- SLE
2. vasculitis
Splenic SLE histology: (1) of the blood vessels and (2) in the capsule and (3) of the penicilliary arteries and central arterioles of the (4)
- fibrinoid necrosis
- collagen
- onion-skin proliferative thickening
- white pulp
granulocytopenia
fewer neutrophils
fibrinoid necrosis of the blood vessels and collagen in the capsule and onion-skin proliferative thickening of the penicilliary arteries and central arterioles of the white pulp
splenic SLE
coagulative necrosis with cell outlines lacking nuclei
splenic infarcts
spleens appear small and fibrotic
SCD
(1) due to hepatic cirrhosis or thromboembolic causes can cause splenomegaly resulting in hypersplenism.
- Portal hypertension
In this disorder and other causes of predominantly increased (1) splenomegaly there is often increased (2) because of programmed transit time within the spleen.
- red pulp
2. removal of erythrocytes and platelets; refers to portal HTN
Microscopically the splenic sinusoids are dilated and have thickened walls with increased macrophages.
portal hypertension
Focal hemorrhages occurring due to removal and sequestration of red cells lead to the formation of (1) which are called (2)
- fibrotic iron-laden nodules
- Gamna-Gandy bodies
refers to portal HTN
Microscopically, the (1) are dilated, and their walls are (2) by fibrous tissue and lined by (3)
- splenic sinusoids
- thickened
- hyperplastic endothelial cells and macrophages
refers to portal HTN
A number of (1) conditions cause splenomegaly because the spleen becomes infiltrated by the (2) cells.
- malignant lymphomas and myeloproliferative
2. malignant
lysosomal storage diseases have incompletely metabolized (1)
- lipids
The lysosomal storage diseases have expansion of the (1) with (2) filled with undigestible material.
- red pulp
2. macrophages
Gaucher disease the undigestible material is ?
glucocerebroside
Niemann-Pick the undigestible material is ?
sphingomyelin.
Mucopolysaccharidoses
Hunter’s and Hurler’s syndromes.
Red pulp contains (1) connected through long dendritic processes
- macrophages
Splenectomy leads to increased levels of?
RBCs, WBCs, and platelets
Blood supply of spleen: The (1) artery comes in and divides into central arteries, and ultimately to (2) arterioles which lead to the (3). In the open circulation, (4) then bring back (this is the open circulation)
- trabecular
- penicilliary
- splenic cords
- venous sinusoids
Infections can cause splenomegaly; acute causes tend to be (1) whereas chronic causes tend to be (2)
- bacterial
2. viral
Infiltration of the (1) systems and of (2) weakens the supporting structure of the spleen and accounts for traumatic splenic rupture
- capsular and trabecular
- blood vessels
refers to infectious mononucleosis
transformed lymphocytes (immunoblasts) prominently infiltrate red pulp
infectious mononucleosis
characterized by fibrinoid necrosis of capsular and trabecular collagen and concentric, or “onion skin,” thickening of the penicilliary arteries and central arterioles of the white pulp
splenic SLE
attributed to an increased rate of removal of erythrocytes, leukocytes, and platelets because of prolonged transit time
Hypersplenism
gross spleen is firm and enlarged, cut surface uniformly deep red, with an inapparent white pulp
portal HTN
Microscopically, the splenic sinusoids are dilated, and their walls are thickened by fibrous tissue and lined by hyperplastic endothelial cells and macrophages
portal HTN
found in any situation (not just spleen) in which focal hemorrhages lead to fibrosis
Gamna-Gandy bodies
splenomegaly in young children with neurological issues
Tay-Sachs
spleen appears like crinkled paper
Gaucher
spleen appears foamy
Niemann Pick
