Splenomegaly

Question 1

function of the red and white pulp of the spleen

Question 2

what artifact on PBS woud indicate someone had their spleen removed?

Answer 2

a howell-jolly body. Shrinking RBC with evident nucleus.

Question 3

what arteries supply the spleen

Answer 3

splenic artery, trabecular, central, penicilliary, sheather and sinus arteries.

Question 4

most prominent portion of the spleen

Answer 4

Question 5

white pulp contains ___ sheathers around branching arterial cessels.

Primarily contains ___ cells that interact wiht dendritic cells and circulating __ cells.

Answer 5

Question 6

Answer 6

Question 7

role of spleen in fetus

Answer 7

hematopoiesis

Question 8

how does the spleen recycle and break down old blood cells

Answer 8

Question 10

which cell inclusions are removed in the spleen/

Answer 10

Question 11

how does the spleen have immune function

Answer 11

contains lymphoid tissue that has T and B cells/

• T cells act with macrophages to stimulate phagocytosis of blood-bourne bacteria and particulate manner.
• B lymphocytes in white pulp are stimulated by antigens to produce speicfic antibodies
• phagocytosis of antibody coated or complement coated particles.

Question 12

what type of bacteria does the spleen specifically protect against?

Answer 12

encapsulated bactiera. without the spleen, a person is predisoposed to infections of streptococcus pneumoniae, hemophilus influenzae B, and Neisseria meningitidis

Question 13

when would the spleen take on a hematopoietic role in an adult?

Answer 13

in chroonic hemolytic anemia like thalassemia, or in bone marrow disease.

Question 14

how does splenomegaly affect the red cell and platelet and granulocyte pool and storage?

Answer 14

CAN cause one or multiple cytopenias.

Question 15

diagnosing hypersplenism

Answer 15

1. splenomegaly
2. one or more cytpenias (thrombocytopenia, anemia, leukopenia)
3. normal or hypercellular bone marrow
4. normal total body platelets.
   mechanism: increased splenic red cell and platelet pooling, decreased red cell survival.

Question 16

2 areas that can be palpated for splenomegaly

Answer 16

castells and traubes space

Question 17

false positive and negatives during the examination of splenomegaly

Answer 17

false negative: obseity

false positive: recent food intake, pleural effusion or pneumonia, cancer, other masses, stool

Question 18

4 broad reasons for splenomegaly

Answer 18

1. congestive
2. infiltrative
3. nflammatory
4. hemolytic disease.

Question 19

what parts of physical exam or history would lead you to believe splenomegaly cause is congestive?

Answer 19

PE:

• stigamata of chronic liver disease contributing to cirrhosis
• abnormal liver enzymes
• decreased liver function (high INR, low albumin)
• U/s to image spleen and liver to assess blood flow.

History:

• liver disease, drinking, viral hepatitis, thrombosis/thrombophilia
• autoimmune disorders.

Question 20

what parts of PE or history would lead you to think that the splenomegaly is caused by hemolytic disease?

Answer 20

History:

Hx of transfusionss, previous diagnosis of a hemoglobinopathy, recurrent or chronic anemia, jaundice, gall stones, ethnic background.

PE:

• jaundice, pallor, anemia symptoms like fatigue.
• reticulocytosis
• high LDH
• low Hb
• unconjugated hyperbilirubinemia
• low haptoglobin
• sickle cells, red cell inclusions, schistocytes, sphereocytes or elliptocytes etc seen on PBS.

Question 21

causes of hyposplenism and asplenia

Answer 21

Question 22

indications for a splenectomy

Answer 22

1. ITP*
2. hereditery spherocytosis (acquired or congenital– do a DAT test)
3. AIHA
4. severe persistant hypersplenism
5. trauma.

Question 23

what must be done prior to an elective splenectomy as a preventative measure?

Answer 23

vaccinations prior to splenectomy– protect against strep penumo, haemofilus, neisseria meningitidis.