Splenomegaly Flashcards
function of the red and white pulp of the spleen
what artifact on PBS woud indicate someone had their spleen removed?
a howell-jolly body. Shrinking RBC with evident nucleus.
what arteries supply the spleen
splenic artery, trabecular, central, penicilliary, sheather and sinus arteries.
most prominent portion of the spleen
white pulp contains ___ sheathers around branching arterial cessels.
Primarily contains ___ cells that interact wiht dendritic cells and circulating __ cells.
role of spleen in fetus
hematopoiesis
how does the spleen recycle and break down old blood cells
which cell inclusions are removed in the spleen/
how does the spleen have immune function
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.
what type of bacteria does the spleen specifically protect against?
encapsulated bactiera. without the spleen, a person is predisoposed to infections of streptococcus pneumoniae, hemophilus influenzae B, and Neisseria meningitidis
when would the spleen take on a hematopoietic role in an adult?
in chroonic hemolytic anemia like thalassemia, or in bone marrow disease.
how does splenomegaly affect the red cell and platelet and granulocyte pool and storage?
CAN cause one or multiple cytopenias.
diagnosing hypersplenism
- splenomegaly
- one or more cytpenias (thrombocytopenia, anemia, leukopenia)
- normal or hypercellular bone marrow
- normal total body platelets.
mechanism: increased splenic red cell and platelet pooling, decreased red cell survival.
2 areas that can be palpated for splenomegaly
castells and traubes space
false positive and negatives during the examination of splenomegaly
false negative: obseity
false positive: recent food intake, pleural effusion or pneumonia, cancer, other masses, stool
4 broad reasons for splenomegaly
- congestive
- infiltrative
- nflammatory
- hemolytic disease.
what parts of physical exam or history would lead you to believe splenomegaly cause is congestive?
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.
what parts of PE or history would lead you to think that the splenomegaly is caused by hemolytic disease?
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.
causes of hyposplenism and asplenia
indications for a splenectomy
- ITP*
- hereditery spherocytosis (acquired or congenital– do a DAT test)
- AIHA
- severe persistant hypersplenism
- trauma.
what must be done prior to an elective splenectomy as a preventative measure?
vaccinations prior to splenectomy– protect against strep penumo, haemofilus, neisseria meningitidis.
