SPLN Flashcards
True of the spleen.
a) largest reticuloendothelial organ
b) arises from the primitive mesoderm
c) evident in an embryo by the 5th week of gestation
d) all of the above
D
Consisting of an encapsulated mass of vascular and lymphoid
tissue, the spleen is the largest reticuloendothelial organ in the
body. Arising from the primitive mesoderm as an outgrowth of
the left side of the dorsal mesogastrium, by the fifth week of
gestation, the spleen is evident in an embryo 8 mm long.
2) The most common anomaly of splenic embrology.
a) large spleen
b) accessory spleen
c) small spleen
d) none of the abov
B
The most common anomaly of splenic embryology is the
accessory spleen. Present in up to 20% of the population, one or
more accessory spleens may also occur in up to 30% of patients
with hematologic disease. Over 80% of accessory spleens are
found in the region of the splenic hilum and vascular pedicle.
3) Average spleen size and weight of a normal spleen.
a) 7-15cm in length, 70-250g
b) 7-21cm in length, 70-150g
c) 7-11 in length, 70-250g
d) none of the above
C
The average adult spleen is 7 to 11 cm in length and weighs 150 g
range, 70 to 250g
4) Definition of splenomegaly
a) 500g or more and 15cm in length
b) 500g or more and 25cm in length
c) 250g or more and 15cm in length
d) 250g or more 25cm in length
A
Most would agree, however, that splenomegaly
applies to organs weighing ≥500 g and/or averaging ≥15 cm
in length.
5) The only vascular ligament of the spleen.
a) splenocolic
b) gastrosplenic
c) phrenosplenic
d) splenorenal
B
Of particular clinical relevance, the spleen is suspended
in position by several ligaments and peritoneal folds to the
colon (splenocolic ligament), the stomach (gastrosplenic ligament),
the diaphragm (phrenosplenic ligament), and the kidney,
adrenal gland, and tail of the pancreas (splenorenal ligament). The gastrosplenic ligament contains the short gastric
vessels; the remaining ligaments are avascular, with rare
exceptions, such as in patients with portal hypertension.
6) Splenic artery is a branch of ____ artery.
a) hepatic artery
b) celiac artery
c) gastric artery
d) none of the above
The spleen derives most of its blood from the splenic
artery, the longest and most tortuous of the three main branches
of the celiac artery.
7) The ff is/are function/s of the spleen.
a) filtration
b) host defense
c) storage
d) cytopoiesis
e) all of the above
E
ppt:
Splenic function has historically been summarized as:
(1) filtration
(2) host defense
(3) storage
(4) cytopoiesis
Most cost-effective modality for spleen imaging.
a) CT
b) plain radiography
c) US
d) MRI
C
ppt:
Ultrasound (US) is the most cost-effective mode of splenic imaging for routine elective splenectomy.The sensitivity of as high as 98%.
What is the Most common indication for open splenectomy ?
Traumatic rupture (iatrogenic or otherwise)
Most common complication for splenectomy.
a) hemorrhage
b) left lung atelectasis
c) pleural effusion
d) pneumonia
Left lower lobe atelectasis is the most common complication
after OS;
The accessory spleen is present in up to __% of the population, one or more accessory spleen (s) may occur in up to __% of patients with hematologic disease
a. 10% and 20%
b. 20% and 30%
c. 30% and 40%
d. 50% and 60^
B
80% of accessory spleens are found in what region?
Splenic hilum and vascular pedicle
What is the average size of the adult spleen? in terms of length?
7-11cm
What is the weight of an average adult’s spleen?
150 g ( 70 - 250 g)
Definition of splenomegaly
> = 500 g, and/or >=15cm in length
To be palpable below the L costal margin a spleen must be at least ____ the normal size
a. 1.5x
b. 2x
c. 3x
d. 4x
B
What are the 4 ligaments of attached to the spleen?
splenocolic
splenorenal
phrenosplenic
gastrosplenic
The splenorenal ligament connects the spleen to these (3) structures
kidney
adrenal gland
tail of the pancrease
(KAT)
What blood vessels are within the gastrosplenic ligaments?
Short gastric vessels
During what condition is there an exception to being avascular of splenorenal, splenocolic and phrenosplenic ligaments?
Portal hypertension
The major blood supply of the spleen is from the ____ which is a branch of the ______
splenic artery
celiac artery
What are the 2 pattens of splenic artery terminal branches?
Distributed and
Magistral
What is the most common pattern of terminal splenic artery branch?
distributed type, 70%
less common: magistral - 30%
splenic artery has Terminal splenic artery branch pattern where a long main trunk dividing near the hilum into short terminal branches, which enter over 25 to 30% of the medial surface of the spleen.
Magistral,
30% of cases
30% of medial surface of the spleen
Major drainage of spleen is via which vein?
splenic vein
What vessels join to form the portal vein?
Splenic vein and SMV
2 main elements of the splenic parenchyma
Red pulp
White pulp
serves as a dynamic filtration system, enabling macrophages to remove microorganisms, cellular debris, antigen/antibody complexes, and senescent erythrocytes from circulation.
a. white pulp
b. red pulp
c. both
d. neither
B
- normally consisting of nodules 1 mm or less in size, can increase to several centimeters in size when nodules coalesce, as occurs with certain lymphoproliferative disorders.
a. white pulp
b. red pulp
c. both
d. neither
A
At the junction between the white and red pulp is the ________,
marginal zone
True about the marginal zone EXCEPT
a. it is the junction between red and white pulp
b. lymphocytes are more compact here
c. Blood is delivered from this zone to the red pulp,
d. home to 2 types of macrophages, marginal zone macrophage and marginal zone metallophilic macrophage,
B. lymphocytes are less aggregated.
Splenic function has historically been summarized as (4)
FCHS filtration cytopoiesis host defense storage
Rate of total splenic inflow of blood
250 to 300 mL/min
The flow of blood is
a. red-pulp - marginal zone - white pulp
b. white-pulp - marginal zone - red pulp
B
The structure and immunophysiology of the white pulp is
very similar to that of lymph nodes. What is there notable difference?
Material enters the lymph node in the lymph whereas
it is delivered to the white pulp in the blood.
The spleen also produces opsonins, tuftsins, and properdin.
Which one is a likely stimulant to general phagocytic funton in the host, and appears to specifically facilitate clearance of bacteria.
a. opsonin
b. tuftsin
c. properdin
B
The spleen also produces opsonins, tuftsins, and properdin.
Which one react with bacteria and make them more susceptible to ingestion by phagocytes.
a. opsonin
b. tuftsin
c. properdin
A
The spleen also produces opsonins, tuftsins, and properdin. Which one is important in the initiation of the alternate pathway of complement activation.
a. opsonin
b. tuftsin
c. properdin
C
True about the spleen EXCEPT
a. splenomegaly alone is an uncommon indication for splenectomy
b. hypersplenism is one of the most common indications for splenectomy
c. hyper splenism is defined as the spleen being 500 g or more and 15cm or more in length
d. NOTA
C. Hypersplenism is defined as the presence of cytopenia in the context of normally responding bone marrow.
Disorders causing hypersplenism can be categorized as either
- normal spleen, increased destruction of abnormal cells
2. primary disorder of spleen, increased sequestration and destruction of normal blood cells
the most cost-effective mode of splenic imaging for routine elective splenectomy.The sensitivity of as high as 98%.
Ultrasound
most common indication for splenectomy
trauma to the spleen
Indications for splenectomy (Red cell disorders)
Acquired/Congenital
Hereditary spherocytosis
Hemoglobinopathies
Autoimmune Hemolytic Anemias
Indications for splenectomy (Platelet Disorders)
- Idiopathic thrombocytopenic Purpura
- Thrombotic thrombocytopenic Pupura
Indications for splenectomy (White Cell Disorders)
- Leukemias
- Lymphomas
Indications for splenectomy (Bone Marrow Disorders)
- CML
- AML
- CMML
- Essential Thrombocytopenia
Indications for splenectomy (MIscellaneous Disorders)
- Storage disdeases
- Feltys’s syndrome - Sarcoidosis
- Portal Hypertension
- Splenic artery aneurysm
preoperative technique became available with advances in angiographic technology. Has an advantage of reduced operative blood loss from a devascularized spleen and reduced spleen size for easier dissection and removal
Splenic artery embolization
Most common organisms responsible for bacterial infections post splenectomy
The most common bacteria are Streptococcus pneumoniae, Haemophilus influenzae type B, and meningococcus.
When should vaccinations be given in a patient who will undergo elective splenectomy? If emergency splenectomy?
2 weeks before
ASAP, 1-2 days for recovery
Booster injections of pneumococcal vaccine should be considered every __ to __ years regardless of the reason for splenectomy?
5 to 6 years
Patients undergoing splenectomy should be treated with DVT prophylaxis. This is done through
sequential compression devices with subcutaneous heparin (5000 U).
Procedure of choice for splenectomy
Laparoscopy
Clinical scenarios wherein open splenectomy is preferred over laparoscopy
- massive 2.splenomegaly
- ascites
- portal hypertension
- multiple prior operations
- extensive
- splenic radiation
- possible splenic abscess
Classification of splenectomy complications (5)
PPHIT
pulmonary, pancreatic, hemorrhagic, infectious, and thromboembolic.
Thromboembolic phenomena occur in what percentage of patients undergoing splenectomy?
5-10%
T/F DVT prophylaxis is recommended routinely
T
