the spleen

Question 1

The spleen is an intraperitoneal organ covered with peritoneum over its entire extent, except for a small area at its ___.

Answer 1

hilum

Question 2

The spleen lies in the posterior left hypochondrium between the ___ of the stomach and the diaphragm. It is protected by the rib cage, located along the shaft of the 8th-10th rib.

Answer 2

fundus

Question 3

Ligament between the spleen and kidney that helps support the greater curvature of the stomach

Answer 3

Splenorenal Ligament (lienorenal)

Question 4

-One of the ligaments between the stomach and spleen that helps to hold the spleen in place

Answer 4

Gastrosplenic ligament

Question 5

can be seen between the spleen and the splenic flexure of the colon. It extends from the splenic flexture to the diaphragm.

Answer 5

Phrenicolic ligament

Question 6

Variable size and shape
“___ segment,” tetrahedral, triangular, or wedge shaped
Generally considered to be ovoid with smooth, even borders with convex superior and concave inferior surfaces

Answer 6

orange

Question 7

Normal measurements: In Adults __-__ cm long, ___ cm wide, and ___ to __ cm thick.

Answer 7

8-13 cm long, 7 cm wide, and 3 to 4 cm thick.

Question 8

Blood is supplied to the spleen by the tortuous ___ artery (branch of the Celiac Axis) which travels horizontally along the superior border of the ___

Answer 8

splenic

pancreas

Question 9

Upon entering the hilum, the splenic artery immediately branches into __ or more segmental arteries

Answer 9

6

Question 10

The splenic arteries are subject to___ (obstruction of blood supply causing tissue death

Answer 10

infarction

Question 11

Splenic infarct is the most common cause of ___ ___lesions. It results from occlusion of the splenic artery or one of its branches.

Answer 11

focal splenic

Question 12

Lymph vessels emerge from the splenic hilum, pass through other lymph nodes along the course of the splenic artery, and drain into the ___ ___

Answer 12

celiac nodes.

Question 13

Nerves to the spleen accompany the splenic artery and are derived from the ___ ___

Answer 13

celiac plexus.

Question 14

The classic sonographic appearance of an ___ ___ ___ is a peripheral wedge‐shaped hypoechoic lesion showing diminished flow on Doppler interrogation.

Fresh hemorrhage has a ____ appearance

Healed infarcts tend to be hyperechoic.

___ may become nodular or hyperechoic with time.

Splenic infarcts are almost always the result of emboli that arise in the ___.

Answer 14

acute splenic infarct

hypoechoic

Infarction

heart

Question 15

The splenic vein is formed by multiple branches within the spleen and leaves the hilum in a horizontal direction to join the ____

The splenic vein usually travels along the posteromedial border of the ____

Answer 15

superior mesenteric vein.

pancreas

Question 16

___ vessels emerge from the splenic hilum, pass through other lymph nodes along the course of the splenic artery, and drain into the ___ ___

Nerves to the spleen accompany the splenic artery and are derived from the ___ ___

Answer 16

Lymph

celiac nodes.

celiac plexus.

Question 17

The spleen lies between the left ____ and the stomach

The ___ surface is related to the stomach and lesser sac

The tail of the pancreas approaches the hilum of the spleen___

The left kidney lies ___ and medial to the spleen

Answer 17

hemidiaphragm

medial

medially

inferior

Question 18

A ___ ___ is a rare birth defect of the dorsal mesentery that fails to fuse with the posterior peritoneum.

The supporting ligaments may be absent or underdeveloped.

Answer 18

wandering spleen

Question 19

____ spleen describes a spleen that has migrated from its normal location in the LUQ.

Answer 19

Wandering

Question 20

A wandering spleen is a rare birth defect of the ___ ___ that fails to fuse with the ___ ___

Answer 20

dorsal mesenteryposterior peritoneum.

Question 21

volvulus means

Answer 21

splenic torsion

Question 22

Often call splenule or spenunculus, may be found in up to 30% of patients. Common congenital anomaly

Answer 22

Accessory Spleen

Question 23

results from the failure of fusion of multiple buds of splenic tissue (forming from the dorsal mesogastrium/dorsal mesentery)

It appears as a homogenous pattern isoechoic to splenic tissue

Answer 23

Accessory Spleen

Question 24

accssesory spleen is usually found near the___ or___ border of the spleen, although can be elsewhere in the body

Answer 24

hilum

inferior

Question 25

complete absence of the spleen is rare and by itself causes no difficulties.

Answer 25

Splenic Agenesis (Asplenia)

Question 26

Characterized by multiple small accessory spleens, rather than a single, full sized normal spleen.

It is also rare and sometimes occurs alone with no difficulties.

Answer 26

Polysplenia

Question 27

___ & ____ can be associated with complex cardiac malformations, bronchopulmonary abnormalities, or visceral heterotaxia.

Answer 27

Asplenia and Polyspenia

Question 28

refers to the abnormal arrangement of the internal thoracic and abdominal organs across the R and L axis of the body .

Answer 28

Visceral Heterotaxy (Hetero-different, taxy- arrangement)

Question 29

Asplenia:

May have bilateral ___ sidedness
Two morphologic ___ lungs,

midline location of the liver, reversed position of the abdominal aorta and IVC, anomalous pulmonary venous return,
and
horseshoe kidneys

Answer 29

right

right

Question 30

Polysplenia:

May have bilateral ___ sidedness
Two morphologic ___ lungs,

left-sided azygos continuation of an interrupted inferior vena cava(absent hepatic segment of the IVC), biliary atresia, absence of the gallbladder, gastrointestinal malrotation, cardiovascular abnormalities

Answer 30

left

left

Question 31

Normal arrangement of asymmetric body parts

Answer 31

Situs solitus

Question 32

Mirror image condition.

Answer 32

Situs inversus

Question 33

Describes anatomy that falls in between situs solitus and situs inversus.

Answer 33

Situs ambiguous

Question 34

The spleen is the largest single mass of___ tissue in the body.

Its main function is the filter the___ blood.

It is a soft organ with___ properties that allow it to distend as blood fills the ___ ___

These characteristics are related to the spleen’s function as a blood reservoir.

The normal spleen contains only about 20 to 30 ml of erythrocytes (RBCs).

In splenomegaly, the reservoir function is greatly___, and the abnormally enlarged spleen contains many times the normal volume of red blood cells.

Active in blood formation (___) during the initial part of fetal life until the 5th or 6th month.

Answer 34

lymphoid

peripheral

elastic

venous sinuses.

increased

hematopoiesis

Question 35

Within the lobules of the spleen are tissues called___.

contains both red and white

Answer 35

pulp

Question 36

White pulp:

Consists of splenic nodules, which are similar to those found in lymph nodes and contain large numbers of___;

the lymphocytes of the spleen help defend the body against___.

The spleen plays an important role in the body’s defense against disease.

Answer 36

lymphocytes

infections

Question 37

Red pulp:

Contains relatively large numbers of red blood cells, which are responsible for its color, along with many ___ and___

Answer 37

lymphocytes

macrophages

Question 38

The functions of the Spleen can be classified under two general headings:
those that reflect the___ system and those that are characteristic of the ___ itself.

Answer 38

reticuloendothelial

organ

Question 39

Functions as an organ of the ___ system :

Production of lymphocytes and plasma cells
Production of antibodies
Storage of iron
Storage of other metabolites

Answer 39

reticuloendothelial

Question 40

Functions characteristic of the ___:

Reservoir
Culling
Pitting
Disposal of senescent (old) or abnormal erythrocytes (pitting and culling)
Functions related to platelet and leukocyte lifespan

Answer 40

organ

Question 41

___is the process of removing the nuclei (inclusion body)from the red blood cells.

Answer 41

Pitting

Question 42

___ is the process by which the spleen removes abnormal red blood cells.

Answer 42

Culling

Question 43

With splenomegaly, the splenic pool of platelets may become so large that it produces ___.

Answer 43

thrombocytopenia

Question 44

Due to splenomegaly the spleen will function abnormally and will sequester up to ___% of the platelets, resulting in a decrease in platelets circulating in the blood.

Answer 44

90

Question 45

___ is a condition characterized by abnormally low levels of platelets, also known as thrombocytes, in the blood

Answer 45

Thrombocytopenia

Question 46

___- Indicates the percentage of red blood cells per volume of blood.

Abnormally low readings indicate___ or internal bleeding within the body.

Answer 46

Hematocrit

hemorrhage

Question 47

___- Indicates the presence of bacteria within the body.

The term ___ indicates bacteria in the bloodstream.

Typical symptoms of fever and chills, along with other medical conditions, may indicate the presence of an infection.

Answer 47

Bacteremia

sepsis

Question 48

____- The increase in the number of white cells present in the blood is usually a typical finding in infection.

This finding may also occur after surgery, in malignancies, or in the presence of leukemia

Answer 48

Leukocytosis

Question 49

____- Abnormal decrease in white blood cells

May be secondry to certain medications or ___ ___ disorder

Answer 49

Leukopenia

bone marrow

Question 50

___- Abnormal decrease in platelets

May be the result of internal ___

Answer 50

Thrombocytopenia

hemorrhage

Question 51

Normal texture and patterns:

The splenic parenchyma should have a fine uniform homogeneous mid- to low-level echo pattern, as is seen within the liver parenchyma.

The texture of the spleen is actually considered to be more ___ than the liver.

As the spleen enlarges, the echogenicity ___ further.

Answer 51

echogenic

increases

Question 52

Splenomegaly is diagnosed when the spleen measures more than ___ cm in the adult patient

Answer 52

13

Question 53

___ of the spleen may be found in normal individuals but it may occur in wasting diseases, chronic hemolytic anemia-particularly sickle cell anemia, excessive loss of pulp, increasing fibrosis, scarring from multiple infarcts and incrustation with iron and calcium deposits.

Answer 53

atrophy

Question 54

Advance atrophy is term ____ becomes shrunken and non functional

Answer 54

auto-splenectomy

Question 55

Caused by an obstruction of venous outflow from the spleen

Answer 55

Splenomegaly: Congestion of the Spleen

Question 56

Active hyperemia accompanies the reaction in the moderately enlarged spleen.

Answer 56

Acute congestion

Question 57

Diffuse enlargement of the spleen

Answer 57

Chronic venous congestion

Question 58

A disease that occurs when substances called amyloid proteins build up in the organs

Amyloid is an abnormal protein that is usually produced in the ___ ___ and may be deposited in any tissue or organ.

The spleen is the most frequently involved organ

Two types of involvement are seen ____ & ___

Answer 58

amyloidosis

bone marrow

nodular and diffuse

Question 59

Amyloid is found in the walls of the sheathed arteries and in the follicles (malpighian corpuscles) but not in the red pulp.

Answer 59

Nodular

Question 60

Follicles (malpighian corpuscles) are not involved; the red pulp is prominently involved, and the spleen is usually greatly enlarged and firm.

Answer 60

Diffuse

Question 61

Disease in which fat-laden Gaucher cells build up in organs, typically the liver and spleen.
This can cause the organ to enlarge and affect their function

Approximately 50% of patients are under 8 years of age, and 17% are under 1 year of age.

Clinical features follow a chronic course, with bone pain and changes in skin pigmentation.

Answer 61

Gaucher’s Disease

Question 62

A rare, inherited disease that affects the body’s ability to metabolize fat within cells.

A rapidly fatal disease that predominantly affects female infants

Clinical features consist of hepatomegaly, digestive disturbances, and lymphadenopathy

Answer 62

NIEMANN-PICK, storage disease

Question 63

An inherited disease characterized by red blood cells that become misshapen or contort into a sickle shape.

These cells become hard and sticky and have trouble moving through small blood vessels.

Answer 63

Sick Cell Anemia

Question 64

Sickle cells break apart easily and die early , leaving a shortage of healthy RBC’s causing ___

In its early stages, as seen with infants and children, the spleen is enlarged with significant congestion of the red pulp.

Answer 64

anemia

Question 65

The spleen undergoes progressive infarction and fibrosis and decreases in size until, in adults, only a small mass of fibrous tissue may be found (____).

Answer 65

autosplenectomy-sickle cell

Question 66

Is a painful episode that may begin suddenly in a person, usually children, who have sickle cell disease

Occurs when sickle shaped RBC’s ___ together and___ small blood vessels that carry blood to certain organs, muscles, and bones. This causes mild to severe pain

Answer 66

Sickle Cell Crisis

clump

block

Question 67

___ sickle cell crisis commonly occurs in children with___ (two mutated genes) sickle cell disease with splenomegaly and a sudden decrease in___ (Splenic Sequestration Crisis).

This is caused by a blockage of the blood vessels leading out of the spleen. Blood___ in the spleen instead of flowing through it. This accounts for the splenomegaly and drop in hematocrit. This can be life threatening.

In addition, these patients may develop a subacute___ that appears as a hypoechoic area in the periphery of the spleen.

Answer 67

Acute

homozygous

hematocrit

stays

hemorrhage

Question 68

Disorder of chronic premature destruction(hemolysis)of RBC’s

Anemia may be minimal or absent, reflecting the ability of the bone marrow to increase production of red blood cells.

When the rate of destruction is greater than what the bone marrow can compensate for then anemia occurs (condition in which the blood does not have enough healthy RBC’s)

Answer 68

Hemolytic Anemia

Question 69

Disorder characterized by a malfunction of the immune system that produces autoantibodies which attack RBC’s as if they were foreign to the body.

Splenomegaly may be present

Answer 69

Autoimmune Hemolytic Anemia

Question 70

type of blood cancer of unknown cause involving all bone marrow elements.

Characterized by an increase in RBC mass and hemoglobin (red protein responsible for transporting O2) concentration.

These excess cells thicken the blood, slowing its flow and can cause serious complications such as blood clots.

A Chronic disease, rare and develops very slowly. Some people have it for years without knowing

Sonographic findings:
Splenomegaly
Infarctions and thrombosis are common.

Answer 70

Polycythemia Vera

Question 71

An inherited disorder in which the body makes an abnormal form or inadequate amount of hemoglobin(protein in RBC that carries O2).

Not only are the RBCs deficient in normal hemoglobin but also in shape.

The lifespan of RBCs is short because they are destroyed by the spleen in large numbers.
The sonographic finding is a very large spleen.

Answer 71

Thalassemia

Question 72

is associated with a MASSIVE spleen

Answer 72

Myelofibrosis

Question 73

Reactive hyperplasia, resulting from acute or chronic infection after exposure to histoplasmosis (fungal infection) , TB and rarely sarcoidosis

___ form when the immune system attempts to wall off substances it perceives as foreign but is unable to eliminate.

Patients who have had a previous granulomatous infection may have bright echogenic lesions on ultrasound, with or without shadowing which represent the walled off areas of prior infection.

Answer 73

Granulocytopoietic Abnormalities

Granulomas

Question 74

Includes diseases characterized by reticuloendothelial hyperactivity and varying degrees of lipid storage in phagocytes

Sonographic findings:
Spleen appears isoechoic with the liver

Answer 74

RETICULOENDOTHELIOSIS

Question 75

Uncommon, due to the phagocytic activity of the spleen’s efficient reticuloendothelial system.

Clinical symptoms: fever, LUQ tenderness, splenomegaly

Sonographic findings:
Simple cystic to mixed echo pattern
Lesion may be hypoechoic, often with a hyperechoic foci that represent debris or gas.

Other findings:
Thick or shaggy walls
Anechoic appearance (without echoes within a mass)

Poor definition of the lesion

Increased-to-decreased transmission (depending on the presence of gas)

Answer 75

Splenic Abscess

Question 76

show irregular masses within the spleen with the “wheels-within-wheels” pattern.

Other patterns include “bulls eye” pattern, hypoechoic or hyperechoic nodules.

Answer 76

Hepatosplenic Candidiasis (fungal

Question 77

Patients with___ infections show tiny diffuse echogenic foci throughout the spleen.

Answer 77

microbacterial

Question 78

The most common finding with AIDS patients is___. There may be multiorgan infectious involvement.(Liver, kidneys, spleen)

Answer 78

splenomegaly

Question 79

The spleen is most commonly injured as a result of blunt abdominal trauma.

If the patient has severe left upper quadrant pain secondary to trauma, a splenic ___ & ___ should be considered.

reatment is with observation, surgical repair, or rarely splenectomy.

Answer 79

hematoma or subcapsular hematoma

Question 80

In cases of splenic trauma, a quick assessment of all___ quadrants to access for ___ ___ can be performed.

Access splenic area for free fluid that may surround the splenic capsule or evidence of splenic hematoma or rupture.

This can lead to a life-saving diagnosis for the patient.

*The entire screening examination should take less than 5 minutes.

Answer 80

4

free fluid

Question 81

Fresh hemorrhage may appear___.

Double-contour sign depicts hematoma as separate from the spleen.

Answer 81

hypoechoic

Question 82

A___ cyst is seen as an anechoic smooth bordered mass.

If complicated may have septations with internal echoes and a thick wall.

Answer 82

congenital

Question 83

An___ cyst is considered posttraumatic because they can be caused by trauma, infection or infarction. On ultrasound they appear as anechoic or mixed homo

Answer 83

acquired

Question 84

is the only parasite that forms splenic cysts; it is uncommon in the United States.

Answer 84

Echinococcus

Question 85

Parasitic cysts appear as anechoic lesions with possible___ cysts and calcification or as solid masses with fine internal echoes and poor distal enhancement.

Answer 85

daughter

Question 86

Patient is asymptomatic.

Consists of lymphoid tissue or a combination of sinuses and structures equivalent to pulp cords of normal splenic tissue.

Tumor may be solitary or multiple and is considered well-defined but not encapsulated.

Answer 86

HAMARTOMA

Question 87

The most common benign tumor of the spleen.

Usually isolated, inhomogeneous, echogenic mass with multiple small hypoechoic areas

Can become symptomatic when the size of the spleen increases and compresses other organs.

Complications occur when the tumor increases in size to cause a splenic rupture with peritoneal symptoms.

Answer 87

CAVERNOUS HEMANGIOMA

Question 88

Is a benign malformation of lymphatic vessels, consisting of endothelium-lined cystic spaces that vary in size.

If the cyst are large enough, they may be anechoic; however, if they are multiple and grouped close together, they may appear as a solid lesion.

This condition may involve multiple organ systems or may be confined to solitary organs.

Answer 88

Cystic Lymphangioma

Question 89

Primary splenic tumors are rare; may be benign or malignant.

Primary tumors: include lymphoma, Hodgkin tumor, and hemangiosarcoma.

Hemangiosarcoma is a malignant neoplasm arising from the vascular endothelium of the spleen.

Answer 89

Hemangiosarcoma

Question 90

The most common malignant tumor is ___ & ___ lymphoma

Answer 90

Hodgkin’s and non-Hodgkin’s

Question 91

Four different sonographic patterns have been cited in patients with malignant lymphoma:

Diffuse involvement
Focal small nodular lesions
Focal large nodular lesions
Bulky disease

Answer 91

Lymphoma

Question 92

The spleen is the tenth most common site of ___, which may originate from the breast, lung, ovary, stomach, colon, kidney, or prostate, as well as from melanoma.

tumors may be microscopic, causing no symptoms.

Answer 92

metastases