The Spleen

Question 1

What two pulps does the spleen consist of?

Answer 1

Red pulp: sinuses lined by endothelial macrophages and cords

White pulp: similar structure to lymphoid follicles

Question 2

What is the blood supply to the spleen?

Answer 2

Splenic artery

Question 3

Which components of the blood pass through which pulps of the spleen?

Answer 3

White cells and plasma preferentially pass through the white pulp

Red cells preferentially pass through the red pulp

Question 4

What are the two indentations found on the underside of the spleen?

Answer 4

That of the stomach and the colon

Question 5

What effect does an enlarged spleen have on appetite?

Answer 5

It reduced meals, because it pushes on the stomach

Question 6

What is the function of the spleen (in adults)?

Answer 6

1. Sequestration and phagocytosis - abnormal/old red cells removed by macrophages
2. Blood pooling- platelets and red cells can be rapidly mobilised during bleeding (secondary reserve of blood)
3. Extramedullary haemopoiesis - ability to make blood cells if the bone marrow cannot (ie myelofibrosis)/during haematological stress
4. Immunological function- 25% of T cells and 15% of B cells are present in the spleen

Question 7

What is the biggest cause of splenomegaly?

Answer 7

Malaria

Question 8

What is splenomegaly?

Answer 8

Enlarged spleen

Question 9

How can you palpate an enlarged spleen?

Answer 9

Start in the right iliac fossa and move up and right,you will feel the spleen edge move towards tour hand on inspiration (moves down).

Can feel for splenic notch on medial side (blood vessels)

*measure in cm from costal margin in mid-clavicular line

Question 10

Why might cause splenomegaly? (6)

Answer 10

Back pressure (chronic liver disease- portal hypertension)
Over working red pulp
Over working white pulp
Reverting to what it used to do (extramedullary haemopoiesis)
Expanding as infiltrated by cells that shouldn’t be there (cancer cells of blood origin- leukaemia/ other cancer metastases)
Expanding as infiltrated by other material (gauchers disease, sarcoidosis)

Question 11

List some causes of mild splenomegaly

Answer 11

Infectious hep
Endocarditis
Sarcoidosis
Autoimmune diseases

Question 12

List some causes of moderate splenomegaly

Answer 12

Lymphoproliferative disorders,
Myeloproliferative disorders
Liver cirrhosis (with portal hypertension)

Question 13

List some causes of massive splenomegaly

Answer 13

Chronic myeloid leukaemia
Myelofibrosis
Chronic malaria

Question 14

What is hypersplenism?

Answer 14

Over active spleen

Question 15

What can hypersplenism cause?

Answer 15

Pancytopenia or thrombocytopenia (low platelet)

Question 16

What is the risk with splenomegaly?

Answer 16

Risk of rupture as is in no longer protected by rib cage

Question 17

What are the complications of splenomegaly?

Answer 17

Haematoma formation due to rupture leading to anaemia/hypotension

Infarctions can lead to hyposplenic functions (get wedge like areas of white infarction) *sickle cell anaemia can also cause this

Question 18

What is hyposplenism?

Answer 18

Lack of functioning splenic tissue

Question 19

What can cause hyposplenism? (3)

Answer 19

• Splenectomy
• Sickle cell disease in older children and adults (due to multiple infarcts then fibrosis)
• Coeliac disease

Question 20

What are Howell Jolly bodies and what are they a sign of?

Answer 20

DNA remnants in a blood film

Show someone is asplenic or has hyposplenism because either way there shouldn’t be any DNA in the red cells of the blood

Question 21

If someone has hyposplensim, what are they at risk of?

Answer 21

Overwhelming sepsis, particularly from encapsulated organisms eg pneumococcus, haemophilus influenzae and meningococcus