The spleen Flashcards
Haematological functions of the spleen
- Removal of aged and deformed red blood cells from circulation
- Removal of platelets and leucocytes from circulation if abnormal or coated with antibodies
- Extramedullary haematopoiesis in certain pathological states
- Platelet resevoir
Immunological function of the spleen
- Removal of bacteria from circulation
- Opsonin production
- Antibody production
- Lymphocyte proliferation
Indications for splenectomy
- Trauma/ disease localized to the spleen or its blood supply
- Haematological conditions which are potentially curable or ameliorated by splenectomy
How may splenic cysts be classified
- Congenital: have an epithelial lining and may be simple / epidermoid/ dermoid
- Hydatid cysts: echinococcus Granulosis infestation
- Pseudocysts; no epithelial lining and form after the resolution of a haematoma, splenic infarction with liquefactive necrosis, Tb or syphillis
Treatment of congenital cysts
- Small and asymptomatic: Observed
- Large and/or symptomatic: partial or total splenectomy
Causes of splenic abscess
- Haematogenous bacterial seeding
- Penetrating trauma
- Extension of sepsis from an adjacent structure
Clinical features of splenic abscess
-fever, left hypochondrium abdominal pain, tenderness or peritonism
Risk factors for splenic abscess
- Sickle cell disease
- Splenic trauma
- IV drug abuse
- Immunodeficiency
Which groups of patients do splenic artery aneurysms usually occur in?
1) elderly patients with atherosclerosis
2) Young females as a congenital condition
3) Complication of acute pancreatitis or pancreatic pseudocysts
How may asymptomatic splenic artery organisms be diagnosed
- Incidentally on abdominal Xray by noting a calcified lesion in the form of an ‘eggshell’ in the left upper quadrant
When is surgery for splenic artery aneurysms indicated
- Aneurysms which are symptomatic and/or larger than 2 cm
- Surgery is recommended for all young females who aim to become pregnant or are in their first two trimesters of pregnancy
Complications of beneign splenic tumours (Haemangiomas, lymphangiomas)
Rupture or thrombocytopaenia
Complications of malignant splenic tumours
Rupture or hypersplenism
Types of primary malignant tumours of the spleen
- Non-Hodgkin lymphoma
- Non-lymphoid malignancies eg langiosarcoma, plasmacytoma
Types of secondary malignant tumours of the spleen
-lung, breast, stomach, pancreas, colon, melanoma
Presentation of portal hypertension caused by thrombosis of the splenic vein and treatment of choice
- Segmental form of portal hypertension along the greater curvature of the stomach
- Gastric varices and splenomegaly are prominent, while oesphageal varices are uncommon
- Splenectomy and devascularisation of the greater curvature of the stomach is the treatment of choice
What four scenarios can rupture of the spleen occur in
- Blunt abdominal trauma
- Penetrating abdominal trauma to the left lower chest, left flank and left hypochondrium
- Iatrogenic trauma due to traction on its ligamentous attachments during surgical procedures eg left hemicolectomy
- Spontaneous rupture of pathological spleen
Clues to splenic injury following trauma
-Abdominal pain and tenderness worse in the left hypochondrium, left shoulder tip pain, let rib fractures or an explained low haematocrit
Criteria for non operative management of splenic trauma
- no clinical or radiological indication for a laporotomy
- No ongoing blood transfusion requirement attributed to splenic injury
- patients should be monitored in a high care environment
- Constant availability of a surgeon in case of sudden deterioration as a result of bleeding
What does the non-operative management of splenic injury entail
Bed rest, regular abdominal examination and serial haematocrit estimation is recommended during a 96 hour observation period. Successfully managed patients are advised to avoid contact sports for 3 - 6 months
Indications of failure of non operative management of splenic injury
- Development of peritoneal irritation
- Development of haemodynamic instability
- Development of increase IV fluid requirement to maintain haemodynamic instability
- Drop in haematocrit requiring transfusion of more than two units of packed red cells
Haematological conditions treated or ameliorated by splenectomy
- Haemolytic anaemias
- Purpuras
- Hypersplenism
- Myeloproliferative disorders
What are haemolytic anaemias characterized by
anaemia, jaundice, splenomegaly and reticulocytosis
What may frequently complicate haemolytic anaemia
pigment gallstones
