Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Gen Surgery > The spleen > Flashcards

The spleen Flashcards

1
Q

Haematological functions of the spleen

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Immunological function of the spleen

A
  • Removal of bacteria from circulation
  • Opsonin production
  • Antibody production
  • Lymphocyte proliferation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Indications for splenectomy

A
  • Trauma/ disease localized to the spleen or its blood supply
  • Haematological conditions which are potentially curable or ameliorated by splenectomy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How may splenic cysts be classified

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Treatment of congenital cysts

A
  • Small and asymptomatic: Observed

- Large and/or symptomatic: partial or total splenectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Causes of splenic abscess

A
  • Haematogenous bacterial seeding
  • Penetrating trauma
  • Extension of sepsis from an adjacent structure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Clinical features of splenic abscess

A

-fever, left hypochondrium abdominal pain, tenderness or peritonism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Risk factors for splenic abscess

A
  • Sickle cell disease
  • Splenic trauma
  • IV drug abuse
  • Immunodeficiency
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Which groups of patients do splenic artery aneurysms usually occur in?

A

1) elderly patients with atherosclerosis
2) Young females as a congenital condition
3) Complication of acute pancreatitis or pancreatic pseudocysts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How may asymptomatic splenic artery organisms be diagnosed

A
  • Incidentally on abdominal Xray by noting a calcified lesion in the form of an ‘eggshell’ in the left upper quadrant
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

When is surgery for splenic artery aneurysms indicated

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Complications of beneign splenic tumours (Haemangiomas, lymphangiomas)

A

Rupture or thrombocytopaenia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Complications of malignant splenic tumours

A

Rupture or hypersplenism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Types of primary malignant tumours of the spleen

A
  • Non-Hodgkin lymphoma

- Non-lymphoid malignancies eg langiosarcoma, plasmacytoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Types of secondary malignant tumours of the spleen

A

-lung, breast, stomach, pancreas, colon, melanoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Presentation of portal hypertension caused by thrombosis of the splenic vein and treatment of choice

A
  • 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
17
Q

What four scenarios can rupture of the spleen occur in

A
  • 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
18
Q

Clues to splenic injury following trauma

A

-Abdominal pain and tenderness worse in the left hypochondrium, left shoulder tip pain, let rib fractures or an explained low haematocrit

19
Q

Criteria for non operative management of splenic trauma

A
  • 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
20
Q

What does the non-operative management of splenic injury entail

A

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

21
Q

Indications of failure of non operative management of splenic injury

A
  • 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
22
Q

Haematological conditions treated or ameliorated by splenectomy

A
  • Haemolytic anaemias
  • Purpuras
  • Hypersplenism
  • Myeloproliferative disorders
23
Q

What are haemolytic anaemias characterized by

A

anaemia, jaundice, splenomegaly and reticulocytosis

24
Q

What may frequently complicate haemolytic anaemia

A

pigment gallstones

25
Q

When is splenectomy indicated in haemolytic anaemia

A
  • Symptomatic splenomegaly
  • Symptomatic aneamia
  • Hypersplenism and symptomatic cholelithiasis
26
Q

In children with haemolytic anaemia, when should splenectomy be delayed until

A

Until the age of four years

27
Q

Which haemolytic anaemias usually require splenectomy

A
  • Hereditary: Hereditary spherocytosis, hereditary elliptocytosis and thalassaemia major
  • Acquired: Automimmune haemolytic anaemia
28
Q

What is ITP characterized by

A

Abnormal bleeding, low platelet count and a normal bone marrow biopsy

29
Q

Options for medical therapy for ITP

A
  • Corticosteroids
  • Plasmapheresis
  • IV immunoglobulins
  • Eltrombopag
30
Q

When is splenectomy indicated for ITP

A
  • Patients fail to respond to 6 weeks of steroid therapy
  • Cannot tolerate steroids
  • Or if the platelet count falls after tapering of steroid therapy
31
Q

What is hypersplenism characterized by

A

splenomegaly, pancytopaenia and a normal bone marrow biopsy

32
Q

Secondary causes of hypersplenism

A
  • Inflammatory conditions: Rheumatoid arthritis, SLE, Sarcoidosis
  • Chronic infective conditions: Malaria,TB, syphillis
  • Acute infective conditions: Infectious mononucleosis, SBE
  • Congestive splenomegaly: portal hypertension
  • Storage disease
  • Chronic haemolytic anaemias
  • Malignancy: Lymphoma, leukaemia, metastatic carcinoma, myeloproliferative disorders
33
Q

Which organisms should splenectomy patients be vaccinated against

A

-S. Pneumoniae, Haemophilus influenzae and neisseria meningitidis

34
Q

When may an open splenectomy be preferred over a laporoscopic procedure

A
  • presence of massive spleen, portal hypertension or extensive adhesions due to previous abdominal surgery
35
Q

Early post-operative complications of splenectomy

A
  • Haemorrhage, gastric perforation, injury to the tail of the pancreas with resultant pancreatic pseudocyst/ fistula, subphrenic abscess and atelectasis of the lower lobe of the left lung, portal vein thrombosis (rare)
36
Q

Early clinical course of OPSI

A

Mild, non-specific influenza like symptoms, followed by sepsis which may rapidly lead to septic shock and death from multi organ failure

37
Q

Antibiotic prophylaxis in children post-splenectomy

A

Daily dose of penicillin/ amoxicillin in first two years after splenectomy

Gen Surgery (31 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions