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3: MED2 Y3 - Gastrointestinal [7] > [4] Splenic Infarct > Flashcards

[4] Splenic Infarct Flashcards

(58 cards)

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1
Q

What causes a splenic infarct?

A

Occlusion of the splenic artery, or one of its branches, resulting in tissue necrosis

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2
Q

What is the cause of a splenic infarct?

A

It is caused by many separate pathophysiological processes

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3
Q

What provides the blood supply to the spleen?

A

The splenic artery and the short gastric arteries

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4
Q

Where does the splenic artery come from?

A

Coeliac axis

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5
Q

Where do the short gastric arteries come from?

A

The left gastroepiploic artery

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6
Q

What is the result of the spleen being supplied with blood from multiple arteries?

A

Infarction is often not complete due to collateral circulation

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7
Q

Are splenic infarctions common?

A

No, they are rare events

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8
Q

Give an example of a condition that has a high incidence of splenic infarcts?

A

Chronic myelogenous leukaemia (72%)

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9
Q

Are splenic infarcts always symptomatic?

A

No

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10
Q

What are the most common causes of splenic infarcts?

A

Haemotological disease or thromboembolism

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11
Q

What is a more common cause of splenic embolism, haemotological disorders or embolic disorders?

A

Haemotological disorders

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12
Q

What haemotoloical disorders can cause splenic infarction?

A 
Leukaemia or lymphoma
Myelofibrosis
Sickle Cell Disease
Chronic Myeloid Leukaemia
Polycythaemia Rubra Vera
Hypercoaguable states
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13
Q

What embolic disorders can lead to splenic infarction?

A

Endocarditis
AF
Infected aneurysm grafts
Post-MI mural thrombus

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14
Q

What are some rarer causes of splenic infarction?

A

Vasculitis
Trauma
Collagen tissue defects
Surgery

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15
Q

What kinds of trauma can cause splenic infarction?

A

Blunt trauma, or torsion of a ‘wandering’ splenic artery

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16
Q

What surgeries can cause splenic infarction?

A

Pancreatectomy

Liver transplantation

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17
Q

How does haematological disease cause splenic infarction?

A

Through congestion of the splenic circulation by abnormal cells

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18
Q

What often confounds splenic infarction caused by haematological disease in conditions such as CML or myelofibrosis?

A

Anaemia and splenomegaly

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19
Q

How will symptomatic splenic infarct patients classically present?

A

Left upper quadrant abdominal pain, radiating to the left shoulder (Kehr’s sign)

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20
Q

What are the less common symptoms of splenic infarcts?

A

Fever

Nausea and vomiting

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21
Q

How can splenic infarcts be diagnosed if they are asymptomatic?

A

Purely by imaging or laparotomy/laparoscopy

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22
Q

What is commonly found on examination with splenic infarcts?

A

LUQ tenderness

Other signs may be present depending on any complications that may have developed

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23
Q

What are the differential diagnoses of splenic infarcts?

A

The most important differentials to consider for LUQ pain include;
Peptic ulcer disease
Pyelonephritis or ureteric colid
Left sided basal pneumonia

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24
Q

What is the gold standard investigation for suspected splenic infarction?

Study These Flashcards
A

CT abdominal scan with IV contrast

25
What routine bloods should be performed in suspected splenic infarction?
FBC U&E LFTs Coagulation screen
26
When are bloods particularly useful for the diagnosis of splenic infarction?
If a haemotological or thromboembnolic cause is suspected
27
What may be found on bloods with splenic infarction?
WCC is high in around half of cases | Raised d-dimer levels may aid diagnosis
28
How does a splenic infarction appear on CT scanning with contrast?
As a segmental wedge of hypoattenuated tissue, with the apex of the wedge pointing to the hilum of the spleen from the segmental branching of the splenic artery
29
Why does CT scanning with contrast produce a hypoattenuated wedge on CT?
Because the IV contrast cannot reach the infarcted area
30
What will be shown on CT with contrast if the splenic artery, rather than one of its segmental branches, is affected?
The entire spleen will be hypoattenuated
31
How are most cases of splenic infarction followed up after treatment?
With repeat CT scanning
32
What may be shown on repeat CT scanning with contrast following treatment for splenic infarction?
Either full resolution, fibrosis of the original infarct, or liquefaction of the affected region
33
Are there any specific treatments for splenic infarcts?
No
34
What is involved in the management of splenic infarct?
Regular monitoring, ensuring haemodynamic stability, with appropriate analgesia and IV hydration prescribed
35
What do most cases of splenic infarct warrant in terms of management?
Suitable management of the underlying condition, in order to minimise future risk
36
Why is it important to identify the cause of splenic infarction?
As it may require the involvement of a haematologist and an ECHO scan, as well as consideration for long-term anticoagulation
37
Why should splenectomy be avoided following splenic infarction?
Due to risks of overwhelming post-splenectomy infection (OPSI) syndrome
38
When might splenectomy be unavoidable in splenic infarction?
If complications develop, or symptoms persist
39
How long should a splenectomy be delayed in young patients?
Most cases should be delayed until the patient >2 years old, ideally >10 years
40
Why should most cases of splenic infarction be delayed until the patient is >2 years of age?
To ensure appropriate immune response can be developed post-splenectomy
41
What is recommended following extensive splenic infarctions?
Vaccinations against Pneumococcus, N. Mengitidis, and H. Influenza Life-long antibiotic cover
42
Why should patients with extensive splenic infarction receive vaccinations and life-long low dose antibiotics?
Due to the spleens role in protection against encapsulated bacteria, which cannot be performed as effectively in those with extensive infarctions
43
What is the prognosis of splenic infarctions?
The prognosis of splenic infarctions varies enormously
44
What does the prognosis of splenic infarction depend on?
The cause and severity of the disease
45
Which patients have an extremely good prognosis following splenic infarction?
Patients with benign underlying disease, and asymptomatic infarcts
46
Which patients have a poor outcome following splenic infarction?
Patients with splenic infaction secondary to haematological malignancy
47
What are the most common complications of splenic infarction?
Splenic rupture Splenic abscess Pseudocyst formation
48
What will most complications of splenic infarction warrant?
Splenectomy
49
When will a splenic abscess be seen post-splenic infarct?
When the underlying cause was from a non-sterile embolus, such as infective endocarditis, or in rarer cases where the patient is immunocompromised
50
How does a non-sterile embolus cause a splenic abscess?
The embolus seeds infection to the necrotic splenic tissue
51
What is the problem with the diagnosis of a splenic abscess?
It can be difficult to differentiate from an uncomplicated infection
52
How can a splenic abscess be diagnosed?
Based on CT scanning viewed by an experienced radiographer, especially when combined with raised inflammatory markers
53
How will most cases of splenic abscess be confirmed?
Explorative surgery
54
What is auto-splenectomy?
A rare condition that results in asplenism
55
What causes auto-splenectomy?
Repeated splenic infarctions, resulting in the progressive fibrosis and atrophy of the spleen. When this continues over a prolonged period of time, it can lead to complete atrophy of the spleen
56
When is repeated infarction particularly likely to cause auto-splenectomy?
During childhood
57
What is the most common cause of auto-splenectomy?
Sickle-cell anaemia
58
How does sickle-cell anaemia cause auto-splenectomy?
Repeated sickle-cell crises lead to recurrent occlusion of the splenic artery.

3: MED2 Y3 - Gastrointestinal [7] (44 decks)

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