Spleen

Question 1

What is massive splenomegaly? Causes of massive splenomegaly?

Answer 1

Enlarged to RIF

CML
Myelofibrosis
Malaria
Gaucher’s

Question 2

moderate spelnomegaly?What are causes of

Answer 2

Infection - EBV, TB, malaria, schistomiasis
Portal hypertension - liver cirrhosis
Haematological - leukaemia - CML, lymphoma
Connective tissue disease - RA, SLE
Sarcoidosis

Question 3

What investigations in splenomegaly?

Answer 3

Image with abdominal USS and CT

Look for lymphadenopathy and liver disease

FBC
ESR
LFT
Liver biopsy
Marro biopsy
Lymph node biopsy

Question 4

What are complications of splenomegaly?

Answer 4

Anaemia
Infection
Bleeding
Cells become trapped in spleen reticuloendothelial system causing pancytopenia

Question 5

What are indications for splenectomy?

Answer 5

Splenic trauma
Hypersplenism
Autoimmune haemolysis in ITP
Congenital haemolytic anaemias

Question 6

What are seen on blood film following splenectomy?

Answer 6

Howell Jolly bodies
Pappeniheimer boddies
Target cells

Question 7

What is the problem post-splenectomy?

Answer 7

Increased risk of infection

spleen contains macrophages which filter and phagocytose bacteria

Question 8

What organisms cause infection post-splenectomy?

Answer 8

Encapsulated:
Streptococcus pneumoniae
Haemophilus influenzae
Neisseria meningitidis

Question 9

How is risk of infection reduced post-splenectomy?

Answer 9

Immunisations:
Penumococal vaccine
Haemophilus influenzae b vaccine
Meningococcal ACWY, B and C
Annual influenza vaccine

Life-long phenoxymethypenicillin (V) or erythromycin

Pendants, bracelets or card to alert medical staff

Urgent medical attention if signs of infection - admission for broad spectrum abx

If traveling - meticulous malaria prophylaxis - nets, repellant, medication

Question 10

What are causes of hyposplenism?

Answer 10

Sickle cell anaemia
Coeliac’s disease
UC/Crohn’s