Spleen

Question 1

What are the functions of the spleen?

Answer 1

Production and maturation of T, B and Plasma cells

Removal of unwanted bacteria - encapsulated

Reservoir for blood cells

Question 2

How does splenomegaly present?

Answer 2

LUQ mass

Early satiety

Abdominal discomfort

Pancytopaenia

Question 3

What is noted on examination of a splenic mass?

Answer 3

Heads towards RLQ
Moves on respitation
Dull to percuss
Can’t palpate above

Question 4

What causes MASSIVE splenomegaly?

Answer 4

CML
Myelofibrosis
Malaria 
Gaucher's syndrome (hereditory)
Visceral Leischmaniasis (parasite)

Question 5

What FBC results would you see with hyperspenism and why?

Answer 5

Pancytopaenia due to pooling and destruction of cells

Question 6

Where are blood cells destroyed in the spleen?

Answer 6

Reticulo-endothelial system

Question 7

How does hypersplenism present?

Answer 7

Anaemia
Infection
Bleeding

Question 8

What are the causes of splenomegaly?

Answer 8

Haematological: malignancies, haemolytic anaemia, sickle cell sequestration crisis

Infectious: Hep, TB, malaria, EBV

Congestive: HF, splenic vein obstruction, liver cirrhosis, Budd-Chiari

Abscess or cyst

Autoimmune/inflammatory: SLE, RA, sarcoid

Question 9

What are the indications for splenectomy?

Answer 9

Spontaneous rupture

Hypersplenism

Malignant Infiltration

Idiopathic thrombocytopaenic purpura

Question 10

What are the complications of splenectomy?

How could you prevent the consequences of one of these complications?

Answer 10

thrombocytosis –> peak within 7-10 days. Give prophylactic aspirin

infection with encapsulated bacteria

Question 11

Give examples of encapsulated bacteria

Answer 11

Haemophilus Influenzae
Neisseria Meningitidis
Streptococcus Pneumoniae
Salmonella Typhi