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Fiser absite > Chapter 34 - Spleen > Flashcards

Chapter 34 - Spleen Flashcards

1
Q

Where is the splenic v in relation to splenic a?

A

Posterior and inferior

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2
Q

Spleen is the largest producer of what antibody?

A

IgM

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3
Q

What % of the spleen is red pulp? Function?

A

85%; acts as filter for aged or damaged RBCs

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4
Q

What is pitting?

A

Removal of abnormalities in RBC membrane

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5
Q

What are Howell-Jolly bodies?

A

Nuclear remnants

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6
Q

What are Heinz bodies?

A

Hemoglobin

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7
Q

What is culling?

A

Removal of less deformable RBCs

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8
Q

What % of the spleen is white pulp? Function?

A

15%; immunologic function, contains lymphocytes and macrophages; major site of bacterial clearance that lacks preexisting abs; site of removal of poorly opsonized bacteria/debris

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9
Q

What is tuftsin?

A

An opsonin; facilitates phagocytosis (produced in spleen)

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10
Q

What is properidin?

A

Activates alternate complement pathway (produced in spleen)

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11
Q

When does hematopoiesis occur in the spleen?

A

Before birth and in conditions such as myeloid dysplasia

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12
Q

Where is the most common location of accessory spleen?

A

Splenic hilum (20%)

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13
Q

What is the most common nontraumatic condition requiring splenectomy?

A

ITP

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14
Q

What happens in ITP?

A

Antiplatelet IgG binds platelets, cause dec. platelet count –> gingival bleeding, petechiae, bruising, soft tissue ecchymosis

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15
Q

Treatment for ITP in children? Adults?

A

Children <10, usually resolves spontaneously; steroids (primary therapy), plasmapheresis, gammaglobulin for steroid-resistant disease, splenectomy for those who fail steroids

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16
Q

Why does splenectomy fix ITP?

A

Spleen is normal; removes IgG production and source of phagocytosis (80% respond)

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17
Q

TTP associated with what conditions?

A

Medial reactions, infections, inflammation, autoimmune disease

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18
Q

What happens in TTP?

A

Loss of platelet inhibition leads to thrombosis and infarction, profound thrombocytopenia; purpura, fever, AMS, renal dysfunction, hematuria, hemolytic anemia

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19
Q

Treatment for TTP?

A

Plasmapheresis (primary), steroids, ASA - 80% respond to medical therapy

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20
Q

Most common cause of death due to TTP?

A

Due to ICH or acute renal failure

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21
Q

Risk of postsplenectomy sepsis?

A

0.1%, increased risk in children; highest in pts with splenectomy due to hemolytic disorders or malignancy

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22
Q

Most common bacteria causing OPSS?

A

S. pneumonia, N. meningitidis, H. flu

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23
Q

Most episodes occur within what time frame?

A

2y post-splenectomy

24
Q

Ideally how old should a child be before splenectomy?

A

5; allows Ab formation, child can get fully immunized

25
Q

Vaccines needed before splenectomy?

A

Pneumococcus, meningococcus, H. flu

26
Q

Postsplenectomy lab changes?

A

Increased RBCs, WBCs, platelets; if plt >1x10^6, need ASA

27
Q

What is the #1 splenic tumor overall as well as the #1 benign splenic tumor? Treatment?

A

Hemangioma; splenectomy if symptomatic

28
Q

What is the #1 malignant splenic tumor?

A

Non-Hodgkin’s lymphoma

29
Q

When is operation indicated for splenic cyst?

A

If symptomatic or >10cm

30
Q

Lab changes in hypersplenism?

A

Decreased platelets, WBCs, and RBCs

31
Q

What is the definition of hypersplenism?

A

Dec. in circulating RBC, plts, or WBC AND normal compensatory hematopoietic response in bone marrow AND correction of cytopenia by splenectomy W/ or W/OUT splenomegaly

32
Q

What is the most common cause of hypersplenism?

A

Secondary: increased venous pressure (portal HTN, CHF), malignant disease, chronic inflammatory disease, myeloproliferative disease, infectious, amyloidosis, AIDS, hemolytic anemias, polycythemia vera

33
Q

Sarcoidosis of the spleen causes what?

A

Anemia, decreased platelets

34
Q

What is Felty’s syndrome?

A

RA, hepatomegaly, splenomegaly

35
Q

What is Gaucher’s disease?

A

Lipid metabolism disorder leading to splenomegaly

36
Q

What is the most common congenital hemolytic anemia requiring splenectomy?

A

Spherocytosis

37
Q

What is the defect in spherocytosis?

A

Spectrin deficit (membrane protein) causing deformed RBCs and splenic sequestration

38
Q

What does spherocytosis lead to?

A

Pigmented stones, anemia, reticulocytosis, jaundice, splenomegaly

39
Q

Treatment for spherocytosis?

A

Splenectomy and cholecystectomy

40
Q

What is elliptocytosis?

A

Spectrin and protein 4.1 deficit (membrane protein); causes symptoms similar to spherocytosis

41
Q

What does pyruvate kinase deficiency cause?

A

Results in congenital hemolytic anemia; altered glucose metabolism, RBC survival enhanced by splenectomy

42
Q

What is the most common congenital hemolytic anemia NOT involving a membrane protein deficit?

A

Pyruvate kinase deficiency

43
Q

What precipitates hemolysis with G6PD deficiency?

A

Infection, certain drugs, fava beans; splenectomy usually not required

44
Q

Is splenectomy required for sickle cell anemia?

A

Spleen autoinfarcts, splenectomy NOT required

45
Q

Use of splenectomy in beta thalassemia?

A

May decrease hemolysis and symptoms; most die in teens secondary to hemosiderosis

46
Q

What cells are characteristic of Hodgkin’s disease?

A

Reed-Sternberg cells

47
Q

How is Hodgkin’s disease staged?

A

Stage I: 1 area or 2 contiguous areas on same side of diaphragm; stage II: 2 noncontiguous areas on same side of diaphragm; stage III: involved on each side of diaphragm; stage IV: liver, bone, lung or any other nonlymphoid tissue except spleen

48
Q

What are the different types of Hodgkin’s lymphoma? What has the best prognosis? Most common?

A

Lymphocyte predominant (best prognosis), lymphocyte depleted (worst prognosis), nodular sclerosing (most common)

49
Q

What is the most common cause of chylous ascites?

A

Lymphoma

50
Q

What % of non-Hodgkin’s lymphomas are B cell?

A

90%

51
Q

Treatment for hairy cell leukemia?

A

Splenectomy, INF-gamma

52
Q

What are the causes of spontaneous splenic rupture?

A

Mononucleosis, malaria, sepsis, sarcoid, leukemia, polycythemia vera

53
Q

What is splenosis? Cause?

A

Splenic implants; usually related to trauma

54
Q

When do you see Howell-Jolly bodies?

A

In hyposplenism

55
Q

What is the most common cause of splenic artery or splenic vein thrombosis?

A

Pancreatitis

56
Q

What patients get splenic artery aneurysms?

A

Females; secondary to fibromuscular dysplasia, atherosclerosis

57
Q

What are pappenheimer bodies?

A

Iron deposits

Fiser absite (58 decks)

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