Chapter 34 - Spleen Flashcards Preview

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Flashcards in Chapter 34 - Spleen Deck (57):
1

Where is the splenic v in relation to splenic a?

Posterior and inferior

2

Spleen is the largest producer of what antibody?

IgM

3

What % of the spleen is red pulp? Function?

85%; acts as filter for aged or damaged RBCs

4

What is pitting?

Removal of abnormalities in RBC membrane

5

What are Howell-Jolly bodies?

Nuclear remnants

6

What are Heinz bodies?

Hemoglobin

7

What is culling?

Removal of less deformable RBCs

8

What % of the spleen is white pulp? Function?

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

9

What is tuftsin?

An opsonin; facilitates phagocytosis (produced in spleen)

10

What is properidin?

Activates alternate complement pathway (produced in spleen)

11

When does hematopoiesis occur in the spleen?

Before birth and in conditions such as myeloid dysplasia

12

Where is the most common location of accessory spleen?

Splenic hilum (20%)

13

What is the most common nontraumatic condition requiring splenectomy?

ITP

14

What happens in ITP?

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

15

Treatment for ITP in children? Adults?

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

16

Why does splenectomy fix ITP?

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

17

TTP associated with what conditions?

Medial reactions, infections, inflammation, autoimmune disease

18

What happens in TTP?

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

19

Treatment for TTP?

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

20

Most common cause of death due to TTP?

Due to ICH or acute renal failure

21

Risk of postsplenectomy sepsis?

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

22

Most common bacteria causing OPSS?

S. pneumonia, N. meningitidis, H. flu

23

Most episodes occur within what time frame?

2y post-splenectomy

24

Ideally how old should a child be before splenectomy?

5; allows Ab formation, child can get fully immunized

25

Vaccines needed before splenectomy?

Pneumococcus, meningococcus, H. flu

26

Postsplenectomy lab changes?

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

27

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

Hemangioma; splenectomy if symptomatic

28

What is the #1 malignant splenic tumor?

Non-Hodgkin's lymphoma

29

When is operation indicated for splenic cyst?

If symptomatic or >10cm

30

Lab changes in hypersplenism?

Decreased platelets, WBCs, and RBCs

31

What is the definition of hypersplenism?

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

What is the most common cause of hypersplenism?

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

33

Sarcoidosis of the spleen causes what?

Anemia, decreased platelets

34

What is Felty's syndrome?

RA, hepatomegaly, splenomegaly

35

What is Gaucher's disease?

Lipid metabolism disorder leading to splenomegaly

36

What is the most common congenital hemolytic anemia requiring splenectomy?

Spherocytosis

37

What is the defect in spherocytosis?

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

38

What does spherocytosis lead to?

Pigmented stones, anemia, reticulocytosis, jaundice, splenomegaly

39

Treatment for spherocytosis?

Splenectomy and cholecystectomy

40

What is elliptocytosis?

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

41

What does pyruvate kinase deficiency cause?

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

42

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

Pyruvate kinase deficiency

43

What precipitates hemolysis with G6PD deficiency?

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

44

Is splenectomy required for sickle cell anemia?

Spleen autoinfarcts, splenectomy NOT required

45

Use of splenectomy in beta thalassemia?

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

46

What cells are characteristic of Hodgkin's disease?

Reed-Sternberg cells

47

How is Hodgkin's disease staged?

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

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

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

49

What is the most common cause of chylous ascites?

Lymphoma

50

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

90%

51

Treatment for hairy cell leukemia?

Splenectomy, INF-gamma

52

What are the causes of spontaneous splenic rupture?

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

53

What is splenosis? Cause?

Splenic implants; usually related to trauma

54

When do you see Howell-Jolly bodies?

In hyposplenism

55

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

Pancreatitis

56

What patients get splenic artery aneurysms?

Females; secondary to fibromuscular dysplasia, atherosclerosis

57

What are pappenheimer bodies?

Iron deposits