spleen Flashcards
(22 cards)
Congenital abnormalities(Spleen)
accessory spleens (splenunculi)
congenital asplenia or polysplenia
Hypersplenism definition
the term is applied to an association between a
peripheral blood pancytopaenia and splenic
enlargement
Signs of Primary hypersplenism
marked and massive splenomegaly
and pancytopaenia
Treatment of Hypersplenism
splenectomy
Causes of splenomegaly
- congestion
- infection
- immune disorders
- red blood cell abnormalities
- primary or metastatic neoplasms
- storage disorders
- amyloidosis
Causes of a grossly enlarged spleen
- Chronic myeloid leukemia
- Myelofibrosis
- Malaria
- Gaucher’s disease
Moderately enlarged splenomegaly
- Congestion
- Amyloidosis
- Haemolytic anemia
- Chronic lymphocytic leukemia
Mildly enlarged
- Any of the above
- Infection
- Autoimmune disease
- Felty’s disease
Causes of Congestive splenomegaly(pre/post/hepatic)
Pre-hepatic: thrombosis of the extrahepatic portion of the portal vein or splenic vein
Hepatic: cirrhosis
Post-hepatic: raised pressure in the inferior vena cava.
* transmitted to the spleen via the portal system
* usually associated with ascites and hepatomegaly
* usual causes - decompensated right heart failure and
pulmonary or tricuspid disease
Morphology of Congestive splenomegaly(capsule and cut surface)
Capsule- thickened and fibrotic
Cut Surface: beefy-red color with inconspicuous white pulp
– contains scattered firm brown nodules – Gamna
Gandy bodies - represent areas of healed infarction -composed of fibrous and elastic tissue with abundant haemosiderin and dystrophic calcification
Splenomegaly due to systemic infection
–may cause moderate splenomegaly
–characterized by congestion and
macrophage hyperplasia
–white pulp- usually prominent
Splenomegaly due to bacterial infection
–in response to infections e.g. bacterial
endocarditis or localized abscesses
–neutrophils can accumulate in the
sinuses and medullary cords
–if extreme – ‘acute septic splenitis’
–becomes soft because of proteolytic
enzyme action
Splenomegaly due to viral infection
–especially infectious mononucleosis
–may produce more severe splenomegaly
–susceptible to rupture
Splenomegaly due chronic malarial infection
–may lead to massive splenomegaly
–splenic capsule – thickened and fibrotic
–cut surface – slate grey color due to
abundant malarial pigment
granulomatous inflammation that causes Splenomegaly
–bacteria : Tuberculosis
–fungi: Histoplasmosis, Cryptococcus
–protozoal: Toxoplasmosis
Immune disorders that cause Splenomegaly
-Rheumatoid arthritis, splenomegaly, and Neutropenia – Felty’s syndrome
-Systemic lupus erythematosus
Red blood cell abnormalities that cause Splenomegaly
Sickle cell anemia
Hereditary spherocytosis
Neoplasms that cause Splenomegaly
- haemangioma
- acute and chronic leukemia
- myeloproliferative disorders
- Hodgkin’s lymphoma
- Non-Hodgkin’s lymphoma
Storage disorders that result in splenomegaly plus morphology
- Niemann Pick disease
- Gaucher’s disease
- Mucopolysaccharidoses
Morphology: Marked red pulp expansion by macrophages whose cytoplasm is distended with the abnormal storage product
causes of splenic infarction
- follows occlusion of the splenic artery or its
branches - usually secondary to emboli that arise in the
heart - may be due to local thrombosis as in:
-sickle cell anemia
-myeloproliferative disorders
-malignant infiltrates
Causes and treatment of rupture of the spleen
caused by blunt abdominal trauma
spontaneous rupture –e.g. with infectious
mononucleosis
Treatment – emergency splenectomy
Causes of Splenic atrophy
*sickle cell disease – multiple splenic infarcts -
the spleen is greatly reduced in size and function.
*may occur in association with intestinal
malabsorption states such as coeliac disease -
the spleen is small and weighs less than 50g
