Spleen

Question 1

Where is the spleen located?

Answer 1

-Peritoneal
-Left hypochondrium (LUQ)

Question 2

Measurement of spleen?

Answer 2

12-13cm length
8cm AP
4cm TRV

(smaller in women, smaller with increase in age, increases during digestion)

Question 3

What does the lienorenal/splenorenal ligament do?

Answer 3

Attaches spleen to left kidney

Question 4

What does the gastrosplenic ligament do?

Answer 4

Attaches spleen to greater curvature of stomach

Question 5

What does phrenicocolic ligament do?

Answer 5

Not attached to spleen but supports the inferior part

Question 6

Is the spleen often a primary site for a disease?

Answer 6

No, spleen reacts as a secondary response to some infection

Question 7

What are the 4 functions of the spleen?

Answer 7

-Reserving
-Filtering
-Producing
-Defending blood products

Question 8

What is white splenic pulp?

Answer 8

-Major site for immunity reactions
-Produces WBC’s and plasma cells for formation of antibodies
-Gets rid of bacteria

Question 9

What is red splenic pulp?

Answer 9

-Filters the blood
-Can store more than 300mL blood
-Filters out debris, microorganisms, and old/damaged/dead blood cells

Question 10

What is erythropoiesis

Answer 10

When the spleen produces RBC’s

(Spleen does this when bone marrow can NOT)

Question 11

What is leukopenia?

Answer 11

-Low WBC count
-Associated with hypersplenism, infection, leukemia, anemia and diabetes mellitus

Question 12

What is leukoytosis?

Answer 12

-High WBC count
-Indicates presence of inflammation, infection and hemorrhage

Question 13

What is hematocrit?

Answer 13

-% of blood volume occupied by RBC’s

Question 14

What is thrombocytopenia?

Answer 14

-Low platlet count

Question 15

What is bacteremia?

Answer 15

Bacteria within the body

Question 16

How does the normal spleen look sonographically?

Answer 16

-Orange wedge shape
-Echogenicity is isoechoic to liver, and isoechoic/slightly brighter to kidney
-Homogeneous

Question 17

What is polysplenia?

Answer 17

Multiple splenules with no main parent spleen

Question 18

What is congenital aplasia + hypoplasia?

Answer 18

Aplasia - spleen is gone
Hypoplasia - spleen is small

Question 19

What is another name for an accessory spleen?

Answer 19

-Supranumerary
-Splenuculus
-Splenule

Question 20

SF of a splenule?

Answer 20

-Round
-Isoechoic to spleen
-Posterior enhancement
-Typically 2cm
-Homogeneous

Question 21

Cause + complications of an ectopic spleen?

Answer 21

-Caused by weakened ligaments
-Torsion + infarction are complications

Question 22

Measurement of splenomegaly?

Answer 22

greater than 13cm

Question 23

M/c cause of splenomegaly?

Answer 23

Portal hypertension (is congestive)

Question 24

Types of splenomegaly + anemia?

Answer 24

Hemolytic - RBC’s destroyed faster than created

Sickle cell - RBC’s change shape.
Complications - acute splenic sequestration, hemorrhage, infarction, fibrosis + atrophy)

Question 25

Is splenomeglay + acute splenic sequestration life threatening?

Answer 25

Yes! Bad complication of sickle cell disease leading to decrease in hematocrit (b/c less % of RBC's)

Question 26

How does malignancy affect splenomegaly?

Answer 26

If malignant cells affect the bone marrow, the spleen will enlarge because it takes over RBC production (hematopoiesis)

Question 27

How do infections affect splenomegaly?

Answer 27

Systemic (mono, TB) - affect spleen size Focal (parasites, abscess) - affect spleen size HIV - associated with infections + lymphoma

Question 28

What is Gaucher disease?

Answer 28

Increase fat build-up

Question 29

What is Niemann-Pick disease?

Answer 29

Decreased fat metabolism

Question 30

What is amyloidosis?

Answer 30

Abnormal protein development + storage

Question 31

What is histicocytosis?

Answer 31

Increased quantity of immune cells

Question 32

What is hemochromatosis?

Answer 32

Increased iron

Question 33

SF of congenital cysts?

Answer 33

-M/c solitary -M/c in children

Question 34

M/c cause of an acquired cyst?

Answer 34

-Trauma -Pseudocysts (80%)

Question 35

SF of a parasitic acquired cyst?

Answer 35

-Leukocytosis -Enfolded membranes -Eggshell calcifications -Defined walls -Acoustic enhancement

Question 36

Lightbulb for lymphangioma acquired cysts?

Answer 36

-M/c children -Obstruction of lymphatic vessels creating cystic spaces -Calcifications, septatations (echogenic lines)

Question 37

Why do splenic abscesses have a high death rate?

Answer 37

-Delayed diagnosis -Risk of rupture

Question 38

What is a splenic infarct?

Answer 38

Occlusion in part of the splenic artery causing tissue death

Question 39

SF sign/lightbulb for splenic infarcts?

Answer 39

Bright band sign (acute - hypoechoic, chronic - hyperechoic)

Question 40

What is the most common organ damaged in blunt abdominal trauma?

Answer 40

Spleen

Question 41

When would a splenic rupture occur after trauma?

Answer 41

Within 1 week of injury

Question 42

Lightbulb sign for splenic calcification?

Answer 42

Starry sky (b/c echogenic foci with acoustic shadowing)

Question 43

SF for the 4 types of splenic infections?

Answer 43

TB - echo poor (think anechoic) Mycobacterial - small diffuse echogenic foci Candidiasis - wheel within a wheel/bullseye AIDS - small round hypoechoic lesions with granulomatous calcifications

Question 44

What is the m/c benign splenic neoplasm?

Answer 44

Hemangioma

Question 45

What is another name for hamartoma?

Answer 45

Splenoma

Question 46

What is the m/c malignant splenic neoplasm?

Answer 46

Lymphoma

Question 47

Lightbulb for lymphoma?

Answer 47

-Leukocytosis -Mass blends in + is very subtle

Question 48

Lightbulb for angiosarcoma?

Answer 48

-High death rate -Heterogeneous -Hypoechoic (image looks quite dark)

Question 49

What is the m/c metastatic lesion?

Answer 49

Melanoma #1 Others include breast, colorectal + ovarian

Question 50

SF lightbulb sign for metastatic lesions?

Answer 50

-Bullseye with hypoechoic halo -Diffusely affected