Spleen

Question 1

What ligaments are attached to the spleen?

Answer 1

Splenorenal, gastrosplenic, splenocolic

Question 2

What goes from the spleen to the greater curve of the stomach and carries the short gastric vessels?

Answer 2

Gastrosplenic ligament

Question 3

What is the blood supply for the spleen?

Answer 3

Mostly from the splenic artery – but some from the short gastrics

Question 4

What is the spleen’s immmune function?

Answer 4

Filters encapsulated bacteria like S. pneumonia, H. influenza, N. meningitides

Question 5

What is hypersplenism?

Answer 5

diffuse enlargement of the spleen

Question 6

What disorders can cause hypersplenism?

Answer 6

Neoplastic disorders
Hematopoietic disorders
Metabolic or storage disorders

Question 7

What diseases are associated with secondary hypersplenism (7)?

Answer 7

Portal HTN
Splenic vein thrombosis
Leukemias/lymphoma
SLE
Gaucher disease
Mononucleosis
Felty syndrome

Question 8

When is splenectomy indicated?

Answer 8

primary hypersplenism

Question 9

What is the treatment for splenic vein thrombosis with bleeding gastric varices with chronic pancreatitis?

Answer 9

Splenectomy

Question 10

What is a hemangioma of the spleen?

Answer 10

benign but requires splenectomy for tissue diagnosis

Question 11

What are hamartomas of the spleen?

Answer 11

benign but may need splenectomy for diagnosis

Question 12

What are lymphangiomas of the spleen?

Answer 12

may lead to hypersplenism. Splenectomy for diagnosis

Question 13

What are angiosarcomas of the spleen?

Answer 13

very rare and malignant. Splenectomy for diagnosis and treatment

Question 14

What should be done in regard to the spleen for Hodgkin’s disease?

Answer 14

may need splenectomy for staging

Question 15

What should be done in regard to the spleen for hairy cell leukemia?

Answer 15

splenectomy if splenomegaly and failed medical management

Question 16

What is acquired hemolytic anemia?

Answer 16

Acute RBC destruction 2° complement fixation of antibiodies bound to the surface of the erythrocyte

Question 17

What is the onset for hemolytic anemia?

Answer 17

Sudden onset

Question 18

Hemolytic anemia is most commonly seen in whom?

Answer 18

Women > men

Age 50

Question 19

How does hemolytic anemia present?

Answer 19

Palpable splenomegaly in 50%
fatigue
Associated with certain medications such as PCN and quinidine

Question 20

What is the first line treatment for acquired hemolytic anemia?

Answer 20

glucocorticoid

Question 21

When is splenectomy indicated in hemolytic anemia?

Answer 21

patients with warm antibodies that fail high-dose corticosteroid treatment or have a contraindication to corticosteroids

Question 22

What is Immune/Idiopathic thrombocytopeniaPurpura (ITP)?

Answer 22

Antibodies to platelet antigens
No splenomegaly
Presence of antiplatelet antibodies

Question 23

How dies ITP present?

Answer 23

• No splenomegaly
• Petechiae, ecchymosis, epistaxis and easy bruising
• Thrombocytopenia (platelets always below 100,000/uL and often < 50,000/uL) and
• Prolonged bleeding time

Question 24

What should never be given for ITP?

Answer 24

Platelets

Question 25

What is the initial treatment for ITP?

Answer 25

Glucocorticoids

Question 26

When is splenectomy indicated in ITP?

Answer 26

Failure of steroids

Question 27

What is the most common congenital hemolytic anemia?

Answer 27

Hereditary spherocytosis

Question 28

What is deficient in the RBCs in hereditary spherocytosis?

Answer 28

spectrin which makes erythrocytes more susceptible to destruction

Question 29

What are the sx of hereditary spherocytosis?

Answer 29

Splenomegaly, abdominal discomfort, jaundice

Question 30

What is the treatment for hereditary spherocytosis?

Answer 30

Splenectomy after age 6

Question 31

What should occur with splenectomy when pt also has gallstones?

Answer 31

Cholecystectomy indicated at time of splenectomy

Question 32

What is the congenital abnormality with hereditary elliptocytosis?

Answer 32

Low level of spectrin

Question 33

How do erythrocytes appear with hereditary elliptocytosis?

Answer 33

Elliptical

Question 34

How is hereditary elliptocytosis treated?

Answer 34

Splenectomy depending on severity

Question 35

When is splenectomy indicated for splenic cysts?

Answer 35

If cyst persists or becomes symptomatic

Question 36

What is overwhelming postsplenectomy sepsis?

Answer 36

Relatively rare condition that may follow a splenectomy. Infection is with encapsulated organisms (S pneumonia, H influenza, N meningitidis)

Question 37

What vaccines should be given pre-splenectomy?

Answer 37

Pneumo, haemophilus, and Meningococcus

Question 38

What is an accessory spleen?

Answer 38

A small nodule of splenic tissue found apart from the main body of the spleen

Question 39

What are the most common locations for accessory spleens?

Answer 39

hilum of the spleen and adjacent to the tail of the pancreas

Question 40

Why are accessory spleens important?

Answer 40

If splenectomy is performed for conditions in which blood cells are sequestered in the spleen, failure to remove accessory spleens may result in the failure of the condition to resolve