Spleen and Splenectomy, C60 P458-463 Flashcards Preview

Section II General Surgery P203Surgical Recall Sixth > Spleen and Splenectomy, C60 P458-463 > Flashcards

Flashcards in Spleen and Splenectomy, C60 P458-463 Deck (45):
1

Which arteries supply the
spleen?
P458

Splenic artery (a branch of the celiac
trunk) and the short gastric arteries that
arise from the gastroepiploic arteries

2

What is the venous drainage
of the spleen?
P458

Portal vein, via the splenic vein and the
left gastroepiploic vein

3

What is said to “tickle” the
spleen?
P459

Tail of the pancreas

4

What percentage of people
have an accessory spleen?
P459

≈20%

5

What percentage of the total
body platelets are stored in
the spleen?
P459

33%

6

What are the functions of
the human spleen?
P459

Filters abnormal RBCs (does NOT store
RBCs like canine spleen!), stores platelets,
produces tuftsin and properdin (opsins),
produces antibodies (especially IGM) and
is site of phagocytosis

7

What is “delayed splenic
rupture”?
P459

Subcapsular hematoma or
pseudoaneurysm may rupture some time
after blunt trauma, causing “delayed
splenic rupture”; rupture classically
occurs about 2 weeks after the injury and
presents with shock/abdominal pain

8

What are the signs/symptoms
of ruptured/injured spleen?
P459

Hemoperitoneum and Kehr’s sign, LUQ
abdominal pain, Ballance’s sign

9

What is Kehr’s sign?
P459

Left shoulder pain seen with splenic
rupture

10

What is Ballance’s sign?
P459

LUQ dullness to percussion

11

What is Seagesser’s sign?
P459

Phrenic nerve compression causing neck
tenderness in splenic rupture

12

How is a spleen injury
diagnosed?
P459

Abdominal CT, if the patient is stable;
DPL or FAST exam if the patient is
unstable

13

What is the treatment?
P459

1. Nonoperative in a stable patient with
an isolated splenic injury without hilar
involvement/complete rupture
2. If patient is unstable, DPL/FAST
laparotomy with splenorrhaphy or
splenectomy
3. Embolization is an option in selected
patients

14

What is a splenorrhaphy?
P460

Splenic salvage operation: wrapping vicral
mesh, aid of topical hemostatic agents or
partial splenectomy, sutures (buttressed)

15

What are the other
indications for splenectomy:
Malignant diseases?
P460

Hodgkin’s staging not conclusive by CT
scan (rare)
Splenic tumors (primary/metastatic/
locally invasive)
Hypersplenism caused by other
leukemias/non-Hodgkin’s lymphomas

16

What are the other
indications for splenectomy:
Anemias?
P460

Medullary fibrosis with myeloid
metaplasia
Hereditary elliptocytosis
Sickle cell anemia (rare, most
autosplenectomize)
Pyruvate kinase deficiency
Autoimmune hemolytic anemia
Hereditary spherocytosis
Thalassemias (e.g., ℬ-thalassemia major
a.k.a. Cooley’s)

17

What are the other
indications for splenectomy:
Thrombocytopenia?
P460

ITP (Idiopathic Thrombocytopenic
Purpura)
TTP (Thrombotic Thrombocytopenic
Purpura)

18

What are the other
indications for splenectomy:
Miscellaneous indications?
P460

Variceal bleeding with splenic vein
thrombosis, Gaucher’s disease, splenic
abscess, refractory splenic cysts,
hypersplenism, Felty’s syndrome

19

Is G6PD deficiency an
indication for splenectomy?
P460

NO

20

What are the possible
postsplenectomy
complications?
P460

Thrombocytosis, subphrenic abscess,
atelectasis, pancreatitis gastric dilation,
and Overwhelming PostSplenectomy
Sepsis (OPSS)

21

What causes OPSS?
P460

Increased susceptibility to fulminant
bacteremia, meningitis, or pneumonia
because of loss of splenic function

22

What is the incidence of
OPSS in adults?
P461

< 1%

23

What is the incidence and
overall mortality of OPSS in
children?
P461

1% to 2% with 50% mortality rate

24

What is the typical
presentation of OPSS?
P461

Fever, lethargy, common cold, sore
throat, URI followed by confusion, shock,
and coma with death ensuing within 24
hours in up to 50% of patients

25

What are the common
organisms associated with
OPSS?
P461

Encapsulated: Streptococcus
pneumoniae, Neisseria meningitides,
H. influenzae

26

What is the most common
bacteria in OPSS?
P461

Streptococcus pneumoniae

27

What is the preventive
treatment of OPSS?
P461

Vaccinations for pneumococcus,
H. influenzae, and meningococcus
Prophylactic penicillin for all minor
infections/illnesses and immediate
medical care if febrile illness develops

28

What is the best time to
give immunizations to
splenectomy patients?
P461

Preoperatively, if at all possible
If emergent, then 2 weeks
postoperatively

29

What lab tests are abnormal
after splenectomy?
P461

WBC count increases by 50% over
the baseline; marked thrombocytosis
occurs; RBC smear is abnormal

30

What are the findings on
postsplenectomy RBC
smear?
P461

Peripheral smear will show
Pappenheimer bodies, Howell-Jolly
bodies, and Heinz bodies

31

When and how should
thrombocytosis be treated?
P461

When platelet count is > 1 million, most
surgeons will treat with aspirin

32

What is the most common
cause of splenic vein
thrombosis?
P461

Pancreatitis

33

What opsonins does the
spleen produce?
P461

PROperdin, TUFtsin (Think:
“PROfessionally TUF spleen”)

34

What is the most common
cause of ISOLATED
GASTRIC varices?
P462

Splenic vein thrombosis (usually from
pancreatitis)

35

What is the treatment of
gastric varices caused by
splenic vein thrombosis?
P462

Splenectomy

36

Which patients develop
hyposplenism?
P462

Patients with ulcerative colitis

37

What vaccinations should
every patient with a
splenectomy receive?
P462

Pneumococcus
Meningococcus
Haemophilus influenzae type B

38

Define hypersplenism.
P462

Hyperfunctioning spleen
Documented loss of blood elements
(WBC, Hct, platelets)
Large spleen (splenomegaly)
Hyperactive bone marrow (trying to keep
up with loss of blood elements)

39

Define splenomegaly.
P462

Enlarged spleen

40

What is idiopathic
thrombocytopenic
purpura (ITP)?
P462

Autoimmune (antiplatelet antibodies IgG
in 90% of patients) platelet destruction
leading to troublesome bleeding and
purpura

41

What is the most common
cause of failure to correct
thrombocytopenia after
splenectomy for ITP?
P462

Missed accessory spleen

42

What are the “I’s” of ITP?
P462

Immune etiology (IgG antiplatelets ABs)
Immunosuppressive treatment (initially
treated with steroids)
Immune globulin
Improvement with splenectomy (75% of
patients have improved platelet counts
after splenectomy)

43

What is TTP?
P462

Thrombotic Thrombocytopenic Purpura

44

What is the treatment of
choice for TTP?
P463

Plasmapheresis (splenectomy reserved as
a last resort—very rare)

45

What is the most common
physical finding of portal
hypertension?
P463

Splenomegaly