Splenic Infarct

Question 1

What are the three branches of the coeliac trunk

Answer 1

Left gastric
Common hepatic
Splenic

Question 2

Which arteries if occluded will cause a splenic infarct

Answer 2

Splenic artery

Short gastric arteries ( from left gastroepiploic arteries )

Question 3

What are some haematological disorders that can lead to splenic infarct

Answer 3

Chronic myeloid leukaemia
Sickle cell disease
Polycythaemia Vera
Hyper coagulated states

Question 4

What are some embolic disorders that can cause splenic infarct

Answer 4

AF
Infective endocarditis
Post MI mural thrombus

Question 5

Clinical features of splenic infarct

Answer 5

Can be asymptomatic but can have LUQ pain and referee shoulder pain ( Kehrs sign )

Question 6

How would you investigate a suspected splenic infarct

Answer 6

CT Abdomen with IV constrast - arterial phase

Routine bloods - FBC, COAGs, LFTs, U&Es

Question 7

Differentials for LUQ pain

Answer 7

PUD
Pyelonephritis
Left sided basal pneumonia

Question 8

How would you manage a splenic infarct

Answer 8

Short term:
Analgesia 
IV fluids 
Long term anti-coag 
Long term: 
Splenectomy ( beware of OPSI )
Protection against NHS if splenectomy not avoidable - eg vaccinations and background low dose pen V

Question 9

3 complications of splenic infarct

Answer 9

Splenic rupture
Splenic abscess - will be seen if the embolus was infective eg - IE
Pseudocyst formation

Question 10

What is auto splenectomy

Answer 10

Rare condition linked with sickle cell disease that results in asplenism - will need long term management options

Asplenism occurs due to repeated infarcts leading to fibrosis and atrophy of the spleen => leads to loss of function