The spleen

Question 1

location of spleen

Answer 1

left hypochondriac region

Question 2

relations of spleen

Answer 2

visceral surface in contact with stomach,left kidney and tail of pancreas

convex surface lies directly under diaphragm

Question 3

is spleen easily palpated

Answer 3

no

Question 4

weight of spleen

Answer 4

152-250g

Question 5

length of spleen

Answer 5

5-13cm

Question 6

when can spleen be seen?

Answer 6

when enlarged,it moves with respiration

Question 7

accessory spleens

Answer 7

found in 10% of people.

usually a piece of tissue found at any site in the abdomen

Question 8

when does spleen become palpable

Answer 8

if the size exceeds 14 cm

Question 9

oxygenated blood enters spleen through

Answer 9

splenic artery

Question 10

splenic artery gives off branches?

Answer 10

True. branches are called trabecular arteries which enter spleen to form central arterioles

Question 11

central arterioles become?

Answer 11

cords which lack an endothelial lining leading to the formation of an open blood system

Question 12

what structures line the cord formed by central arterioles

Answer 12

loose reticular connective tissue network lined by macrophages and fibroblasts

Question 13

From the cords how does blood re enter circulation

Answer 13

by passing across endothelium of venus sinuses to splenic vein to general circulation

Question 14

what is the red pulp

Answer 14

this is formed by the cords and venus sinuses

Question 15

volume of red pulp

Answer 15

forms 75% of the spleen

Question 16

function of the red pulp

Answer 16

monitors integrity of RBCs. Macrophages pick up old RBCs and destroy them

Question 17

what surrounds central arterioles

Answer 17

White pulp, a core of lymphatic tissue similar to lymph nodes made up of B cells

Question 18

The white pulp is equivalent to this zone in lymph noded

Answer 18

t zone

Question 19

are all central arteriole to venous connection terminated?

Answer 19

No. a minority of them are closed in, presenting with continuous endothelial lining and circulation

Question 20

Functions of spleen

Answer 20

Quality control of RBCs by destroying old ones

Destruction of blood borne pathogens

Question 21

What is splenomegaly?

Answer 21

increase in size of spleen. remember above 14cm

Question 22

How does one detect that there is splenomegaly

Answer 22

usually palpable under left costal margin and if exaggerated may be felt as far as right iliac fossa

moves with respiration

medial splenic notch may be palpable

Question 23

causes of splenomegaly

Answer 23

hematological disorders

portal hypertension

storage diseases

infections

tropical diseases

systemic disorders

Question 24

hematological causes of splenomegaly

Answer 24

sickle cell dx
chronic myeloid leukemia
chronic lymphocytic leukemia
acute leukemia
hairy cell leukemia
polycythemia vera
thalassemia major/ intermediate
Malignant lymphoma
hemolytic anemia
primary myelofibrosis

Question 25

portal hypertension causes of splenomegaly

Answer 25

liver cirrhosis hepatic, portal, splenic artery thrombosis

Question 26

Storage disease causes of splenomegaly

Answer 26

Gauchers disease Niemann Picks disease Histocytosis X

Question 27

Infections that cause splenomegaly

Answer 27

ACUTE CHRONIC septicemia Tuberculosis bacterial endocarditis brucellosis typhoid syphillis infectious mononucleosis leshmaniasis Schistosomiasis

Question 28

Tropical causes of splenomegaly

Answer 28

Malaria

Question 29

Systemic diseases that cause splenomegaly

Answer 29

``` Sarcoidosis Amyloidosis Collagen dx SLE rheumatoid arthritis systemic mastocytosis ```

Question 30

What is hypersplenism?

Answer 30

A condition where the spleen is overactive and removes blood cells too quickly.

Question 31

Presentation of hypersplenism

Answer 31

Anemia Enlargement of spleen reduction of one or more cell lines in peripheral circulation Bone marrow hyperplasia

Question 32

A normal cell has these amounts of cell lines

Answer 32

5% or 50-70mls of RBC 50% of marginating neutrophils 30% of platelet mass

Question 33

A hypersplenic spleen has these amount of cell lines

Answer 33

40% of red cell mass 90% of platelets

Question 34

Why will hypersplenism present with anemia

Answer 34

This is due to hoarding of RBCs in the spleen leading to low counts in peripheral blood film

Question 35

Many diseases that cause hypersplenism associated with

Answer 35

diseases that cause splenomegaly

Question 36

Is hypersplenism a major disease?

Answer 36

NO. It is just a clinical sign and a sign of underlying dx

Question 37

Treatment of hypersplenism

Answer 37

Treat underlying dx Splenectomy in cases of severe anemia. Benefits should outweigh risk

Question 38

What is hyposplenism?

Answer 38

A reduction in splenic function as a result of various medical conditions. It does a poor job of filtering out old RBCs

Question 39

Why do sickle cell anemia patients present with hyposplenism?

Answer 39

There is functional asplenia after 1 year of age - splenic tissue present but doesnt work well There is anatomical asplenia after 6-8 yrs due to autoinfarction of spleen. Blockage of blood supply to the spleen causes hypoxia and subsequently necrosis

Question 40

Congenital absence of spleen is

Answer 40

rare can occur due to transposition of organ Malformation of heart and lungs

Question 41

Atrophy of the spleen seen at what age

Answer 41

Old age, around 65 yrs

Question 42

Danger for hyposplenic patients

Answer 42

Increased susceptibility to infections especially in infants and sickle cell anaemia.

Question 43

Common infections that affect hyposplenic patients

Answer 43

S. Pneumoniae H. Influenza type B N. Meningitides Malaria and Infections caused by bites ( more common in those who have had splenectomy)

Question 44

Causes of hyposplenism

Answer 44

``` Splenectomy Sickle cell Anaemia Splenic arterial thrombosis Amyloidosis Adult gluten induced entropathy Essential thrombocytopenia ```

Question 45

Red blood cell film features in hyposplenism

Answer 45

``` Howell Jolly bodies Acanthocytosis Irregularly contracted cells Pappenhaumer bodies Target cells Iron granules ```

Question 46

White blood cell blood film features in hyposplenism

Answer 46

Mild lymphocytosis Monocytosis

Question 47

Platelets blood film count in hyposplenism

Answer 47

Thrombocytosis. 30% of platelets that was supposed to be in spleen present in circulation

Question 48

How to prevent infection in Hyposplenic patients

Answer 48

Patients should be told about their susceptibility to infection and if possible shouls carry a card around Prophylactic oral penicillin for life Vaccination against pneumococcus, influenza, meningococcus etc

Question 49

What drug will you give to patients allergic to penicillin

Answer 49

Erythromycin

Question 50

High risk groups that should be given oral penicillin

Answer 50

Patients under 16 Patients above 50 Patients who have undergone splenectomy Patients with a history of previous pneumococcal dx