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I. Anatomy
- weight approximately 100-150
grams
- located in the left upper and
protected
by the lower portion of the rib cage
- its position is maintained by several
ligaments
a. splenophrenic
b. splenorenal
c. splenocolic
d. gastrosplenic short gastric a.
Spleen
Blood supply
histology
B. Immunologic Function
1. opsonin production
2. antibody synthesis (IgM)
3. protection from infection
C. Storage Function
1. plateletes 1/3 are stored in the
spleen
2. in splenomegaly, up to 80% of the
plateletes may be stored in the spleen
thrombocytopenia
splenomegally
splenomegally
III. Diagnostic
A. Evaluation of size
1. physical examination
a. not normally palpable
b. felt in 2% of healthy adults
c. no significant dullness elicited by
percussion over spleen
d. as organ enlarges, dullness is detected at
the level of the 9th ICS in
the left anterior
axillary line
IV. Pathologies
A. Rupture of the Spleen
1. Etiology disruption of the spleens
parenchyma, capsule, and blood supply
a. spleen is the most commonly injured
organ following blunt trauma
b. 2% splenic injury during surgery
in
the LUQ Gastric surgery
c. spontneous rupture hematologic
disorders
2. Pathology
a. splenic rupture
i. intraperitoneal bleed
ii. 90% of blunt trauma
b. delayed rupture
i. interval of days or weeks between
injury and bleeding; 10%-15%
tamponade
slowly
hematoma
4. diagnostic studies
a. CBC serial Hct determination
leukocytosis
b. x-ray of the abdomen
i. fractured ribs
ii. elevated immobile
diaphragm
iii. enlarged splenic shadow
iv. medial displacement of
gastric shadow
v. widening shadow between
splenic flexure and
preperitoneal
fat
c. CT scan
d. angiography
5. Treatment surgery
a. children delayed surgical
management
b. adult - splenectomy
c. splenectomized patients should
receive pneumovax Haemophilus
influenza vaccine and children should also
be given oral penicillin daily until age 18
B. Hypersplenism
1. Primary hyperslenism
a. diagnosis by exclusion made
has been excluded
b. rare entity affecting women
c. anyone or all formed elements
may be affected
d. enlarged spleen
e. recurring fever and infection
f. lymphoma and leukemia
g. responds to splenectomy
h. steroids do not improve condition
c. other causes
i. neoplasms leukemia,
carcinoma
lymphoma, metastatic
destruction thalassemia
spleen
Splenic tumor
V. Splenectomy
A. Absolute Indications for Splenectomy
1. splenic tumors echinoccocal cyst
2. metastatic disease
3. splenic abscess
4.hereditary spherocytosis most
common
hemolytic anemia for which
splenectomy is
indicated
5. bleeding esophageal varices
ease
A. Complications
1. left lower lobe atelectasis
most common
2. subphrenic hematoma
3. subphrenic abscess can occur
with
placement of a drain
4. pancreatitis trauma to the tail
of the pancreas
5. deep vein thrombosis low
dose anticoagulants
B. Hematologic outcomes
1. initial
a. thrombocytopenia rise in
platelete count within a few days
b. chronic hemolytic anemias
level above 10 g/dl
Hgb
2. long-term
a. increase in platelete count
rise
to >150,000 more than 2
months
after surgery
b. 90-100% success for
hereditary
spherocytosis
C. Overwhelming Post-Splenectomy
Infection (OPSI) 1. lifetime risk of
severe infection
2. incidence of 3.2% post-splenectomy
3. loss of the spleens ability to filter
and phagocytose bacteria and
infected
RBC
7. prevention
a.vaccine against
i. pneumoccocus
ii. H. influenzae
iii. meninggococcus
- to be given within 7-14 days
after splenectomy