56. Spleen disorders

THEME XII: THE SPLEEN

1. Which are the major functions of the Spleen?

1. I. Hematologic
2. a. Destruction of senescent erythrocytes
3. b. Reservoir for platelets and granulocytes
4. c. Hematopoiesis in fetus or in conditions with bone marrow destruction
5. II. Immunologic functions
6. a. Filtration and trapping of circulatory antigens
7. b. Lymphocyte stimulation and proliferation
8. c. Antibody production

2. What does " Hypersplenism " mean?

• Hypersplenism is increased ↑ splenic function
• That is manifested clinically by the decrease ↓ in one or more of the circulating blood elements.

3. Which are the specific criteria for Hypersplenism?

The specific criteria for hypersplenism are:

Anemia

Thrombocytopenia

Leukopenia

• Normal compensatory response by the bone marrow to correct the cytopenia
• Correction of cytopenia by splenectomy.

4. Which is the most common indication for elective Splenectomy?

• Hypersplenism is the most common indication for elective splenectomy.

5. What is the aim of elective Splenectomy in Hypersplenism?

The aim is to

• Reverse the cytopenia
• Relieve compressive symptoms in cases of splenomegaly

6. Which are the most common primary tumors of the spleen?

7. What is usual clinical presentation of Splenic Abscess?

The patients present with signs and symptoms of:

Sepsis: including fever, malaise, and leukocytosis.

• When the spleen is the sole site of infection, patients will have significant LUQ left upper quadrant tenderness and guarding

8. What is the treatment of choice in splenic abscess?

• The treatment of choice is splenectomy

9. What is the cause of ectopic spleen?

The cause of ectopic spleen is:

• Extreme laxity or
• Absence of the normal ligaments that attach the spleen to the left upper quadrant

10. What is usual localization of ectopic spleen?

• In ectopic spleen the organ is usually dropped to the lower abdomen in either the right or the left lower quadrant
• by the force of gravity attached by its vascular pedicle

11. What is the definition of " Hyposplenism "?

• Hyposplenism is a state seen after a splenectomy
• Characterized with hematologic changes in the circulating cells and changes in the immunologic responses

12. What is the main danger for the patients after splenectomy and which aged group is most commonly affected?

• Overwhelming postsplenectomy sepsis due to the changes in the immunologic responses
• Infants or young children are under the highest risk of postsplenectomy sepsis

13. Which is the most common micro - organism causing postsplenectomy sepsis?