Spleen
Lien(l)
--- Content provided by FirstRanker.com ---
Splen (g)Definition
? A large, highly vascular
--- Content provided by FirstRanker.com ---
lymphoid organ .
? It is the largest of the ductless
--- Content provided by FirstRanker.com ---
glands,? Its soft, and dark purplish
color.
--- Content provided by FirstRanker.com ---
AnatomyShape ? Wedge (Tetrahedral)
Location- Lt. Hypochondrium partly epigastrium
--- Content provided by FirstRanker.com ---
Wedged between the gastric Fundus and the
diaphragm,
--- Content provided by FirstRanker.com ---
lies beneath the 9th to 12th ribs,
The hilum sits in the angle between stomach and the
--- Content provided by FirstRanker.com ---
kidney and is in contact with the tail of the pancreas? Size & weight ? markedly variable
? Normal y ? not palpable
--- Content provided by FirstRanker.com ---
? Harri's Dictum
? Its related to the odd numbers 1,3,5,7,9,11,
--- Content provided by FirstRanker.com ---
? Thick , Broad, length, weight & relation.? Position- Axis of spleen
lies obliquely along the long axis of the 10th rib.
--- Content provided by FirstRanker.com ---
Directed- downwards, forwards & lateral y. (45*)External features-
Two ends, Three borders & Two surfaces.
--- Content provided by FirstRanker.com ---
? Peritoneal Relations-
? Surrounded by peritoneum & suspended by fol owing ligamnets-
--- Content provided by FirstRanker.com ---
? Gastrosplenic ligament- short gastric vessels, lymphatics & symp.N.
? Lienorenal ligamnet- tail of pancreas, splenic vessels,
--- Content provided by FirstRanker.com ---
? pancreaticospleni lymoh nodes? phrenicocolic ligamen ? supports only.
? Visceral relations-
visceral & diaphragmatic surface- costodiaphragmatic recess of
--- Content provided by FirstRanker.com ---
pleura, lung, & 9,10,11th ribs of left side.
Blood Supply
--- Content provided by FirstRanker.com ---
? Arteries :
The splenic artery which is the largest branch of
the celiac artery
--- Content provided by FirstRanker.com ---
? Veins :
The splenic vein which joins the superior
mesenteric vein to form the portal vein
--- Content provided by FirstRanker.com ---
? Lymph drainage :
The lymph vessels emerge from the hilum and
drain into the celiac nodes .
--- Content provided by FirstRanker.com ---
? Lymph drainage :
The lymph vessels emerge from the hilum and drain into the celiac nodes .
--- Content provided by FirstRanker.com ---
Nerve Supply- sympathetic fibres are derived from the coeliac plexus,vasomotor in nature.
Functions of the spleen
--- Content provided by FirstRanker.com ---
? the spleen processes foreign antigen
Immune
--- Content provided by FirstRanker.com ---
? Make bacteria and fungi more susceptible tofunction
phagocytosis.
--- Content provided by FirstRanker.com ---
? Macrophages capture cel ular and noncel ular
material from the blood and plasma includes
--- Content provided by FirstRanker.com ---
bacteria, especial y pneumococciFilter function
?
--- Content provided by FirstRanker.com ---
culling
Removal of effete, platelets and red cel s
--- Content provided by FirstRanker.com ---
? removing the inclusions from red cel s and returningthe repaired red cel to the circulation
Pitting
--- Content provided by FirstRanker.com ---
? up to 30--40 per cent of blood platelets are
Pooling
--- Content provided by FirstRanker.com ---
sequestered within the spleen.? removal of iron from ingested degraded haemoglobin
during red cel cul ing and return the iron to the
--- Content provided by FirstRanker.com ---
plasma.
Iron reutilisation
? PALPATION OF THE SPLEEN
--- Content provided by FirstRanker.com ---
? SPLENOMEGALY
? SPLENECTOMY
--- Content provided by FirstRanker.com ---
? SPLENIC PUNCTURE? SPLENIC INFARCTION- Kehr's sign.
SPLENOMEGALY
--- Content provided by FirstRanker.com ---
What is splenomegaly ?? Splenomegaly is an enlargement of the spleen beyond its normal size
Symptoms and signs
--- Content provided by FirstRanker.com ---
Symptoms:? Abdominal pain
? chest pain
? back pain
--- Content provided by FirstRanker.com ---
Signs:
? palpable left upper quadrant
? Abdominal mass
--- Content provided by FirstRanker.com ---
Causes of splenomegalyInfection
Infarctio
--- Content provided by FirstRanker.com ---
Cel ular
n and
--- Content provided by FirstRanker.com ---
proliferainjury
Causes of
--- Content provided by FirstRanker.com ---
tion
splenom
--- Content provided by FirstRanker.com ---
egalyCel ular
Congesti
--- Content provided by FirstRanker.com ---
infiltrati
on
--- Content provided by FirstRanker.com ---
on1- Infection
Bacterial
--- Content provided by FirstRanker.com ---
ViralProtozoal
2- Cellular Proliferation
--- Content provided by FirstRanker.com ---
Malignancies
Anemia
--- Content provided by FirstRanker.com ---
? leukemia? Spherocytosis
? lymphoma
--- Content provided by FirstRanker.com ---
? Hemolytic
? Sarcoidosis
--- Content provided by FirstRanker.com ---
? Myelofibrosis? pernicious
3- Congestion
--- Content provided by FirstRanker.com ---
Portal hypertensionHepatic vein obstruction
Congestive heart failure
--- Content provided by FirstRanker.com ---
4- collagen disease :
Felty's
--- Content provided by FirstRanker.com ---
Still'ssyndrome syndrome
Felty's syndrome
--- Content provided by FirstRanker.com ---
? Felty syndrome is characterized by thecombination of:
1. rheumatoid arthritis
--- Content provided by FirstRanker.com ---
2. splenomegaly3. Neutropenia
5-Infarction and Injury
--- Content provided by FirstRanker.com ---
? Embolism from ; bacterial endocarditis1
, AF, MI
--- Content provided by FirstRanker.com ---
? Splenic artery or vein thrombosis
2
--- Content provided by FirstRanker.com ---
? Hematoma3
Hypersplenism
--- Content provided by FirstRanker.com ---
? Definition:Hypersplenism is a type of disorder which causes the
spleen to rapidly and prematurely destroy blood
--- Content provided by FirstRanker.com ---
Types & causes1ry
? The problem within the spleen
--- Content provided by FirstRanker.com ---
itself.
hypersplenism
--- Content provided by FirstRanker.com ---
? chr. malaria? TB
2ry
--- Content provided by FirstRanker.com ---
? Polycythemia vera
? Tumors.
--- Content provided by FirstRanker.com ---
hypersplenism ? Portal hypertensionSymptoms & signs
--- Content provided by FirstRanker.com ---
? Symptoms of anemiaRBC
? Symptoms of leukopenia & recurrent
--- Content provided by FirstRanker.com ---
WBC
infections
--- Content provided by FirstRanker.com ---
? Symptoms of thrombocytopeniaplatelets
+ splenomegaly
--- Content provided by FirstRanker.com ---
Diagnosis & ttt
History taking
--- Content provided by FirstRanker.com ---
Clinical examinationImaging studies
Laboratory investigation
--- Content provided by FirstRanker.com ---
Treat underlying dis.
splenectomy
--- Content provided by FirstRanker.com ---
SPLENECTOMY
Splenectomy
--- Content provided by FirstRanker.com ---
? Definition:A splenectomy is the total or partial surgical removal of
the spleen
Indication of Splenectomy
--- Content provided by FirstRanker.com ---
? Trauma:A- accidental
B- during surgical procedure of
--- Content provided by FirstRanker.com ---
surrounding structures
? As a part of other procedures:
--- Content provided by FirstRanker.com ---
eg. Radical gastrectomy in gastric carcinoma. Total ordistal pancreatectomy.
? Hematological conditions:
--- Content provided by FirstRanker.com ---
? A- RBC:
?
--- Content provided by FirstRanker.com ---
- Hereditary spherocytosis?
- Thalassaemia
--- Content provided by FirstRanker.com ---
?
- SCA
--- Content provided by FirstRanker.com ---
?- Autoimmune hemolytic anemia (AIHA)
? B- WBC:
--- Content provided by FirstRanker.com ---
?
- CML)
--- Content provided by FirstRanker.com ---
?- Lymphomamanagement
? C- Platelets:
--- Content provided by FirstRanker.com ---
? - Idiopathic thrombocytopaenic purpura
(ITP)
? Vascular conditions:
--- Content provided by FirstRanker.com ---
? a- Splenic Artery Aneurysm
? b- Portal hypertension (only if there are
--- Content provided by FirstRanker.com ---
symptomatic esophageal varices) which wecalled it segmental portal hypertension.
? Tumors or Abscess:
--- Content provided by FirstRanker.com ---
? primary tumors of the spleen
? Splenic Abscess(Both are rare conditions)
--- Content provided by FirstRanker.com ---
? Others: like cysts in spleen which could becongenital, degenerative or parasitic like in hydatid
dis.
--- Content provided by FirstRanker.com ---
? Remember that :
There are two diseases for which a splenectomy is the
--- Content provided by FirstRanker.com ---
only treatment--primary cancers of the spleen andhereditary spherocytosis (HS)
--- Content provided by FirstRanker.com ---
Pre Operative Preparation1.VACCINATIONS
2.PLT Transfusion
--- Content provided by FirstRanker.com ---
3. Steroids
Special Pre-Op Preparations
--- Content provided by FirstRanker.com ---
In SCD:1 Prevention of hypoxia [ O2 ]
--- Content provided by FirstRanker.com ---
2 hydration
3 Antibiotics
--- Content provided by FirstRanker.com ---
4 Blood!!!!Types
--- Content provided by FirstRanker.com ---
partiallaparoscopic
complete
--- Content provided by FirstRanker.com ---
open
splenectomy
Laparoscopic splenectomy
--- Content provided by FirstRanker.com ---
? Removal through several small incisions.
? hospital stay.
? postoperative pain.
? risk of get infection
--- Content provided by FirstRanker.com ---
? Leave smaller scars.? Remove only middle size enlarged spleen.
Complete splenectomy
--- Content provided by FirstRanker.com ---
Removal of enlargedRemoval of ruptured
spleen
--- Content provided by FirstRanker.com ---
spleen
? Performed under
--- Content provided by FirstRanker.com ---
? Common cause ofgeneral anesthesia.
rupture is accidental
--- Content provided by FirstRanker.com ---
? One of the open surgery.
trauma.
--- Content provided by FirstRanker.com ---
? Most common? To avoid bleeding, we
technique used if we
--- Content provided by FirstRanker.com ---
ties the splenic artery
have .....
--- Content provided by FirstRanker.com ---
before removing theruptured organ.
Partial splenectomy
--- Content provided by FirstRanker.com ---
? Removes only part.? Useful to reduces pain caused by splenomegaly.
? The pt. is less vulnerable to infection.
Complications
--- Content provided by FirstRanker.com ---
co Earmplicyations Late complications
Postoperative complications
--- Content provided by FirstRanker.com ---
? Lung:
Atelactasis
Pleural effusion
Subphrenic
--- Content provided by FirstRanker.com ---
abscess
--- Content provided by FirstRanker.com ---
Postoperative complications
? Stomach
--- Content provided by FirstRanker.com ---
Dilatation
Perforation
Fistula
Haematemesis
--- Content provided by FirstRanker.com ---
? Pancreas
Abscess
Pancreatitis
Fistula
--- Content provided by FirstRanker.com ---
Postoperative complications
? Haematological
--- Content provided by FirstRanker.com ---
increase in Plts
&WBC.
--- Content provided by FirstRanker.com ---
? Postsplenectomy
Septicaemia
--- Content provided by FirstRanker.com ---
D/T *H.inf
*St.pneum
--- Content provided by FirstRanker.com ---
*N.mening