Download MBBS Surgery Presentations 52 Spleen Lecture Notes

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Spleen

Dept of Surgery

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Word "spleen" in English is "ill temper

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Anatomy

Largest reticuloendothelial organ in the body

Intra-abdominal wedge shaped organ.

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Left hypochondrium & epigastrium.

Soft , highly vascular.

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Variable size & weight

Average 12.5 X 7.5 X 2.5 in size

150 -230 gm in weight.

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It derives most of its blood from the splenic artery

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Small amount from short gastric vessels

Venous drainage: splenic vein

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Total splenic inflow of blood is approximately 250 to 300
mL/min

Physiology

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Filtration

Host defence

Storage

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Hematopoiesis

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Congenital Anomalies

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Complete absence is rare
associated with other congenital abnormalities such as situs
inversus and cardiac malformations.

Hypoplasia: more common finding

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Accessory spleens (spleniculi) are common
Generally situated in the gastrosplenic ligament or the tail of
the pancreas,omentum or mesenteries of the small or large
intestine.

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In splenectomy if an accessory spleen is overlooked, the

benefit of removal of the definitive spleen can be lost

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Splenomegaly

Means enlargement of spleen.

Normal spleen not palpable.

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has to enlarge 2 time to be detectable.

Enlarges from left hypochondrium to right

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illiac fossa.

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Examination

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Examination

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Examination

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Classification Of Splenomegaly

Alotaibi G et al. classification splenomegaly as:

? Moderate

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: 11?20 cm

? Severe : >20 cm

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Another classification acc. to extent below coastal

margin:

? Mild

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: <5 cm

? Moderate

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: 5-8 cm

? Severe : >8 cm

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Splenomegaly Grading (Hacket's Grading)

Pathology

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Basical y splenomegaly is due to:

vIncreased function

vAbnormal blood flow

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vInfiltration

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Increased Function

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Removal of defective RBCs
Spherocytosis
Thalassemia
Hemoglobinopathies
Nutritional anemias

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Early sickle cell anemia

Increased Function

Immune hyperplasia

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Response to infection (viral, bacterial, fungal,parasitic)

mononucleosis, AIDS, viral hepatitis

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subacute bacterial endocarditis, bacterial septicemia

splenic abscess, typhoid fever

brucel osis, leptospirosis, tuberculosis

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histoplasmosis

malaria, leishmaniasis, trypanosomiasis

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Increased Function

Immune hyperplasia

Disordered immunoregulation

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Rheumatoid arthritis

Systemic lupus erythematosus

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Serum sickness

Autoimmune hemolytic anemia

Sarcoidosis

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Increased Function

Extramedullary hematopoiesis

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Myelofibrosis

marrow infiltration by tumors, leukemias

marrow damage by radiation, toxins

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Abnormal Blood Flow

Organ Failure

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cirrhosis

Vascular

hepatic vein obstruction

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portal vein obstruction
Budd?Chiari syndrome
splenic vein obstruction

Infiltration

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Metabolic diseases

Gauchers disease
Niemann?pick disease

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Hurler syndrome
Mucopolysaccharidoses
Amyloidosis

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Infiltration

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Benign and malignant "infiltrations"

leukemias (acute, chronic, lymphoid, and myeloid)

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lymphomas (Hodgkins and non-Hodgkins)

myeloproliferative disease

metastatic tumors (commonly melanoma)

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histiocytosis X

hemangioma, lymphangioma

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splenic cysts

hamartomas

Mild Splenomegaly

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Malaria

Typhoid

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Disseminated TB

Viral hepatitis

Septicemia

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Thalessemia minor

HIV

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Moderate Splenomegaly

Cirrhosis

Lymphomas

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Leukaemia

Infectious mononeucleosis

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Hemolytic anemia

Splenic abcess

Amylodosis

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hemochromatosis

Severe Splenomegaly

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Chronic malaria

Kala azar

CML

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Portal hypertension

Thalessemia major

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Infiltrative & metabolic disorders

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Management

Depends on cause

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Various investigations as per clinical features &
epidemiology are employed
Basic investigations done are:

? CBC

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? USG
? CECT scan

Treatment

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Can be medical or surgical

Medical management involves treatment of

cause if possible

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Surgical treatment is splenectomy

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Indications Of Splenectomy

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Trauma : splenic rupture (MC)

ITP

Hemolytic anemias

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CLL, Lymphomas

Primary Myelofibrosis

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Tropical splenomegaly

Preoperative Considerations

Splenic Artery Embolization

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Vaccination

Deep Venous Thrombosis Prophylaxis

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Splenectomy Techniques

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Open Splenectomy Technique

Laparoscopic Splenectomy

Partial Splenectomy

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Complications

Pulmonary

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Left lower lobe atelectasis, pleural effusion, pneumonia

Hemorrhagic

Infectious

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Subphrenic abscess. Wound infection

Pancreatic

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Pancreatitis, pseudocyst, pancreatic fistula

Thromboembolic

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Overwhelming Post splenectomy Infection (OPSI)

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loss of the ability to filter and phagocytose bacteria

loss of a significant source of antibody production

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MC source of infection:Streptococcus pneumoniae

Others: H.influenzae type B, meningococcus, group A

streptococci , Babesia microti

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