Download MBBS Surgery Presentations 52 Spleen Lecture Notes

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Spleen

Dept of Surgery

Word "spleen" in English is "ill temper








Anatomy

Largest reticuloendothelial organ in the body

Intra-abdominal wedge shaped organ.

Left hypochondrium & epigastrium.

Soft , highly vascular.

Variable size & weight

Average 12.5 X 7.5 X 2.5 in size

150 -230 gm in weight.




It derives most of its blood from the splenic artery

Small amount from short gastric vessels

Venous drainage: splenic vein

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

Physiology

Filtration

Host defence

Storage

Hematopoiesis






Congenital Anomalies

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

Hypoplasia: more common finding

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.

In splenectomy if an accessory spleen is overlooked, the

benefit of removal of the definitive spleen can be lost

Splenomegaly

Means enlargement of spleen.

Normal spleen not palpable.

has to enlarge 2 time to be detectable.

Enlarges from left hypochondrium to right

illiac fossa.













Examination

Examination






Examination

Classification Of Splenomegaly

Alotaibi G et al. classification splenomegaly as:

? Moderate

: 11?20 cm

? Severe : >20 cm

Another classification acc. to extent below coastal

margin:

? Mild

: <5 cm

? Moderate

: 5-8 cm

? Severe : >8 cm








Splenomegaly Grading (Hacket's Grading)

Pathology

Basical y splenomegaly is due to:

vIncreased function

vAbnormal blood flow

vInfiltration






Increased Function

Removal of defective RBCs
Spherocytosis
Thalassemia
Hemoglobinopathies
Nutritional anemias
Early sickle cell anemia

Increased Function

Immune hyperplasia

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

mononucleosis, AIDS, viral hepatitis

subacute bacterial endocarditis, bacterial septicemia

splenic abscess, typhoid fever

brucel osis, leptospirosis, tuberculosis

histoplasmosis

malaria, leishmaniasis, trypanosomiasis






Increased Function

Immune hyperplasia

Disordered immunoregulation

Rheumatoid arthritis

Systemic lupus erythematosus

Serum sickness

Autoimmune hemolytic anemia

Sarcoidosis

Increased Function

Extramedullary hematopoiesis

Myelofibrosis

marrow infiltration by tumors, leukemias

marrow damage by radiation, toxins






Abnormal Blood Flow

Organ Failure

cirrhosis

Vascular

hepatic vein obstruction
portal vein obstruction
Budd?Chiari syndrome
splenic vein obstruction

Infiltration

Metabolic diseases

Gauchers disease
Niemann?pick disease
Hurler syndrome
Mucopolysaccharidoses
Amyloidosis






Infiltration

Benign and malignant "infiltrations"

leukemias (acute, chronic, lymphoid, and myeloid)

lymphomas (Hodgkins and non-Hodgkins)

myeloproliferative disease

metastatic tumors (commonly melanoma)

histiocytosis X

hemangioma, lymphangioma

splenic cysts

hamartomas

Mild Splenomegaly

Malaria

Typhoid

Disseminated TB

Viral hepatitis

Septicemia

Thalessemia minor

HIV






Moderate Splenomegaly

Cirrhosis

Lymphomas

Leukaemia

Infectious mononeucleosis

Hemolytic anemia

Splenic abcess

Amylodosis

hemochromatosis

Severe Splenomegaly

Chronic malaria

Kala azar

CML

Portal hypertension

Thalessemia major

Infiltrative & metabolic disorders






Management

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

? CBC
? USG
? CECT scan

Treatment

Can be medical or surgical

Medical management involves treatment of

cause if possible

Surgical treatment is splenectomy






Indications Of Splenectomy

Trauma : splenic rupture (MC)

ITP

Hemolytic anemias

CLL, Lymphomas

Primary Myelofibrosis

Tropical splenomegaly

Preoperative Considerations

Splenic Artery Embolization

Vaccination

Deep Venous Thrombosis Prophylaxis




Splenectomy Techniques

Open Splenectomy Technique

Laparoscopic Splenectomy

Partial Splenectomy

Complications

Pulmonary

Left lower lobe atelectasis, pleural effusion, pneumonia

Hemorrhagic

Infectious

Subphrenic abscess. Wound infection

Pancreatic

Pancreatitis, pseudocyst, pancreatic fistula

Thromboembolic






Overwhelming Post splenectomy Infection (OPSI)

loss of the ability to filter and phagocytose bacteria

loss of a significant source of antibody production

MC source of infection:Streptococcus pneumoniae

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

streptococci , Babesia microti