Download Splenic function:

Aproach to the
patient with
Splenomegaly:
‫اعمال طحال‬
1-Filtration
2-Immunologic
3-Reservoir
4-hematopoietic
Dr.Azarm
Dr.Azarm
The presence of
HowellJolly bodies in the
peripheral blood indicates
that the patient has had a
splenectomy or has a
process that has rendered
the spleen nonfunctional
Dr.Azarm
The white pulp of the spleen
contains macrophages, B
lymphocytes, and T
lymphocytes, participates in
the recognition of
microorganisms and foreign
proteins, and is involved in the
primary immune response
Splenic function:
 Cellular and humoral immiunity
 Removal of senescent red blod
cells,bacteria and other particulates
from the circulation
 One third of circulating platelets are
sequestered in the spleen
 The spleen may become the site of
extramedullary
hematopoisis,abnormally
How could we diagnose splenomegaly?
Physical examination(the most important)
X-ray
Nuclear medicine
CT scan
MRI
The
splenic
red
pulp
occupies more than half the
volume of the spleen and is
the site where senescent red
cells are identified and
destroyed and red blood cell
inclusions are removed by a
process known as pitting
Anatomical information of the spleen:
It’s in posterior portion of the left upper
quadrant of peritoneal cavity.
It’s below the diaphragm and adjacent to the
9th to the 11th ribs,stomach,colon,left kidney
and tail of pancreas.
It weighs 80 to 200 gr in males and 70 to 180
gr in females.
It is not usually palpable,except in
children,adolescents and some adults
especially those of asthenic build.
What happens if we remove spleen?
These patients are more
susceptible to bacterial
sepsis,especially with
encapsulated organisms.
What happens if we remove spleen?
Without spleen, different abnormal
red cells will be present in blood
circulation:

senescent red cells

red cells with nuclear
remnants(Howell-jolly bodies)

insoluble globin
precipitates(Heinz bodies)
Symptoms of hyposplenism and asplenia:
Sepsis with encapsulated
organisms,esp in children
Mild degrees of thrombocytosis
and leukocytosis
Howell-jolly bodies in circulating
red cells,along with increased
number of target cells ans
misshapen red cells.
Increased number of erythrocyte
and Heinz bodies.
Splenosis:
It is caused by splenic
implants which may result
from the spillage of cells
from the splenic pulp
following injury or
splenectomy.
Splenosis:
.
It can be located in peritoneal
cavity and even in pleural or
pericardial cavities.
These are normal splenic tissues
and can be diagnosed via tissue
biopsy techniques
The spleen is the larg
est lymphatic organ in the
body and is sometim
es approached clinic
ally as though it wer
.e a very large lymph node