Download spleen

Dr. Mezjda Ismail Rashaan, consultant surgeon
University of sulaymania
Faculty of medical sciences
School of medicine
Kurdistan
Anatomy:-origin
-location & surface anatomy
-its ligaments ; (gastrosplenic, splenocolic,
phrenicosplenic, splenorenal)
-arterial and venous supply
-white and red pulp( cords & sinuses),marginal
zone
-trabeculae art., central art., pencillar artery
-skimming effect
-defense spleen & storage spleen
1-immune function
.specific like igM production
. Nonspecific( opsions tuftin,properdin) to phagocyte
the bacteria, fungi.
2-filter function
. macrophages catch bacteria specially pnumoccocci,
H. influnzie, noncellular materials .
3-removal of effecte platelets, RBC bu Culling
4-Pitting, removing particular inclusions from RBCs like
parasite of malaria, nucleated RBCs
5-iron reutilization
6-pooling
30-40% platelet. In splenomegaly may reach
80%
7-reservoir function in dogs
8-haematopoiesis up to 5monthes of intrauterine
life
Depend on the type of the disease which causing
splenomegaly, like :
-blood disease …blood investigation
-liver cirrhosis causing portal hypertention
…LFT,OGD for esophageal variesis
-associated with lymphadenopathy do LN biopsy
1-plain abdomen
-calcification(s)( hydatid cyst, haemangioma,
spleenic anurysm, TB, old infarct of SCA…etc.)
-soft tissue shadow at upper lt. hypochonderial
area
-descending colonic gas shadows
-obliteration of the psoas shadow
-size and consistency
-cystic or solid ?
-rapture..
-haematoma
-therapeutic i.e abscess drainage or aspiration of
the cyst, biopsy!!!!
4- MRI
5-radio-isotop scans Te 99
-recurrent disease?
-position & site
-RBC life duration and place of their destruction
6- angiography
-embolization of selected cases of splenic hge.
-liver schirosis
-before splenectomy to decrease its size
1- absence
-rare and it is usually associated with congenital heart disease
and fatal sepsis.
2- accessory spleen ( splenuculi)
-20% of population & 30% of pts. with haemolytic disease
-no more than 2cm
-80% found in splenic hilum and vascular pedicle
-omentum,gastrosplenic ligament,splenocolic
ligament,stomach greater curvature, small & large bowel
mesetery,in left broad ligament and spermatic cord…etc.
-if not removed after splenectomy ,it cause recurrent of the
disease
4- cysts
-rare
a-true one, non-parasitic
-may be dermoid, mesenchymal inclusion cysts,
epithelial cysts.
B- false cysts
.parasytic –echinococcus
.seroma
Clinical features:
-asymptomatic
-symptomatic
.mass in lt. upper hypochonderial area
Diagnosis:
sonography of the abdomen
Treatment:
.depend on symptomes.
if asyptomatic……observation and follow up by sonography.
if symptomatic … depend on its size
small one do excision
large one unroofed if
or do aspiration, drainage, sclerosing
Etiology;
-direct trauma
-without trauma in diseased spleen duo to malaria,
infectiouse mononucleosis
-iatrogenic during operation
It is suspected when there is # ribs at lt
hypochonderial area.
3 groups:
1- patient sccumbs rapidly from massive he.
2-initial shock ,recovery and later sings of internal
bleeding.
Kehrs sings, shifting dullness in flanks, rectal
examination fullness in pelvis
3- delayed case
-plain abdomen
-sonography of abdomen
-CT-abdomen
Treatment:
Surgical options
-splenectomy( total or partial)
- splenorraphy
-mesh net pressure compression
-rare
-cause spontaneous rapture of spleen
-duo to:
- infectious mononucleosis, CMV
-malaria
-fungal infection
-amylodosis, pregnancy, lymphoma, Q-fever…
-duo to myloproliferative syndrome
-vascular occlusion in sickle cell anemia, infected
heart valves bacterial endocarditis
-may be asymptomatic or causing abdominal pain in
left hypochondrium, gaurdening, friction rub
-uncommon ,most common in tropical area
-occurs with thrombosis of vessels or infarct of SCA.
- Splenic thrombosis infected
- Metastatic abscess duo to typhoid, paratyphoid,
oestiomylitis, otitis media, pureperal sepsis
-mechanism:.haematological
.contagious
.haemoglobinopathy
.trauma
.immunosuppression
-delayed
-fever, pain left hypochondria, increase WBC,
splenomegaly in 1/3 of the patients
Diagnosis:u/s or CT of abdomen
Treatment:drainage
-rare,< 1%
-female : male is 2:1
-involve main trunk
- May be single or multiple
-asymptomatic unless ruptured
-occasionally palpable in epigastrium with bruit in left
hypochonderial area
-incidentally on plain abdomen with calcified ring
-usually < 45 years, ¼ pregnant at 3rd trimester.
-in young females asymptomatic
-maternal mortality high( 70 %)
-treatment usually surgery by splenectomy