Diseases of Spleen

Diseases of Spleen

1. NUR FADZLINA ZABRI 082013100006 SPLEEN

2. Embryology  Condensations of mesogastrium in dorsal mesogastrium

3. Anatomy

4. Functions of spleen Immune function – major site of IgM production and opsonins Filter function – cellular and non cellular Reservoir function – contains 8% of red cell mass Hematopoesis – in fetal life and hematological disorder

5. Investigations History – pain, infection, hemolytic disease in family Examination findings – splenomegaly , splenic bruit Laboratory examination – full blood count, reticulocyte count, hemolytic test Radiological imaging – plain radiology, US,CT, MRI

6. DISEASES OF SPLEEN Spleen anomalies Splenic agenesis Polysplenia – results from failure of splenic fusion Splenunculi – single/multiple spleen accessory Hamartomas Non parasitic splenic cyst

7. B) Splenic artery aneurysm, infarct and rupture Splenic artery rupture Associated with atherosclerotic patient Consequence of intraabdominal sepsis or pancreatic necrosis Presence of splenic bruit Detected on Xray or scan Treatment – splenectomy and removal of diseased artery

8. Splenic infarction Massive splenomegaly : Myeloproliferative syndrome Portal hypertension Splenic vein thrombosis Sickle cell disease Left shoulder tip pain Infarct causing abscess requires splenectomy

9. Splenic rupture Causes ; Blunt abdominal trauma Iatrogenic injury Rupture of malarial spleen R upture of enlarged spleen due to malaria Must undergo s plenectomy before perisplenic hematoma ruptures

10. C) Splenomegaly and hypersplenism

11. Splenic abscess Rare- should be suspected when there is progressive splenic enlargement with bacteremia and abscess formation at other sites Associated with Pancreatic necrosis Intra abdominal infection Care : percutaneus drainage of the splenic abscess under radiological guidance

12. Tuberculosis of spleen Young adults with splenomegaly : asthenia, loss of weight, fever Anti tuberculous drug Splenectomy is difficult

13. Tropical splenomegaly Occurs in tropical country Malaria Kalazar Schistosomiasis Occult infection Malnutrition Requires splenectomy Results from portal hypertension associated with Hepatic fibrosis or Hyperplasia of induced phagocytosis of disintegrated worms, ova or toxin

14. Idiopathic thrombocytopenic purpura Antibodies develop against platelet membrane glycoprotein that damages patient’s platelet Features Purpuric patches on skin and mucosa ( ecchymoses ) Numbers of petechial hemorrhages Tendency of spontaneous bleeding Corticosteroids Steroid relapses or platelet remains low  splenectomy

15. Hemolytic anemia Hereditary spherocytosis AD hereditary disorder Presence of spherocytic red cells, various in molecular defects in the gene Mild jaundice, anemia, splenomegaly and gallstones Splenectomy done after 6 years of age

16. Thalassemia Defects in the hemoglobin peptide chain synthesis Chronic anemia, jaundice, splenomegaly , hemolytic facies Requires blood transfusion Splenectomy ; Transfusion dependent Hemolytic antibodies develop

17. Sickle cell anemia Hb A is being replaced by Hb S Hb S crystallises when oxygen tension is reduce  distorting elongated red cell Increase blood viscosity Obstruct the flow of blood in spleen Crisis – adequate hydration, partial exchange transfusion Splenectomy in splenic sequestration aggravates anemia

18. Porphyria Hereditary error of hemoglobin catabolism Features : Abdominal crises – intestinal colic, constipation Anemic Photosensitivity Splenomegaly Port-wine colour urine Splenectomy has little role in management

19. Gauchers disease Defect of glycosphingolipid metabolism- accumulation of glucocerebroside Enormous splenic enlargement + yellowish brown discoloration of skin, anemia, conjunctival thickening

20. Hypersplenism due to portal hypertension Results in thrombytopenia and granulocytopenia Care : shunt surgery or liver transplantation Symptomatic esophagogastric varices requires splenectomy

21. Felty’s syndrome Treated with steroids or splenectomy

22. Common benign tumor of spleen Rarely develop into hemangiosarcoma Treatment – splenectomy D ) Neoplasm Hemangioma

23. Lymphoma Common cause of neoplastic enlargement Splenectomy is required for achieving the diagnosis in the absence of palpable lymph node or Relieving gross splenomegaly

24. Results from abnormal proliferation of mesenchymal elements in the bone marrow, spleen, liver, lymph node Pain due to gross enlargement or splenic infarction S plenectomy Myelofibrosis

25. INDICATIONS Trauma Oncological – part en bloc resection, therapeutic, diagnostic To reduce anemia or thrombocytopenia in spherocytosis , ITP, hypersplenism Variceal surgery for portal hypertension SPLENECTOMY

26. Preoperative preparation Coagulation profile Should be near normal Bleeding tendency – blood transfucion , FFP, cryoprecipitate, platelets Antibiotic prophylaxis To prevent post- splenectomy sepsis

27. Technique of open splenectomy

28. Hemostasis Ligation or application of metal clips to intrasplenic vessels Application of hemostatic agents or mesh

29. A long incision is made from the xiphoid process down to just below umbilicus Splenic blood vessels are ligated and the spleen is dissected out The vessels are tied off and the packing is removed Packing is placed in the abdomen to stop the bleeding. Blunt dissection is then used to locate the source od hemorrhage

30. Technique of laparoscopic splenectomy

31. Spleen is separated from the kidney and diaphragm Pulled the liver aside Pull back the stomach to reveal the spleen Spleen tissue are then cut.

32. Self retaining opening bag is introduced and spleen is broken into smaller pieces Splenic artery and vein are closed off and cut

33. Hemorrhage dt slipped ligature Hematemesis dt gastric mucosal damage Left basal atelectasis , Pleural effusion Fistula from damage of the greater curvature of stomach Pancreatitis , localised abscess Postoperative thrombocytosis Post splenectomy septicemia Opportunist post- splenectomy infection Post operative complication

34. Opportunist post- splenectomy infection (OPSI) Recommendations I mmunisation Antibiotic prophylaxis Education : travel advise Prompt treatment of infection

35. Antibiotic prophylaxis Oral penicillin,erythromycin , amoxicillin, co- amoxiclav <5 years age : daily dose of penicillin for 10 years Older children : prophylaxis is continued till 16 years of age Immunization Vaccination against pneumococcus , meningococcus C, H. influenzae type B Given 2 weeks before elective surgery or as soon as possible as recovery from surgery Allergy to penicillin– cefotaxime , ceftriaxone , chloramphenicol

36. Education Should carry medical alert and Up to date vaccination card Give specific advice on travel : use all physical anti-mosquito barriers, anti-malarial therapy animal handling : C apnocytophaga canimorsus

37. REFERENCES Bailey and Love https://www.youtube.com/watch?v=gC0aaE7JW2Y http://preop.com/