Spleen Powerpoint
Spleen Powerpoint
Spleen Powerpoint
R.A.M
Anatomy
Blood Supply
• Splenic artery (pattern of terminal branches)
• Distributed type: (70%) – Short trunk w/ many long branches
over ¾ of the medial surface of the spleen
• Magistral type: (30%) – Long main trunk dividing near the hilum
into short terminal branches
• Short gastric artery: - Which are branches of the left
gastroepiploic artery running within the gastrosplenic ligament
Anatomy
• Accessory Spleen
• The accessory spleens seen here at the hilum of
the normal sized spleen are not uncommon and
by themselves have no significance
• Splenosis
• Autotransplantation of splnenic fragments after
trauma
• Capable of performing some reticuloendothelial
function
Anatomy
The pulp consist of three (3) zones:
• Red Pulp
• 75% of total volume
• Comprised of venous sinuses, separated by reticulum. Contains macrophages
• Serves as filter, removes microorganism, cellular debris, antigen-antibody
complexes and old erythrocytes
• White Pulp
• Peri-articular lymphatic sheath T-lymphocytes
• B- lymphocytes - lymphoid follicles
• Serves the immunologic function of the spleen
• Marginal Zone
• It contains sequestered foreign materials and plasma as well as abnormal
cellular elements
Physiologic Functions
• Filtration
• Host defense
• Storage
• Cytopoiesis
Physiologic Functions
• Filtering Functions
– Most important function o Splenic blood flow is approximately 350 L/day
– Removal of abnormal red blood cells-Howell-jolly bodies, Heinz bodies, Pappenheimer
bodies. Approximately 20 ml of aged RBC are removed during the course of the day
– Removal of abnormal white cells, normal and abnormal platelets and cellular debris o It
can clear organisms contained w/in the erythrocytes( malaria & Bartonella)
– Can clear unopsonized bacteria and microorganisms for w/c the body has no anti-bodies
• Open circulation (90%)
– Blood goes first to reticular space and cords o Comes in contact with macrophages
• Closed circulation(10%)
– Goes directly to the arteriovenous anastomosis
Physiologic Functions
• Host Defense
– Opsonins-makes organism attractive to phagocytes
– Tuftsin-enhances the phagocytic activity of leukocytes
– Properdin-stimulates the alternative pathway of complement fixation
– Circulating monocytes are converted to fixed macrophages
• –at the red pulp
– Produces !immunoglobulin (IgM) o T and B lymphocytes-from the
lymphatic sheath surrounding the central arteries
Physiologic Functions
• Storage
– 30% of platelets are stored in the spleen
• Cytopoeisis
– Contributes to the process of RBC maturation
– Minor role in hematopoeisis in the 4th month
– Can be reactivated in childhood if the bone marrow fails to meet the
hematologic need Myeloid metaplasia - abnormal RBC are
produced
DIAGNOSTICS
Evaluation of size
• Physical Examination
• Normally not palpable
• Felt in about 2 % of healthy adults
• No significant dullness elicited by percussion over spleen
either anteriorly or laterally
• As organ enlarges, dullness is detected at the level of the 9th
ICS in the left anterior axillary line
DIAGNOSTICS
ULTRASOUND
• Ultrasound is the least invasive mode of splenic imaging
• Rapid, easy to perform, and does not expose the patient to ionizing radiation
• It is often the first imaging modality applied to the spleen during evaluation and
resuscitation of the trauma patient
• Percutaneous ultrasound-guided procedures for splenic disease are becoming more
common as the safety of these procedures is being increasingly demonstrated
DIAGNOSTICS
CT SCAN
• Computed tomography (CT) affords a high degree of resolution and detail of the splenic
parenchyma
• In the nontrauma setting, CT is extremely useful for assessment of splenomegaly,
identification of solid and cystic lesions, and guidance of percutaneous procedures
• The use of iodinated contrast material adds diagnostic clarity to CT imaging of the
spleen, although at the cost of the small real risks of renal impairment or allergic
reaction.
DIAGNOSTICS
PLAIN RADIOGRAPHY
• Rarely is plain radiography used for primary splenic imaging
• Plain films can indirectly provide an outline of the spleen in the left upper quadrant or
suggest splenomegaly by revealing displacement of adjacent air-filled
• Plain films may also demonstrate splenic calcifications – often are found in association
with splenomegaly but are otherwise a nonspecific finding
• Splenic calcifications can indicate a number of benign, neoplastic, or infectious
processes, including phlebolith, splenic artery aneurysm, sickle cell changes, tumors,
echinococcosis, or tuberculosis
DIAGNOSTICS
MRI
• Although magnetic resonance imaging offers excellent detail and versatility in
abdominal imaging, it is more expensive than CT scanning or ultrasound and
offers no obvious advantage for primary imaging of the spleen
ANGIOGRAPHY
• Angiography of the spleen most commonly refers to invasive arterial imaging,
and when it is combined with therapeutic splenic arterial embolization (SAE) v
localization and treatment of hemorrhage in select trauma
NUCLEAR IMAGING
• Radioscintigraphy with technetium Tc 99m sulfur colloid demonstrates splenic
location and size v It may be especially helpful in locating accessory spleens
after unsuccessful splenectomy for ITP and has recently proven useful in
diagnosing splenosis
INDICATIONS FOR SPLENECTOMY
Hereditary Spherocytosis
• Deficiency in one of the membrane proteins
(spectrin,ankyrin,band3 protein)
• Spherical less deformable shape, they
sequestered and destroyed in the spleen
• The only type of hemolytic anemia which
splenectomy is the primary treatment
• In children-delayed until ages of 4-6 years
Red Blood Cell Disorders
• Thalassemia
• Treatment:
– Blood transfusion
– Maintain Hgb > 9 mg/dL
– Iron chelation therapy (deferoxamine)
– Splenectomy
• high risk of pulmonary Hypertension
• Excessive transfusion 200 ml/kg per year
• Discomfort
• Painful splenic infarction
Red Blood Cell Disorders
• Open Splenectomy
• Indication:
– traumatic rupture of the spleen (most
common)
– massive splenomegaly
– ascites
– portal hypertension
– multiple prior operations
– extensive splenic radiations
– possible splenic abscess
SPLENECTOMY