Spleen

Universidad de Guadalajara

November 2011

Spleen

Centro Universitario Ciencias de la Salud

Giovanna Lazcano Sherman

Dr. Héctor Manuel Virgen Ayala

Dr. Benjamín Robles Mariscal

Anatomy

Develops from mesenchymal

cells in the dorsal mesogastrium during the fifth

week of gestation.

The

peritoneum covering the

spleen, except in the hilum.

7cm

12 cm

3 – 4 cm

150 gr. (80 -300 gr).

Ligaments • Splenophrenic • Splenocolic

• Gastrosplenic• Splenorenal

Irrigation and venous drainage

Histology/Physiology

1. Splenic Trauma/Injury

2. Hypersplenism

Cronic Lymphocytic Leukemia

Is a B-cell leukemia that is characterized by the

progressive accumulation of relatively mature, but

functionally incompetent, lymphocytes.

Splenectomy for palliation of symptomatic splenomegaly and for treatment of cytopenia related to

hypersplenism

Hairy cell leukemia Splenomegaly,

pancytopenia, and neoplastic mononuclear cells in the

peripheral blood and bone marrow

Administration of purine analogues, as initial treatment. Splenectomy…massive enlargement of the spleen or with evidence of hypersplenism.

Myelodysplastic syndrome

Splenectomy ...* Hemolysis unresponsive to treatment.

* Symptoms esoplenomegalia graces of mass.* Life-threatening thrombocytopenia.

The bone marrow is usually replaced by fibrous tissue.

Systemic mast cell disease

indolent

aggressive

Splenectomy(thrombocytopenia)

Gaucher disease

Autosomal recessive disorder caused by a deficiency of

beta-glucosidase. (an enzyme that degrades the

sphingolipid glucocerebroside)

Splenectomy for hypersplenism-related

pancytopenia. (leaving a remnant)

Wiskott-Aldrich syndromeA X-linked recessive disease characterized by eczema,

thrombocytopenia (20,000 – 40,000) immune deficiency, and bloody diarrhea (secondary to the thrombocytopenia).

Splenectomy normalizes the shape, size and function of platelets. (Increased survival).

Sarcoidosis

Granulomatous disease of unknown

origin.

Splenectomy for hypersplenism-related pancytopenia.

3. Disorder Autoimmune/Erythroc

yte

Hereditary spherocytosis

Hemolytic anemia, the deficiency of

membrane proteins (spectrin, ankyrin and

protein 4-2)Characterized by

sphere-shaped red blood cells.

Hereditary elliptocytosis

Only 10% are symptomatic Splenectomy

Hereditary nonspherocytic hemolytic anemia.

• Anaerobic metabolism (energy).

• Production of antioxidants (glutathione)

Splenectomy is not curative but improve some conditions.

Immune hemolytic anemia

• IgM

• IgG

Splenectomy

Immune Thrombocytopenic Purpura

IGg fibrinogen receptor

Treatment

Mild symptoms or asymptomatic ... not require specific treatment.

Corticosteroids.

Splenectomy

Felty’s syndromeRheumatoid arthritis

Neutropenia SplenomegalyIgG

• Fever• Thrombocytopenic

purpura• Hemolytic anemia• Neurologic

manifestations• Renal failure

Trombotic trombocitopenic purpura

Plasmapheresis

Splenectomy

4. Vascular disease.

Splenic vein thrombosis

20%

5. Cysts, abscesses and primary splenic

tumors.

Rx calcification in the cyst wall

Cysts

• Lymphoma• Sarcoma• Hemangioma• Hamartoma

Primary Splenic tumors Abscesses

40-100% mortalityRx Presence of gas in the spleen (pathognomonic)CT Diagnostics

6. Diagnostic splenectomy

Single lesions of the spleen

Malignant lesions 60%

Benign lesions 40%

7. Incidental splenectomy

8. Iatrogenic splenectomy

40 - 50% Hematologic disorders.35 - 40% Trauma.20 -30% Neoplastic disease.

Splenectomy most common ...

Immune Thrombocytopenic Purpura has the highest incidence