Universidad de Guadalajara November 2011 Spleen Centro Universitario Ciencias de la Salud Giovanna Lazcano Sherman Dr. Héctor Manuel Virgen Ayala Dr. Benjamín Robles Mariscal
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