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31 Cards in this Set
- Front
- Back
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***what is a grave sign in young, healthy pts w/ hypotension
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if there is suspected splenic injury, this could be a grave sign requiring surgery
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***the spleen
stores how much RBCs what % of pletelets why were early dog studies of shock useless? |
40-50 mL of RBCs
25-35% of circulating platelets dogs can autotransfuse using splenic mm; humans can't |
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what are common causes of splenic rupture?
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trauma
L posterior rib fx even if no injury; still can have ruptured spleen iatrogenic injury hemolytic anemia |
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what type of splenic rupture is rare in the us?
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spont rupture due to ds; seen in malaria & infxs mono
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what is the MC reason for splenectomy in the US?
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splenic trauma
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if origin of pain is below diaphragm, where would the pain be felt?
not be felt? |
radiates to L shoulder or jaw
may not radiate down to anus |
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hemodynamic presentation of spleen injury?
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hypotension, compensatory tachycardia
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what happens if there is a capsular rupture?
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blood into abdmnl cavity - peritonitis - pain and peritoneal signs
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what kinds of signs would be present during the physical exam?
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dec. BS
firm to rigid abd - guarding rebound |
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how many types of XR studies can be used?
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5 - size/whether or not injury present
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***what is the gold standard?
used for? |
CT scan
differentiates hematoma from enlargement stage lymphoma detects other organ involvement |
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what are the 4 other studies?
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angiography (veins, arteries, 1*tumor)
routine abd xr (fx) US (size, evaluation of cyst/abscess) radionucleide scan |
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***What is the 1st rule w/ splenectomy?
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followed by inc platelets in nL pts since spleen stores 1/3 of platelets, moves into blood when removed
(no longer sequester platelets) |
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indications for splenectomy?
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if repair not possible
attempt repair if >=50% salvagable |
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***when should attempts at surgery be abandoned?
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if pt has other injuries or remains unstable
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what are is a non-traumatic indication for splenectomy?
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hemolytic anemia
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what are the 3 types of hematologic disorders of splenic function
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1. membrane structural abnLs
2. metabolic abnL 3. hemoglobinopathies |
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what is the indication of a splenectomy with thrombocytopenia?
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only in idiopathic, immune mediated thrombocytopenia
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what types of leukemias where splenectomy is not indicated?
when is it indicated? |
acute leukemias not indicated
CLL |
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what is important w/ splenectomies in hemolytic anemias?
age cut off? |
ensure removal of all accessory spleens to cure ds
<5 yoa |
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CI in ITP splenectomy?
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don't operate on on post-transfusion purpura
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When is splenectomy indicated in sickle cell disorder?
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a person ~12 yoa w/ sickle cell disorder and recurring crises; and/or huge spleen
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what should be done in the case of secondary hypersplenism?
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remove cause, not splenectomy
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In what situation would a splenectomy be indicated in 2* hypersplenism?
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when it reaches a point where you simply have to remove it due to size (oblique expansion)
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enlarged spleen usually non-tender, unless the following happens:
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- infection
- infarction - trauma w/ blood from peritoneum, or subcapsular, or splenic hematoma |
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what is one of the MCC of hypersplenism/splenomegaly?
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portal HTN
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what are the potential complications w/ splenectomy
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1. large cavity in LUQ
2. **resp complications - 10-48% 3. **atelectasis - MC pulm problem post-splenectomy 4. PNA |
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when thrombocytosis as complication, what is CI
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don't use heparin or warfarin
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how much does the risk of an immune complication increase when pt receives splenectomy...with hematologic disorders?
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risk inc x40
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what splenic injuries are indicative for a splenectomy?
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major lacerations
fragmentation hilar injuries |
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what are the surgical post op complications:
1. early: day 0-3 2. late: day 6 or later |
1.
- fever - UTI, PNA, wound infection - dehiscence - hemorrhage - ileus 2. - abscesses - obstruction - failure of sx procedure |
