• Share
  • Email
  • Embed
  • Like
  • Save
  • Private Content
Splenomegaly and post splenectomy care
 

Splenomegaly and post splenectomy care

on

  • 5,773 views

A presentation about

A presentation about
* causes of splenomegaly (in the tropics);
* treatment options
* splenectomy and post-splenectomy care

Statistics

Views

Total Views
5,773
Views on SlideShare
5,762
Embed Views
11

Actions

Likes
5
Downloads
0
Comments
2

4 Embeds 11

http://parksmedicallegal.blogspot.com 7
http://parksmedicallegal.blogspot.in 2
http://www.health.medicbd.com 1
http://www.docseek.net 1

Accessibility

Categories

Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel

12 of 2 previous next

  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment
  • The human spleen is located in the upper left part of the abdomen, behind the stomach and just below the diaphragm. In normal individuals this organ measures about 125 × 75 × 50 mm (5 × 3 × 2 inches) in size, with an average weight of 150 gramsApproximately 10% of people have one or more accessory spleens. They may form near the hilum of the main spleen, the junction at which the splenic vessels enter and leave the organ.There are several peritoneal ligaments that support the spleen[3] (to understand their naming it helps to know that "lien" is an alternate root for "spleen") * gastrolienal ligament (gastrosplenic) - connects stomach to spleen. * lienorenal ligament (splenorenal) - connects spleen to kidney. * phrenicocolic ligament - connects left colic flexure to the thoracic diaphragm. The middle connects to the spleen.
  • G6PD Deficiency gives rarely splenomegaly
  • For parasitic spleen cyst a splenectomy is only indicated when the spleen is the only involved organNon parasitic cysts only require splenectomy when there are symptoms or > 10cm
  • But in the case splenomegaly, the cause of this splenomegaly is usually also causing hepatomegaly.Hyper reactive malarial splenomegaly is caused by an abnormal response to repeated malaria infections that results in overproduction of IgM. The consequent immune complexes are removed by the spleen which can enlarge to huge proportions. The disorder is more common in woman and predominantly affects those aged between 20-40 years. Pregnant woman with hyper-reactive malarial splenomegaly commonly experience sudden episodes of hemolysiswhich may be life threatening. A Spleen which is over 10 cm from the left costal margin is almost always duetohyperreactive malarial splenomegaly.
  • When S. mansoni eggs are carried in the portal venous bloodstream as far as the liver, they cause a physical obstruction of the bloodstream. Local inflammation around the eggs exacerbates this. Because the eggs obstruct the branches of the portal venous system and fibrosis occurs around these foreign bodies, periportal fibrosis develops. The result is increased pressure in the portal circulation (portal hypertension). Clinically, it takes the form of:Enlargement of the spleen (splenomegaly)Collateral circulation with oesophagealvarices and increased venous markings on the abdominal skin, principally around the navel, the so-called "caput medusa". Eggs can also reach other organs subsequently via this collateral circulation (lung).Ascites is a late sign.
  • Erythromycin in case of penicillin allergy

Splenomegaly and post splenectomy care Splenomegaly and post splenectomy care Presentation Transcript

  • Splenomegaly &Post Splenectomy Care
    Dr Christian van Rij
    July 2008, Wasso DDH
    1
  • Overview Lecture
    2
  • Anatomy
    3
  • Function & Histology
    Red pulp; for phagocytosis of debris, composed:
    Sinuses filled with blood (expulsion of reservoir blood in animals)
    Splenic cords
    Marginal zone
    White pulp: composed of Malpighian corpuscles, composed of:
    Lymphoid follicles; rich in B-lymphocytes
    Periarteriolar lymphoid; sheaths; rich in T-lymphocytes
    4
  • Causes for Splenomegaly1/6
    Non malignant hematological disorders with Splenic Sequestration:
    Hereditary Spherocytosis
    Chronic Autoimmune Hemolytic Anemia
    Pyruvatekinase Deficiency
    Sickle Cell Disease
    Thalassemia
    Thrombotic Thrombocytopenic Purpura (TTP)
    (Idiopathic Thrombocytopenic Purpura (ITP) doesn’t give splenomegaly, but needs sometimes splenectomy)
    5
  • Causes for Splenomegaly2/6
    Malignancies causing Splenomegaly
    Lymphoma’s
    Spleen usually secondary involved, but in 10% of Hodgkin Lymphoma’s the spleen is the primary site
    Leukemias
    Myelofibrosis & Myeloproliferative disorders
    Angiosarcoma
    6
  • Causes for Splenomegaly3/6
    Benign Spleen Tumors
    Hemangioma
    Hamartoma
    Lymphangioma
    Abcesses
    Rare but fatal
    Hematoma
    If large, then high risk for splenic rupture
    7
  • Causes for Splenomegaly4/6
    Parasitic Cysts
    Echinococcusgranulosus / Hydatid cysts
    Non-parasitic
    Epithelium-lined cysts
    Epidermoid cysts – most common
    SplenicPseudocysts
    Pancreatic pseudocyst
    Posttraumatic cyst
    8
  • Causes for Splenomegaly5/6
    Infectious:
    Hyperreactive Malarial Splenomegaly
    All spleens which are over 10cm from the costal margin palpable
    Tuberculosis
    Leishmaniasis
    9
  • Causes for Splenomegaly6/6
    Portal Hypertension
    Caput Medusae
    10
  • Splenomegaly Consequences
    Splenic Sequestration
    Trombocytopenia:
    Normally 30% of platelets are trapped in the spleen, in extreme splenomegaly this can be 90%
    Normally no significant clinical problems
    Significant increased risk for Splenic Rupture
    Most patients with a ruptured spleen die within a few hours after arriving at the hospital
    11
  • Investigations with Splenomegaly
    Abdominal Ultrasound
    Bloodslide for MPS
    Thin blood film for Sickling(if patient is < 25 years)
    Full bloodpicture to exclude malignancy
    Urine and stool for Schistosomiasis
    Leishmaniasis
    Trypanosomiasis
    12
  • Care for Splenomegaly Patients
    Chronic malaria preventive treatment lifelong
    Proguanil: 100mg daily
    Chloroquine: 300mg once a week
    Mefloquine: 1 tab of 250mg once a week
    Maloprim(Pyrimethamine + Dapson)
    Earlier antibiotic treatment for infections
    Always ultrasound after abdominal trauma
    13
  • Reasons for Splenectomy 1/3
    Always with
    Splenic Rupture
    Very large hematoma after trauma
    Malignancy
    HereditarySpherocytosis (at the age of 4 years)
    Pyruvate kinase Deficiency
    Very large non-parasitic cysts
    Parasitic cysts when no other organs are involved
    Splenicabcess
    14
  • Reasons for Splenectomy 2/3
    If other treatment fails with:
    Thrombotic Thrombocytopenic Purpura (TTP)
    AutoimmuneHemolyticAnemia
    15
  • Reasons for Splenectomy 3/3
    In case of the following if symptomatic spleen:
    Benign tumors
    Non-Hodgkin’s Lymphoma (usually only Chemo/Radiotherapy)
    Myelofibrosis & Myeloproliferative disorders
    Thalassemia
    Pseudocysts
    Splenectomy as paliative measure only:
    Angiosarcoma
    Sickle cell crisis
    16
  • Major Risk Post Operatively
    Bleeding
    Abdominal Abcess
    Pancreatitis or fistula formation
    LLL atelectasis, pneumonia, effusion
    Deep vein thrombosis (DVT)
    Portal veinthrombosis (PVT)
    17
  • Post Splenectomy Risks
    Overwhelming Post-Splenectomy Sepsis
    Estimated life-time risk of 5%
    Mortality of 50%
    Coping difficulties with specific infections
    Especially those involving encapsulated bacteria, (e.g. Streptococcus pneumoniae)
    18
  • Post Splenectomy Care 1/2
    Pneumococcalimmunisation
    Reimmunisation every 5 years
    Haemophilusinfluenzae type b (HIB) vaccine
    Meningococcal group C vaccine
    Meningococcal group A vaccine
    Influenza vaccine yearly
    19
  • Post Splenectomy Care 2/2
    Life-long prophylactic antibiotics are recommended
    In need of early broad spectrum if any infection
    Malaria prophylaxis only if inadequate immunity
    20
  • Auto Transplantation
    21
    Transplant small slices of spleen and cover them into the peritoneum / omentum
    If they have attached you will see target cells and Holley Jones body in the peripheral blood after 4 weeks
  • Alternatives for Splenic Rupture
    Splenorrhaphy
    22
  • Alternatives for Splenic Rupture
    Splenorrhaphy
    23