SPLEEN James Taclin C. Banez, MD, FPSGS, FPCS
Anatomy <ul><li>Largest reticuloendothelial organ </li></ul><ul><li>Mesodermal in origin </li></ul><ul><li>Spleen size & w...
Anatomy <ul><li>Blood Supply: </li></ul><ul><li>Splenic artery  (pattern of terminal branches) </li></ul><ul><ul><li>Distr...
Anatomy <ul><li>Support of the spleen: </li></ul><ul><ul><li>Splenocolic lig. </li></ul></ul><ul><ul><li>Gastrosplenic lig...
Anatomy <ul><li>Microstructure of the spleen: </li></ul><ul><ul><li>Red pulp (75%): </li></ul></ul><ul><ul><ul><li>Large n...
FUNCTIONS  <ul><li>Filtration </li></ul><ul><li>Host defense </li></ul><ul><li>Storage </li></ul><ul><li>Cytopoiesis </li>...
Anatomy <ul><li>The most common anomaly of splenic embryology is the  accessory spleen. </li></ul><ul><li>80% in the  sple...
Evaluation of Size of Spleen <ul><li>Indications for imaging of the spleen: </li></ul><ul><ul><li>assess size of the splee...
Evaluation of Size of Spleen <ul><li>Ultrasound: </li></ul><ul><ul><li>Most cost-effective </li></ul></ul><ul><ul><li>Rapi...
Evaluation of Size of Spleen <ul><li>Plain radiography </li></ul><ul><li>MRI: </li></ul><ul><ul><li>More expensive </li></...
Evaluation of Size of Spleen <ul><li>Angiography: </li></ul><ul><ul><li>Little diagnostic role </li></ul></ul><ul><ul><li>...
Indications for Splenectomy <ul><li>Most common indication is  trauma to   spleen , whether iatrogenic or otherwise </li><...
Indications for Splenectomy <ul><li>Red Blood Cell Disorders: </li></ul><ul><ul><li>Congenital: </li></ul></ul><ul><ul><ul...
Indications for Splenectomy <ul><li>Platelet Disorders: </li></ul><ul><ul><li>Idiopathic Thrombocytopenic purpura (ITP) </...
Indications for Splenectomy <ul><li>Bone Marrow Disorders : </li></ul><ul><ul><li>Myelofibrosis </li></ul></ul><ul><ul><li...
Indications for Splenectomy <ul><li>Miscellaneous disorders: </li></ul><ul><ul><li>Infectious/abscess </li></ul></ul><ul><...
Preoperative Considerations <ul><li>Splenic artery embolizations: </li></ul><ul><ul><li>Recommended for: </li></ul></ul><u...
Preoperative Considerations <ul><li>Splenic artery embolizations: </li></ul><ul><ul><li>Advantages: </li></ul></ul><ul><ul...
Preoperative Considerations <ul><li>Vaccination: </li></ul><ul><ul><li>Splenectomy imparts <1 to 5% fulminant infection (o...
Preoperative Considerations <ul><li>Vaccination: </li></ul><ul><ul><li>Common bacteria: </li></ul></ul><ul><ul><ul><li>Str...
Preoperative Considerations <ul><li>Vaccination: </li></ul><ul><ul><li>in emergency splenectomy, trauma, give vaccine 3 rd...
Preoperative Considerations <ul><li>Deep venous Thrombosis Prophylaxis: </li></ul><ul><ul><li>Specially in splenectomy for...
Preoperative Considerations <ul><li>Deep venous Thrombosis Prophylaxis: </li></ul><ul><ul><li>Risk factors: </li></ul></ul...
SPLENECTOMY <ul><li>Preparations: </li></ul><ul><ul><li>polyvalent pneumococcal, meningococcal & haemophilus vaccines 1 wk...
SPLENECTOMY <ul><li>Preparations: </li></ul><ul><ul><li>pt. on corticosteroid therapy shd. receive it parenteraly </li></u...
SPLENECTOMY <ul><li>Open Splenectomy: </li></ul><ul><ul><li>Indication: </li></ul></ul><ul><ul><ul><li>traumatic rupture o...
SPLENECTOMY <ul><li>Open Splenectomy: </li></ul><ul><ul><li>Position: </li></ul></ul><ul><ul><ul><li>Supine: </li></ul></u...
SPLENECTOMY <ul><li>Laparoscopic Splenectomy: </li></ul><ul><ul><li>for normal size spleens </li></ul></ul><ul><ul><li>Pos...
Partial Splenectomy <ul><li>Indicated: </li></ul><ul><ul><li>children (risk of splenectomy sepsis) </li></ul></ul><ul><ul>...
Changes in blood after splenectomies <ul><li>Appearance of Howell-Jolly bodies & siderocytes </li></ul><ul><li>Leukocytosi...
Complications of Splenectomies <ul><li>Pulmonary complications: </li></ul><ul><ul><li>Left lower lobe atelectasis (most co...
Complications of Splenectomies <ul><li>Pancreatic complications : due to intra-op trauma to tail of pancreas </li></ul><ul...
Complications of Splenectomies <ul><li>Overwhelming Postsplenectomy Infection (OPS): </li></ul><ul><ul><li>lifetime risk o...
Complications of Splenectomies <ul><li>Overwhelming Postsplenectomy Infection (OPS): </li></ul><ul><ul><li>Loss the abilit...
Complications of Splenectomies <ul><li>Overwhelming Postsplenectomy Infection (OPS): </li></ul><ul><ul><li>Risk Factors: <...
Complications of Splenectomies <ul><li>Overwhelming Postsplenectomy Infection (OPS): </li></ul><ul><ul><li>Immunoprophylax...
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Spleen.. Dr.banez surgery

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Spleen.. Dr.banez surgery

  1. 1. SPLEEN James Taclin C. Banez, MD, FPSGS, FPCS
  2. 2. Anatomy <ul><li>Largest reticuloendothelial organ </li></ul><ul><li>Mesodermal in origin </li></ul><ul><li>Spleen size & weight diminish in the elderly </li></ul><ul><li>Splenomegaly – apply to weight > 500mg and/or 15cm or more in length. </li></ul><ul><ul><li>If palpable below the left costal margin ---> double normal size </li></ul></ul>
  3. 3. Anatomy <ul><li>Blood Supply: </li></ul><ul><li>Splenic artery (pattern of terminal branches) </li></ul><ul><ul><li>Distributed type: (70%) </li></ul></ul><ul><ul><ul><li>Short trunk w/ many long branches over ¾ of the medial surface of the spleen. </li></ul></ul></ul><ul><ul><li>Magistral type: (30%) </li></ul></ul><ul><ul><ul><li>Long main trunk dividing near the hilum into short terminal branches. </li></ul></ul></ul><ul><li>Short gastric artery: </li></ul>
  4. 4. Anatomy <ul><li>Support of the spleen: </li></ul><ul><ul><li>Splenocolic lig. </li></ul></ul><ul><ul><li>Gastrosplenic lig. (short gastric vessels) </li></ul></ul><ul><ul><li>Phrenosplenic lig. </li></ul></ul><ul><ul><li>Splenorenal lig. </li></ul></ul>
  5. 5. Anatomy <ul><li>Microstructure of the spleen: </li></ul><ul><ul><li>Red pulp (75%): </li></ul></ul><ul><ul><ul><li>Large numbers of venous sinuses that drains into splenic veins </li></ul></ul></ul><ul><ul><ul><li>Sinuses is surrounded & separated by reticulum where the macrophages lies. </li></ul></ul></ul><ul><ul><ul><li>Serves as a dynamic filtration system where macrophages remove the microorganisms, cellular debris, Ag & Ab complexes and senescent erythrocytes. </li></ul></ul></ul><ul><ul><li>White pulp: </li></ul></ul><ul><ul><ul><li>Periarticular lymphatic sheaths </li></ul></ul></ul><ul><ul><ul><li>Comprised T lymphocytes and intermittent aggregations of B lymphocytes or lymphoid follicles. </li></ul></ul></ul>
  6. 6. FUNCTIONS <ul><li>Filtration </li></ul><ul><li>Host defense </li></ul><ul><li>Storage </li></ul><ul><li>Cytopoiesis </li></ul>
  7. 7. Anatomy <ul><li>The most common anomaly of splenic embryology is the accessory spleen. </li></ul><ul><li>80% in the splenic hilum and vascular pedicle </li></ul><ul><ul><ul><li>gastrocolic lig. </li></ul></ul></ul><ul><ul><ul><li>tail of pancreas </li></ul></ul></ul><ul><ul><ul><li>greater omentum </li></ul></ul></ul><ul><ul><ul><li>greater curve of the stomach </li></ul></ul></ul><ul><ul><ul><li>splenocolic lig. </li></ul></ul></ul><ul><ul><ul><li>small & large bowel mesentery </li></ul></ul></ul><ul><ul><ul><li>left broad lig in women </li></ul></ul></ul><ul><ul><ul><li>left spermatic cord in men. </li></ul></ul></ul>
  8. 8. Evaluation of Size of Spleen <ul><li>Indications for imaging of the spleen: </li></ul><ul><ul><li>assess size of the spleen before elective splenectomy </li></ul></ul><ul><ul><li>investigating a left upper quadrant pain </li></ul></ul><ul><ul><li>delineation of tumors or cysts of the spleen </li></ul></ul><ul><ul><li>characterization of splenic abscesses </li></ul></ul><ul><ul><li>guidance for percutaneous procedures involving the spleen </li></ul></ul>
  9. 9. Evaluation of Size of Spleen <ul><li>Ultrasound: </li></ul><ul><ul><li>Most cost-effective </li></ul></ul><ul><ul><li>Rapid, easy to perform, no radiation </li></ul></ul><ul><ul><li>Sensitivity – 98% </li></ul></ul><ul><li>CT scan: </li></ul><ul><ul><li>High degree of resolution </li></ul></ul><ul><ul><li>Identification of splenic lesions </li></ul></ul><ul><ul><li>Guidance for percutaneous procedures </li></ul></ul><ul><ul><li>Iodinated contrast material </li></ul></ul>
  10. 10. Evaluation of Size of Spleen <ul><li>Plain radiography </li></ul><ul><li>MRI: </li></ul><ul><ul><li>More expensive </li></ul></ul><ul><ul><li>Offers no advantages in depicting abnormalities of the spleen </li></ul></ul><ul><li>Radioscintigraphy: </li></ul><ul><ul><li>Tc-sulfur colloid demonstrates splenic location and size </li></ul></ul><ul><ul><li>Very useful locating accessory spleen after splenectomy </li></ul></ul>
  11. 11. Evaluation of Size of Spleen <ul><li>Angiography: </li></ul><ul><ul><li>Little diagnostic role </li></ul></ul><ul><ul><li>Provides an effective therapeutic modality for embolizating bleeding splenic branches in tauma </li></ul></ul><ul><li>Splenic Index (SI): (by Cools) </li></ul><ul><ul><li>expresses the size of the spleen as a volume in ml. </li></ul></ul><ul><ul><li>length x width x height (cm) </li></ul></ul><ul><ul><li>NV: 120ml to 480ml </li></ul></ul>
  12. 12. Indications for Splenectomy <ul><li>Most common indication is trauma to spleen , whether iatrogenic or otherwise </li></ul><ul><li>Most common elective splenectomy is ITP followed by hereditary spherocytosis ----> autoimmune hemolytic anemia -----> thrombotic thrombocytopenic purpura . </li></ul>
  13. 13. Indications for Splenectomy <ul><li>Red Blood Cell Disorders: </li></ul><ul><ul><li>Congenital: </li></ul></ul><ul><ul><ul><li>Hereditary spherocytosis </li></ul></ul></ul><ul><ul><ul><li>Hemoglobinopathies </li></ul></ul></ul><ul><ul><ul><ul><li>Sickle cell disease </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Thalasemia </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Enzyme deficiencies </li></ul></ul></ul></ul><ul><ul><li>Acquired: </li></ul></ul><ul><ul><ul><li>Autoimmune hemolytic anemia </li></ul></ul></ul><ul><ul><ul><li>Parasitic disease </li></ul></ul></ul>
  14. 14. Indications for Splenectomy <ul><li>Platelet Disorders: </li></ul><ul><ul><li>Idiopathic Thrombocytopenic purpura (ITP) </li></ul></ul><ul><ul><li>Thrombotic thrombocytopenic purpura (TTP) </li></ul></ul><ul><li>White Blood Disorders: </li></ul><ul><ul><li>Leukemias </li></ul></ul><ul><ul><li>Lymphomas </li></ul></ul><ul><ul><li>Hodgkin’s disease </li></ul></ul>
  15. 15. Indications for Splenectomy <ul><li>Bone Marrow Disorders : </li></ul><ul><ul><li>Myelofibrosis </li></ul></ul><ul><ul><li>Chronic myeloid leukemia </li></ul></ul><ul><ul><li>Acute myeloid leukemia </li></ul></ul><ul><ul><li>Chronic myelomonocytic leukemia </li></ul></ul><ul><ul><li>Essential thrombocythemia </li></ul></ul><ul><ul><li>Polycythemia vera </li></ul></ul>
  16. 16. Indications for Splenectomy <ul><li>Miscellaneous disorders: </li></ul><ul><ul><li>Infectious/abscess </li></ul></ul><ul><ul><li>Storage dse/infiltrate disorder </li></ul></ul><ul><ul><ul><li>Gaucher’s disease </li></ul></ul></ul><ul><ul><ul><li>Niemann-Pick dse </li></ul></ul></ul><ul><ul><ul><li>Amyloidosis </li></ul></ul></ul><ul><ul><li>Felty’s syndrome </li></ul></ul><ul><ul><li>Sarcoidosis </li></ul></ul><ul><ul><li>Cysts & tumors </li></ul></ul><ul><ul><li>Portal hypertension </li></ul></ul><ul><ul><li>Splenic artery aneurysm </li></ul></ul>
  17. 17. Preoperative Considerations <ul><li>Splenic artery embolizations: </li></ul><ul><ul><li>Recommended for: </li></ul></ul><ul><ul><ul><li>Massive splenomegaly </li></ul></ul></ul><ul><ul><ul><li>Previous pancreatitis, gastric or pancreatic surgery </li></ul></ul></ul><ul><ul><ul><li>Portal hypertension, varices </li></ul></ul></ul><ul><ul><ul><li>Uncorrectable thrombocytopenia </li></ul></ul></ul>
  18. 18. Preoperative Considerations <ul><li>Splenic artery embolizations: </li></ul><ul><ul><li>Advantages: </li></ul></ul><ul><ul><ul><li>Reduced operative blood loss from devascularized spleen </li></ul></ul></ul><ul><ul><ul><li>Reduces spleen size for easier dissection and removal. </li></ul></ul></ul><ul><ul><li>Disadvantages: </li></ul></ul><ul><ul><ul><li>Acute left sided pain (limited duration) </li></ul></ul></ul><ul><ul><ul><ul><li>This is mitigated by general anesthesia ---> OR </li></ul></ul></ul></ul><ul><ul><ul><li>pancreatitis </li></ul></ul></ul><ul><ul><li>Currently no consensus </li></ul></ul>
  19. 19. Preoperative Considerations <ul><li>Vaccination: </li></ul><ul><ul><li>Splenectomy imparts <1 to 5% fulminant infection (overwhelming post-splenectomy infections) </li></ul></ul><ul><ul><li>Vaccination against encapsulated bacteria 2 wks before surgery. </li></ul></ul>
  20. 20. Preoperative Considerations <ul><li>Vaccination: </li></ul><ul><ul><li>Common bacteria: </li></ul></ul><ul><ul><ul><li>Streptococcus pneumoniae </li></ul></ul></ul><ul><ul><ul><li>Hemophilus influenzae type B </li></ul></ul></ul><ul><ul><ul><li>Meningococcus </li></ul></ul></ul><ul><ul><ul><li>Grp A streptococcus </li></ul></ul></ul><ul><ul><ul><li>Capnocytophaga canimorsus (related to dog bites) </li></ul></ul></ul><ul><ul><ul><li>Grp B streptococcus </li></ul></ul></ul><ul><ul><ul><li>Enterococcus sp. </li></ul></ul></ul><ul><ul><ul><li>Bacteroides sp. </li></ul></ul></ul><ul><ul><ul><li>Salmonella sp. </li></ul></ul></ul><ul><ul><ul><li>Bartonella sp. </li></ul></ul></ul>
  21. 21. Preoperative Considerations <ul><li>Vaccination: </li></ul><ul><ul><li>in emergency splenectomy, trauma, give vaccine 3 rd day </li></ul></ul><ul><ul><li>booster injections every 5 – 6 yrs regardless of the reason for splenectomy for pneumococcal </li></ul></ul><ul><ul><li>annual influenza immunization </li></ul></ul>
  22. 22. Preoperative Considerations <ul><li>Deep venous Thrombosis Prophylaxis: </li></ul><ul><ul><li>Specially in splenectomy for myeloproliferative disorders (MPD). </li></ul></ul><ul><ul><li>40% risk for PVT (portal vein thrombosis) </li></ul></ul><ul><ul><ul><ul><li>Anorexia </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Abdominal pain </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Leukocytosis & thrombocytosis </li></ul></ul></ul></ul><ul><ul><li>Early diagnosis w/ contrast-enhanced CT scan </li></ul></ul><ul><ul><li>Anticoagulation ---> keys for successful tx </li></ul></ul><ul><ul><li>Prophylaxis: --> subcutaneous heparin (5000U) </li></ul></ul>
  23. 23. Preoperative Considerations <ul><li>Deep venous Thrombosis Prophylaxis: </li></ul><ul><ul><li>Risk factors: </li></ul></ul><ul><ul><ul><li>Obesity </li></ul></ul></ul><ul><ul><ul><li>History of venous thromboembolism </li></ul></ul></ul><ul><ul><ul><li>Known hypercoagulable state </li></ul></ul></ul><ul><ul><ul><li>> 60y/o </li></ul></ul></ul>
  24. 24. SPLENECTOMY <ul><li>Preparations: </li></ul><ul><ul><li>polyvalent pneumococcal, meningococcal & haemophilus vaccines 1 wk. preop. </li></ul></ul><ul><ul><li>check hgb and coagulation status of pt. (at least 10g/dl) </li></ul></ul><ul><ul><ul><li>2 to 4 units of cross-matched bld. available at time of surgery. </li></ul></ul></ul><ul><ul><ul><li>platelet transfusion (thrombocytopenia) started right after ligation of splenic artery. </li></ul></ul></ul>
  25. 25. SPLENECTOMY <ul><li>Preparations: </li></ul><ul><ul><li>pt. on corticosteroid therapy shd. receive it parenteraly </li></ul></ul><ul><ul><li>deep vein thrombosis prophylaxis </li></ul></ul><ul><ul><li>1 st generation cephalosporin IV as brought to the OR. </li></ul></ul><ul><ul><li>NGT to decompress the stomach after placing the endotracheal tube. </li></ul></ul>
  26. 26. SPLENECTOMY <ul><li>Open Splenectomy: </li></ul><ul><ul><li>Indication: </li></ul></ul><ul><ul><ul><li>traumatic rupture of the spleen (most common) </li></ul></ul></ul><ul><ul><ul><li>massive splenomegaly </li></ul></ul></ul><ul><ul><ul><li>ascites </li></ul></ul></ul><ul><ul><ul><li>portal hypertension </li></ul></ul></ul><ul><ul><ul><li>multiple prior operations </li></ul></ul></ul><ul><ul><ul><li>extensive splenic radiations </li></ul></ul></ul><ul><ul><ul><li>possible splenic abscess </li></ul></ul></ul>
  27. 27. SPLENECTOMY <ul><li>Open Splenectomy: </li></ul><ul><ul><li>Position: </li></ul></ul><ul><ul><ul><li>Supine: </li></ul></ul></ul><ul><ul><ul><ul><li>midline incision for rupture or massive splenomegaly or for staging Hodgkin’s dse. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Left subcostal incision – for elective splenectomies </li></ul></ul></ul></ul>
  28. 28. SPLENECTOMY <ul><li>Laparoscopic Splenectomy: </li></ul><ul><ul><li>for normal size spleens </li></ul></ul><ul><ul><li>Position: </li></ul></ul><ul><ul><ul><li>supine or low lithotomy position (needs 5-6 trocars) </li></ul></ul></ul><ul><ul><ul><li>Right lateral decubitus (needs 3-4 trocars) </li></ul></ul></ul><ul><ul><li>Excised spleen placed in a durable nylon sac and is morcellated and extracted piecemeal using a blunt instrument avoiding splillage ----> splenosis. </li></ul></ul>
  29. 29. Partial Splenectomy <ul><li>Indicated: </li></ul><ul><ul><li>children (risk of splenectomy sepsis) </li></ul></ul><ul><ul><li>Lipid storage disorders (Gaucher’s dse) </li></ul></ul><ul><ul><li>Some blunt & penetrating splenic injuries </li></ul></ul><ul><li>open or laparoscopically </li></ul><ul><li>Bleeding from cut surface of the spleen is controlled by: </li></ul><ul><ul><li>cauterization </li></ul></ul><ul><ul><li>argon coagulation </li></ul></ul><ul><ul><li>application of hemostatic agents (cellulose gauze / fibrin glue) </li></ul></ul>
  30. 30. Changes in blood after splenectomies <ul><li>Appearance of Howell-Jolly bodies & siderocytes </li></ul><ul><li>Leukocytosis </li></ul><ul><li>Increased platelet counts </li></ul>
  31. 31. Complications of Splenectomies <ul><li>Pulmonary complications: </li></ul><ul><ul><li>Left lower lobe atelectasis (most common) </li></ul></ul><ul><ul><li>Pleural effusion </li></ul></ul><ul><ul><li>Pneumonia </li></ul></ul><ul><li>Hemorrhage ----->subphrenic hematoma </li></ul><ul><li>Infectious complication: </li></ul><ul><ul><li>Subphrenic abscess (due to placement of drains, hence not routinely recommended) </li></ul></ul>
  32. 32. Complications of Splenectomies <ul><li>Pancreatic complications : due to intra-op trauma to tail of pancreas </li></ul><ul><ul><li>Pancreatitis </li></ul></ul><ul><ul><li>Pseudocyts </li></ul></ul><ul><ul><li>Pancreatic fistula </li></ul></ul><ul><li>Thromboembolic phenomena (5-10%) </li></ul><ul><ul><li>For pt. w/ hemolytic anemia / myeloproliferative disorders and splenomegaly </li></ul></ul><ul><ul><li>Subcutaneous heparin & low-dose anticoagulantion therapy postop </li></ul></ul>
  33. 33. Complications of Splenectomies <ul><li>Overwhelming Postsplenectomy Infection (OPS): </li></ul><ul><ul><li>lifetime risk of severe infection (1-5%) </li></ul></ul><ul><ul><li>incidence similar among children & adult but mortality is higher in children. </li></ul></ul><ul><ul><li>mortality is highest in hematologic conditions: </li></ul></ul><ul><ul><ul><li>Thalaseemia major </li></ul></ul></ul><ul><ul><ul><li>Sickle cell dse </li></ul></ul></ul><ul><ul><li>lowered due to pneumococcal vaccine </li></ul></ul>
  34. 34. Complications of Splenectomies <ul><li>Overwhelming Postsplenectomy Infection (OPS): </li></ul><ul><ul><li>Loss the ability to filter and phagocytose bacteria and parasitized bld cells ----> infection to encapsulated bacteria or parasites </li></ul></ul><ul><ul><li>Loss a significant source of antibody production: </li></ul></ul><ul><ul><ul><li>Streptococcus pneumoniae (most common infection 50-90%) </li></ul></ul></ul><ul><ul><ul><li>Haemophilus influenzae type B </li></ul></ul></ul><ul><ul><ul><li>Meningococcus </li></ul></ul></ul><ul><ul><ul><li>Grp A streptococcus </li></ul></ul></ul>
  35. 35. Complications of Splenectomies <ul><li>Overwhelming Postsplenectomy Infection (OPS): </li></ul><ul><ul><li>Risk Factors: </li></ul></ul><ul><ul><ul><li>Splenectomies for hematologic indications </li></ul></ul></ul><ul><ul><ul><li>Compromised immune system: </li></ul></ul></ul><ul><ul><ul><ul><li>Hodgkin’s dse. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>taking chemotherapy / radiation therapy </li></ul></ul></ul></ul><ul><ul><ul><li>Children usually develops w/in 2 yrs postsplenectomy </li></ul></ul></ul><ul><ul><li>Shd. always have a 5 day supply of stand-by antibiotics </li></ul></ul>
  36. 36. Complications of Splenectomies <ul><li>Overwhelming Postsplenectomy Infection (OPS): </li></ul><ul><ul><li>Immunoprophylaxis: </li></ul></ul><ul><ul><ul><li>7 – 14 days before splenectomies or as soon as possible after surgery </li></ul></ul></ul><ul><ul><ul><li>Pneumococcal vaccine – booster injection every 5-6yrs </li></ul></ul></ul><ul><ul><ul><li>Annual influenza immunization </li></ul></ul></ul><ul><ul><li>Antibiotic prophylaxis usually single daily dose of penicillin or amoxillin for children for 1 st 2 yrs after splenectomies </li></ul></ul>
  37. 37. THANK YOU

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