THE SPLEEN

1. DISORDERS OF THE SPLEEN
PAULINE TEMBO (RN,BSC)

2. REVIEW OF SYSTEMS

3. DISORDERS OF THE SPLEEN

4. • The spleen is a small organ that sits inside the left rib cage,
just above the stomach. In adults, the spleen is about the size
of an avocado.
• The spleen is part of the immune system
FUNCTIONS OF THE SPLEEN INCLUDE:
• This largest lymphatic organ
• Stores blood.
• Filters blood by removing cellular waste and getting rid of old
or damaged blood cells.
• Makes white blood cells and antibodies that help fight
infection.
• Maintains the levels of fluid in the body.
• Produces antibodies that protects against infection.

5. SPLENIC ABSCESS
• splenic abscess: these are localized collections of
necrotic inflammatory tissue caused by bacterial,
parasitic or fungal agents.
• Infection reach the spleen through blood /lymph as a
complication from abdominal infections like appendicitis
or peritonitis

6. Signs and symptoms
• Fever due to presence of infection
• Tenderness
• Enlargement of the spleen-visibly enlarged or felt
on palpation

7. investigations
• Blood culture for sensitivity
• FBC will reveal raised leukocytes
• Ultrasound scan will show inflammation
• CT Scan / MRI will show the pus filled pouches in the
spleen.

8. TREATMENT
• High dose antibiotics ie ceftriaxone 1g BD for 10-14
days
• Splenic drainage of pus
• Splenectomy-removal of the spleen in cases where the
abscesses are diffuse and not responding to treatment.

9. SPLEENOMEGALLY
(ENLARGED SPLEEN)
DEF: This is enlargement of the spleen beyond
its normal size cause by infections, cancers or
auto-immune.

10. CAUSES
• Viral infections ie mononucleosis
• Bacterial infections ie syphilis
• Parasitic infections ie malaria
• Hemolytic aneamia
• Blood cancers ie leukeamia
• Autoimmune disorders
• Pressure on a vein draining the spleen

11. Signs and symptoms
An enlarged spleen typically doesn’t cause any symptoms, but
at times patients can present with:
• Pain or fullness in the left upper quadrant that can spread to
the shoulder
• A feeling of fullness without eating anything as the spleen is
pressing on the stomach
• Frequent infections
• Bleeding easily

12. TYPES OF SPLEENOMEGALY
• Reactive splenomegaly: occurs in acute and chronic
inflammatory conditions probably caused by phagocytosis of
blood or bacteria and the release of chemicals form the
inflammatory processes. Ie in malaria, rheumatoid arthritis.
• Congestive splenomegaly: results from chronic congestion
of the spleen from conditions such as; C.C.F ,heart failure
and portal hypertension.
• Other causes are: Hyperplasic disorders caused by
haemolytic anaemia ,Cysts and tumours: these maybe rare
but they do occur e.g. leukaemia as well as lymphoma.

13. diagnosis
• Physical examination will reveal an enlarged spleen, aneamia
• FBC will reveal raised WBC, low RBCs and platelets.
• Check the clotting factors
• Ultrasound scan will reveal an enlarged spleen
• MRI/CT Scan
• Biopsy of the spleen is not commonly done due to high risk
of bleeding

14. TREATMENT
• Treat according to cause.
• High dose antibiotic if the enlargement is due to bacterial involvement
• Splenectomy-removal of the spleen
• After removal, put patient on regular checks for platelet count and
clotting factors
• Patient is given vaccinations against pneumococcal , meningococcal
and heamophilus influenza as these can prove to be deadly if
contracted.
• Patient is put on penicillin's for prevention of infection and anti
malarial prophylaxis like Malo-prim to prevent malaria

15. • Following splenectomy, the patient is at high risk
of developing Overwhelming Post Splenectomy
Infection. This is usually fatal. It is characterized
by either meningitis or sepsis.
• It can be prevented by vaccinations and
prophylaxis and telling patient to prevent
infections by putting on a mask and
handwashing/wearing gloves.

16. Complications
• Severe infections
• Raptured spleen

17. RAPTURED SPLEEN

18. RAPTURED SPLEEN
• A raptured spleen is a surgical emergency that occurs
to spleen bursts
This can be caused:
• Sudden blow to the spleen
• Accidental trauma during surgery
• In spleenomegally when the spleen becomes too
enlarged
• In splenic sequestration: this is when blood pulls into
the spleen and cant escape.

20. Signs and symptoms
• Pain in the left upper abdomen
• Tenderness on touch
• Confusion, lightheadedness or dizziness
• Signs of shock ie cold clammy skin, low bp, fast
thready pulse.

21. Surgical intervention
• Splenectomy-removal of the spleen.
• All the preventive measures of overwhelming
infections post splenectomy occurs.

22. MANAGEMENT OF A PATIENT WITH
RAPTURED SPLEEN
• Raptured spleen is an emergency, if patient is not handled well, they may
die.
• Upon receiving a suspected raptured spleen patient, canulate patient with
large bore canular(grey) and commence Ringers lactate which is a blood
expander.
• Inform the surgeon.
• Vitals should be done quarter hourly to rule out hypotension and shock.
Monitor patient for signs of shock.
• Do ultra-sound scan as soon as possible. Do other investigations like
grouping and crossmatching. Full blood count and label as urgent.
• Catheterize and prepare patient for theater(explain procedure, consent,
tagging and NG tube insertion)

23. SPLENECTOMY

24. DEFINITION
A splenectomy is the total or partial surgical removal of
the spleen, an organ that is part of the lymphatic
system.

25. FUNCTIONS OF THE SPLEEN
1. Phagocytosis: destroys old and abnormal RBCs,
parasites, cellular debris and other cells
2. Storage of blood: a reservoir of about 350ml of
blood, important during haemorrhage
3. Immune response: contain T- and B- lymphocyte,
which are activated by presence of antigens, e.g.
infection
4. Erythropoiesis: major hematopoietic functions until
5th month of gestation when the bone marrow
assumes its function.

26. INDICATIONS FOR SPLENECTOMY
1. Trauma of the spleen
• The spleen is the most commonly injured solid organ in the
abdomen following blunt trauma,
• The spleen can be ruptured by blunt as well as penetrating
injuries to the chest or abdomen.
• E.g. Car accidents are the most common cause of blunt
traumatic injury to the spleen
• This causes massive bleeding intra-abdominally and it is an
emergency due to shock.

27. INDICATIONS FOR SPLENECTOMY cont’d
2. Primary cancers of the spleen ( malignancy)
• Metastatic tumors of any kind, e.g.: cancer of the breast,
lung, melanoma and virtually any primary malignancy may
metastasize to the spleen.
• Evidence of metastasis to the spleen detected early
requires surgical removal of the spleen.

28. Indications Cont’d
3. Hereditary spherocytosis
• The absence of a specific protein(spectrin),in the red blood cell
membrane leads to the formation of relatively fragile
cells(spherocytes) that are easily damaged when they pass
through the spleen.
• The cell destruction does not occur elsewhere in the body and
ends when the spleen is removed.

29. Indications cont’d
4. Immune (idiopathic) thrombocytopenic purpura (ITP).
• ITP is a disease in which platelets are destroyed by antibodies in the
body's immune system.

30. Indications cont’d
5. AUTOIMMUNE HEMOLYTIC DISORDERS.
• The red blood cells are destroyed by antibodies produced by the
patient's own body (autoantibodies)
• E.g. as in patients with sickle cell disease with
acute Splenic sequestration crisis (rapid enlargement of spleen, anemia,
pain)

31. Indications cont’d
Non-Hodgkin's Lymphoma
• This is a cancer of the lymph nodes or organs
7. SPLENIC ABSCESSES
• Splenic abscess is an uncommon and potentially fatal
illness.
• 8. SPLENIC CYSTS

32. MANAGEMENT
DIAGNOSIS
• The most important part of a medical assessment in disorders
of the spleen is the measurement of splenomegaly
• Ultrasound scan
• Computed Tomography (CT) scan
• The rate of platelet or red blood cell destruction by the spleen
can also be measured by tagging blood cells with radioactive
chromium or platelets with radioactive indium

33. PREOPERATIVE CARE FOR A SPLENECTOMY
• Admit client a day or 2 before operation
• Offer psychological care on importance of the
operation
• Collect blood for grouping and x- match in
preparation for transfusion of fresh whole blood/
fresh platelets where indicated.
• Obtain consent form for legal purposes

34. PREOP. CARE CONT’D
• Give vitamin K 2mg intravenously to prevent haemorrhage
during and after splenectomy as prescribed by the surgeon
• Give Haemophilus influenza B (HIB),
• Pneumococcal (Pneumovax or Pnu-Imune 23 )
• and Meningococcal (Menomune-A/C/Y/W-135 ) vaccines to
children whose immunization status is unclear to prevent
infection with streptococcal pneumonia, flu and meningitis
infections post operatively, ie, after splenectomy.

35. POST- OPERATIVE CARE
• In addition to the general post operative care, the follow
is also specific to splenectomy:
• Maintain patent airway to prevent aspiration
• Give fresh whole blood or fresh platelets to prevent post
operative haemorrhage as prescribed by the surgeon
• Maintain an intake and output chart to prevent fluid
overload( fluids are given with caution to avoid
haemodilution)

36. POST- OPERATIVE CARE CONT’D
• Give Pethidine 10mg -100mg IM 8 hrly as prescribed to
relieve post operative pain
• Give prescribed antibiotics such as X-pen (infant under 1
year 300 mg; child 1–9 years 600 mg, 10 years and over as
for adult 2.4 mega) 6 hrly IV for 7 days.
• Give malaria prophylaxis to prevent malaria infection with
Fansidar
• Give a splenectomy card/ medicalert bracelet to alert
health care providers in case of massive infection

37. COMPLICATIONS OF SPLENECTOMY
• Pain
• Bleeding
• Developing a hernia in the scar
• Post-splenectomy sepsis
• Pancreatitis: occasionally follows splenectomy. This is due to handling and
bruising of the tail of the pancreas during immobilization of the pancreas.
• Transient increase in the platelet and white cell count: these predispose to the
risk of venous thrombosis. Low dose heparin is advised in all patients
undergoing splenectomy.
• . Loss of lymphoid tissue: reduces immune activity and impairs the response to
bacteremia.