++
++
++
++
Splenectomy results in the loss of what immunologic protein?
+
+
++
+
++
+
++
C. Membrane attack complex
+
++
++
++
Tuftsin and properdin are immunologic proteins produced by the spleen. After splenectomy these 2 immunologic proteins are absent, increasing the susceptibility to encapsulated organisms.
++
++
++
What is the most common cause of splenic artery/vein thrombosis?
+
+
++
+
++
+
++
+
++
+
++
E. Antiphospholipid syndrome
++
++
Pancreatitis is the most common cause of splenic artery/vein thrombosis.
++
++
++
What ligament contains the vascular supply to the spleen?
+
+
++
+
++
B. Gastrosplenic ligament
+
++
C. Phrenosplenic ligament
+
++
++
++
The gastrosplenic ligament contains the splenic artery/vein and short gastric arteries. In the setting of portal hypertension, the splenorenal ligament may contain vascular supply.
++
++
++
What is the treatment for bleeding gastric varices in the setting of sinistral hypertension?
+
+
++
+
++
B. Transjugular intrahepatic portosystemic shunt
+
++
+
++
+
++
++
++
Splenectomy is the treatment for isolated gastric varices in the setting of sinistral hypertension.
++
++
++
Which of the following is not an indication to repair a splenic artery aneurysm?
+
+
++
A. Asymptomatic and size >2 cm
+
++
+
++
C. Symptomatic and size = 1.5 cm
+
++
D. Presence of collagen vascular disease
++
++
Resection, with or without splenectomy, or embolization of a splenic artery aneurysm should be performed in pregnant patients, asymptomatic aneurysms >2 cm, and any symptomatic aneurysm.
++
++
++
When should a patient be vaccinated prior to elective splenectomy?
+
+
++
+
++
+
++
+
++
++
++
Patients should be vaccinated preoperatively if possible prior to a splenectomy. Two weeks prior to surgery is the preferred time frame for an adequate immune response to occur. Emergent splenectomy patients should be vaccinated prior to discharge. In the trauma population, recidivism is low, and therefore vaccination prior to discharge may help vaccinate patients who will not come back for vaccination 2 weeks post-op.
++
++
++
What is the embryologic origin of the spleen?
+
+
++
+
++
+
++
+
++
++
++
The spleen arises from the primitive mesoderm and is evident by the 5th week of gestation.
++
++
++
What is the optimal timing of platelet transfusion in a patient with ITP?
+
+
++
+
++
B. After ligation of the splenic vein
+
++
C. After ligation of the splenic artery
+
++
++
++
The optimal time to give a platelet transfusion to a patient undergoing splenectomy for ITP is after ligation of the splenic artery. Be aware that a question like this on the ABSITE will describe a patient with low platelets and not bleeding preoperatively, making it very tempting to transfuse prior to operation. If the patient is actively bleeding preoperatively, then a transfusion is required prior to surgery.
++
++
++
Which of the following conditions is an indication for splenectomy?
+
+
++
+
++
+
++
+
++
D. Asymptomatic 1.5 cm midsplenic artery aneurysm
++
++
Myelofibrosis leads to extramedullary hematopoiesis and can be alleviated by splenectomy.
++
++
++
What type of bacteria does the spleen opsonize better than the liver?
+
+
++
A. Encapsulated organisms
+
++
+
++
+
++
++
++
Encapsulated organisms are opsonized by the reticuloendothelial system, namely the spleen.