Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ TEST TAKING TIPS ++ Test Taking Tips Be wary about idiopathic thrombocytopenic purpura (ITP) questions. Pay close attention to the preoperative details regarding platelet count, patient status, and timing of platelet transfusion. Treatment of gastric varices (sinistral hypertension) with splenectomy is frequently covered. Don't forget about an accessory spleen in a refractory ITP patient. +++ ANATOMY +++ What is the arterial blood supply to the spleen? ++ Splenic artery from the celiac plexus; short gastric arteries (vasa brevia) from the gastroepiploic artery ++ FIGURE 17-1. Relation of splenic artery and splenic vein. (A) Vein posterior to artery (this is the usual pattern); (B) vein both anterior and posterior to artery; (C) vein anterior to artery (this is the least common configuration). (Modified from Skandalakis' Surgical Anatomy: The Embryologic Basis of Modern Surgery. Paschalidis Medical Publications; 2004, with permission.) Graphic Jump LocationView Full Size||Download Slide (.ppt) Graphic Jump LocationView Full Size||Download Slide (.ppt) Graphic Jump LocationView Full Size||Download Slide (.ppt) ++ FIGURE 17-2. Sites where accessory spleens are found in order of importance. (A) Hilar region, 54%; (B) pedicle, 25%; (C) tail of pancreas, 6%; (D) splenocolic ligament, 2%; (E) greater omentum, 12%; (F) mesentery, 0.5%; (G) left ovary, 0.5%. Graphic Jump LocationView Full Size||Download Slide (.ppt) +++ What is the relationship between the splenic artery and the splenic vein? ++ The splenic artery is anterior and superior to the splenic vein +++ What percentage of patients have an accessory spleen? ++ ~20% +++ Where is an accessory spleen most commonly found? ++ The accessory spleen is found in the region of the splenic hilum and vascular pedicle in 80% of cases +++ What ligaments suspend the spleen? ++ Splenocolic, gastrosplenic, phrenosplenic, and splenorenal ligaments +++ PHYSIOLOGY +++ What is the function of the spleen? ++ Hematologic: removal of cytoplasmic inclusions in the erythrocytes (pitting); destruction of senescent erythrocytes (culling); hematopoiesis in the fetus or in patients with bone marrow destruction; reservoir for platelets and granulocytes Immunologic: production of the opsonins tuftsin and properdin; antibody production in germinal follicles; filtration and trapping of circulatory antigens; lymphocyte stimulation and proliferation +++ What is the largest producer of IgM in the body? ++ The spleen +++ What 2 opsonins are produced by the spleen? ++ Tuftsin and properdin +++ NONTRAUMATIC DISEASES +++ What is idiopathic thrombocytopenic purpura (ITP)? ++ A condition in which circulating IgG antiplatelet antibodies destroy platelets +++ In which patient population does ITP usually resolve spontaneously?... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.