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Spleen

Ryan Lawless

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TEST TAKING TIPS

Test Taking Tips

  1. 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.

  2. Treatment of gastric varices (sinistral hypertension) with splenectomy is frequently covered.

  3. 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.)

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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%.

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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?

  • Children (rarely ...

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