abd

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Author:
rbeacr
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122460
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abd
Updated:
2011-12-10 15:08:05
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15 spleen
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The spleen
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  1. spleen
    • largest single mass of lymphoid tissue in body- defense
    • sythesis of blood protien
    • blood formation in fetus (hemapoisis)
    • left hypochondrium
    • peritoneal
    • less or equal echogen to liver, as it gets bigger it gets more echogenic
  2. reticuloendothelial system
    • defense against infection and formation of blood
    • spleen and liver
  3. spleen size location
    • 9-12 x 7 x 3-4cm
    • over 13cm is splenomegally
    • 9,10,11th ribs
    • left hypochondrium
  4. spleen vascularity
    • splenic artery- superior border of panc
    • branches into 6 arteries at hilum
    • splenic vein joins smv and imv to form portal vein tranvels posteriomedial border of panc
  5. spleen ligaments
    • lineorenal
    • gastrosplenic
    • phrenocolic
  6. wandering spleen
    • migrates from normal location
    • loosening of ligaments- can be congenital
    • use color doppler to check for torsion
  7. splenic agenesis
    • asplenia
    • no difficulties but may be linked to anomolies
    • absence of immune response
  8. asplenia and polysplenia
    • linked to cardiac malformation
    • bronchopulmonary abnormalities
    • anomolous placement of organs/vessles
  9. polysplenia sidedness
    • bilateral left sidedness
    • two left lungs, biliary atresia, absense of gallbladder, gi malrotation, cardiovascular abn, ivc interruption
  10. asplenia sidedness
    • bilateral right sidedness
    • two right lungs, midline location of liver, reversed ao and ivc position, horseshoe kidney
  11. acessory spleen
    • splenunculus
    • homogenous to spleen
    • usually hilum or along vessles but can be anywhere in abd cavity
  12. spleen physiology
    • involved in metabolic hematopoeitic and infectious disorders
    • filter peripheral blood
    • red and white pulp
  13. white pulp
    • tiny islands like in lymphnodes
    • contain lymphocytes
    • malpighian corpuscles- lymphoid tissue
  14. malpingian corpuscles
    small nodular masses of lymphoid tissue attached to smaller arterial branches in white pulp
  15. red pulp
    • blood cells lymphocytes and macrophages (destroy foreign particles)
    • splenic sinuses that filter blood
  16. functions of spleen as organ of reticulendothelial system
    • produce lymphocytes and plasma cells
    • produce antibodies
    • store iron
    • store other metabolites
  17. functions characteristic to spleen
    • maturation of surface erythrocytes
    • resoviour
    • culling
    • pitting
    • dispose of abn eryhtrocytes
    • functions related to platelet and leukocyte lifespan
  18. pitting
    removing neucli from rbc
  19. culling
    spleen removes abnormal rbc
  20. spleen labs
    • hematocrit- % of rbc per volume
    • bacteremia- bacteria in blood
    • leukocytosis- increased wbc infection
    • leukopenia- decrease in wbc
    • thrombocytopenia- decrease in platelets- hemorrahage
  21. calculate child organ/spleen size
    5.7 + .31 x age (years)

    usually measures greater than kidney legnth
  22. splenomegally related to
    • chirrohsis with esophogeal varicies
    • splenic artery enlarges
    • systemic inflammation
    • hematopoietic disorders
  23. atrophy
    • occurs in wasting diseases
    • sickle cell anemia
    • (autosplenectomy)
    • loss of pulp
    • increased fibrosis
    • scarring from infarcts
    • iron and calcium deposits
  24. spleen congestion
    acute or chronic

    • acute
    • moderately enlarged spleen

    • chronic
    • diffuse enlargement

    can be systemic- intrahepatic obstruction or obstructive portal/splenic veins, can be from cardiac decompensation

    chirrosis- common cause
  25. amyloidosis
    • systemic storage disease
    • nodular or diffuse
    • nodular-amyloid in walls of arteries but not in red pulp
  26. Gaucher's Disease
    • storage disease
    • 50% under 8yrs
    • splenomegally, heterogeneous, multiple nodules from fibrosis and infart
  27. niemann-pick disease
    • rapid fatal disease in female infants
    • lymphadenopathy, digestive disturbances, hepatomegally
  28. sickle cell anemia
    • diffuse disease
    • large spleen as child
    • undergoes infarct and fibrosis and decreases in size as adult (autospenectomy)
    • abn shapped rbc plug vasularity
  29. congenital spherocytosis
    • diffuse disease
    • hereditary red blood cells are small and shperoid
    • produced by bone marrow and destroyed by spleen
    • enlarged spleen
  30. hemolytic anemia
    • diffuse disease
    • anemia related to decreased life of erythrocytes
    • destroyed faster than can be made
  31. autoimmune hemolytic anemia
    • diffuse disease
    • secondary to underlying disease lymphoma, leukemia, mono
    • enlarged spleen
  32. polycythemia vera
    • diffuse disease
    • excess of rbs and hemoglobin
    • weakness, fatigue, tinitus, black and blue spots
    • enlarged spleen blue-red
    • infarcts and thromboses
  33. thalassemia
    • diffuse disease
    • supression of synthesis (alpha &beta polypeptide) of normal hemoglobin
    • erythrocytes have abn shape and are destroyed in spleen in large numbers
    • very very large spleen
  34. myeloproliferative disorders
    • acute and chronic myelogenous leukemias, polycynthia vera, myelofibrosis..
    • hypoechoic compared to liver
  35. granulocytopoietic abnormalities
    • reactive hyperplasia resulting from chronic or acute iinfection (tb)
    • splenomegally
    • echogenic lesions from previous episodes
  36. reticuloenditheliosis
    • reticuloendithelial hyperactivity and degrees of lipid storage in phagocytes
    • spleen is isoechoic
  37. Letterer-siwe disease
    • aka nonlipid retiuculoendotheliosis
    • proliferation of reticuloendothelial cells in splenic lymphnodes and bone marrow
    • children under 2 yrs
    • hepatosplenomegaly
    • rapidly fatal
  38. Hand-schuller-christian disease
    • benign and chronic
    • similar to letterer-siwe
    • children older than 2 yrs
    • diabetes hepatosplenomegally
  39. lymphopoietic abnormalities
    • lymphocytic leukemia
    • lymphoma
    • hodgkins disease
    • hypoechoic ith lesions
    • nonhodgkins-isoechoic

    leukemia- responsible for extreme splenomegally
  40. abcess
    • focal disease
    • uncommon
    • spread form abdomen (panc abcess)
    • bacteria endocarditis or septicemia, decreased immun state
  41. splenic infection
    • splenomegally
    • many infections effect spleen
    • nodules in spleen when compromised
    • candidiasis- wheel within wheel
  42. aids
    • splenomegally
    • focal lesions
    • lymphadenopathy
    • ascites
  43. splenic infarction
    • most common cause of focal splenic lesions from occulsion of major splenic arter or branches
    • can be from vegetation in lt side heart valves

    echogenic when healed, wedge shape
  44. splenic trauma
    • most commonly injured as a result of blunt trauma
    • luq pain
    • 1- subcapsular hematoma holds pressur on itself
    • 2- rupture capsule free peritoneal hematoma
    • quickly acess free fluid- need surgery
  45. fast scan
    • 4 quadrants
    • morrisons pouch
    • subdiaphragmatic
    • liver and splenic capsule
    • bladder and ant rectus
    • for free fluid
  46. splenic cyst
    • parasitic or non parasitic
    • usually secondary to trauma infection or infarction
    • Echinoccocus- parasite that forms splenic cysts, calcification,uncommon in us

    rare-primary cysts - contain epithelial common-lining, secondary have no cell lining- trauma
  47. hamartoma
    • benign
    • well defined solitary or multiple
    • lymphoid tissue
    • solid or cystic hyperechoic
  48. cavernous hemangioma
    • isolated inhomogenous echogenic mass
    • only symptomatic when spleen pressed on other organs
    • can have complication if spleen ruptures
  49. cystic lymphangioma
    • benign malformation of lymphatics
    • endothelial lines cystic spaces
    • mass with cystic replacement of splenic parenchyma
    • rare in spleen- but can be other organs
  50. hemangioscarcoma
    • rare malignant neoplasm from vascular endothelium of spleen
    • mixed cystic - resembles cavernous hemangioma
  51. lymphoma
    • spleen is involved with lymphoma
    • hypoechoic, focal areas
    • diffuse, focal small nodular, focal large nodular, bulky
  52. metastases
    • 10th most common site
    • breast lung ovary stomach colon kidney prostate melanoma
    • look for focal lesions

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