Elective Splenectomy

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Elective Splenectomy
2011-03-06 23:09:52
Spleen Surgery

Questions on splenectomy for ITP, TTP, etc, geared toward surgical residents.
Show Answers:

  1. What causes low platelets in ITP?
    IgG produced by the spleen
  2. First line tx for ITP?
    Steroids (1 mg/kg/day)
  3. Non-op treatment of severe ITP?
  4. Indications for splenectomy in ITP?
    • Failure of medical management after 8 weeks steroids
    • or...
    • If thrombocytopenia recurs after steroid tapering
  5. When do you transfuse platelets during splenectomy for ITP?
    AFTER splenic artery is divided/clamped (to avoid additional platelet consumption)
  6. How often is there an accessory spleen in ITP patients?
    30% of the time
  7. Where are some good places to look for an accessory spleen?
    Gastrosplenic, gastrocolic, splenorenal ligament
  8. What is the success rate for surgery in ITP?
  9. What is the pathophysiology of TTP?
    Capillaries have an anomolous hyaline membrane that causes platelet aggregation and occlusion.
  10. Do you give platelets in TTP?
    NO! gives you a worse outcome
  11. How does TTP kill you (2 main ways)
    • 1. intracranial hemorrage
    • 2. renal failure
  12. Cure rate for splenetomy for TTP?
    Unfortunately, only 40%
  13. What is the pathophysiology of hereditary spherocytosis (name the gene!)?
    Missing spectrin gene causes RBC's that are not distensible, so they get stuck in the spleen.
  14. What is the hereditary spherocytosis triad?
    Anemia, jaundice, splenomegally
  15. What other biliary abnormality to hereditary spherocytosis patients have?
    pigment gallstones!