1 / 20

spleen

spleen. Dr . Mezjda Ismail Rashaan , consultant surgeon University of sulaymania Faculty of medical sciences School of medicine Kurdistan. Anatomy & physiology. Anatomy:- -origin

arama
Download Presentation

spleen

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. spleen Dr. Mezjda Ismail Rashaan, consultant surgeon University of sulaymania Faculty of medical sciences School of medicine Kurdistan

  2. Anatomy & physiology Anatomy:- -origin -location & surface anatomy -its ligaments ; (gastrosplenic, splenocolic, phrenicosplenic, splenorenal) -arterial and venous supply

  3. Consistency of the spleen -white and red pulp( cords & sinuses),marginal zone -trabeculae art., central art., pencillar artery -skimming effect -defense spleen & storage spleen

  4. Function of the spleen 1-immune function .specific like igM production . Nonspecific( opsionstuftin,properdin) to phagocyte the bacteria, fungi. 2-filter function . macrophages catch bacteria specially pnumoccocci, H. influnzie, noncellular materials . 3-removal of effecte platelets, RBC bu Culling 4-Pitting, removing particular inclusions from RBCs like parasite of malaria, nucleated RBCs

  5. Function cont. 5-iron reutilization 6-pooling 30-40% platelet. In splenomegaly may reach 80% 7-reservoir function in dogs 8-haematopoiesis up to 5monthes of intrauterine life

  6. Investigations Depend on the type of the disease which causing splenomegaly, like : -blood disease …blood investigation -liver cirrhosis causing portal hypertention …LFT,OGD for esophageal variesis -associated with lymphadenopathy do LN biopsy

  7. Investigation cont. 1-plain abdomen -calcification(s)( hydatid cyst, haemangioma, spleenicanurysm, TB, old infarct of SCA…etc.) -soft tissue shadow at upper lt. hypochonderial area -descending colonic gas shadows -obliteration of the psoas shadow

  8. 2-ultrasound -size and consistency -cystic or solid ? -rapture.. -haematoma -therapeutic i.e abscess drainage or aspiration of the cyst, biopsy!!!!

  9. 3-CT abdomen with or without contrast 4- MRI 5-radio-isotop scans Te 99 -recurrent disease? -position & site -RBC life duration and place of their destruction 6- angiography -embolization of selected cases of splenichge. -liver schirosis -before splenectomy to decrease its size

  10. Congenital anomaly 1- absence -rare and it is usually associated with congenital heart disease and fatal sepsis. 2- accessory spleen ( splenuculi) -20% of population & 30% of pts. with haemolytic disease -no more than 2cm -80% found in splenichilum and vascular pedicle -omentum,gastrosplenicligament,splenocolicligament,stomach greater curvature, small & large bowel mesetery,in left broad ligament and spermatic cord…etc. -if not removed after splenectomy ,it cause recurrent of the disease

  11. 3-Hamartoma-1cm …huge size causing abdominal swelling-2 types arise from red and white pulp-incidentaly sometimes found by CT- abdomen 4- cysts -rare a-true one, non-parasitic -may be dermoid, mesenchymal inclusion cysts, epithelial cysts.

  12. Cyst cont. B- false cysts .parasytic –echinococcus .seroma Clinical features: -asymptomatic -symptomatic .mass in lt. upper hypochonderial area Diagnosis: sonography of the abdomen Treatment: .depend on symptomes. if asyptomatic……observation and follow up by sonography. if symptomatic … depend on its size small one do excision large one unroofed if or do aspiration, drainage, sclerosing

  13. Rapture of spleen Etiology; -direct trauma -without trauma in diseased spleen duo to malaria, infectiouse mononucleosis -iatrogenic during operation It is suspected when there is # ribs at lthypochonderial area.

  14. Clinical features: 3 groups: 1- patient sccumbs rapidly from massive he. 2-initial shock ,recovery and later sings of internal bleeding. Kehrs sings, shifting dullness in flanks, rectal examination fullness in pelvis 3- delayed case

  15. Investigations -plain abdomen -sonography of abdomen -CT-abdomen Treatment: Surgical options -splenectomy( total or partial) - splenorraphy -mesh net pressure compression

  16. Infection of the spleen:- -rare -cause spontaneous rapture of spleen -duo to: - infectious mononucleosis, CMV -malaria -fungal infection -amylodosis, pregnancy, lymphoma, Q-fever…

  17. Splenic infarction:- -duo to myloproliferative syndrome -vascular occlusion in sickle cell anemia, infected heart valves bacterial endocarditis -may be asymptomatic or causing abdominal pain in left hypochondrium, gaurdening, friction rub

  18. Absces of the spleen:- -uncommon ,most common in tropical area -occurs with thrombosis of vessels or infarct of SCA. • Splenic thrombosis infected • Metastatic abscess duo to typhoid, paratyphoid, oestiomylitis, otitis media, pureperal sepsis -mechanism:- .haematological .contagious .haemoglobinopathy .trauma .immunosuppression

  19. Symptomes:- -delayed -fever, pain left hypochondria, increase WBC, splenomegaly in 1/3 of the patients Diagnosis:- u/s or CT of abdomen Treatment:- drainage

  20. Aneurysm of splenic artery:- -rare,< 1% -female : male is 2:1 -involve main trunk • May be single or multiple -asymptomatic unless ruptured -occasionally palpable in epigastrium with bruit in left hypochonderial area -incidentally on plain abdomen with calcified ring -usually < 45 years, ¼ pregnant at 3rd trimester. -in young females asymptomatic -maternal mortality high( 70 %) -treatment usually surgery by splenectomy

More Related