The Spleen

Anatomy/Physiology

100

The splenic artery most commonly originates from this artery

Celiac artery

200

This/these anatomical structure(s) protect the spleen from injury

Ribs 9, 10, and 11 on the left side (except in situs inversus)

300

These peritoneal "reflections" tether the spleen to surrounding structures (please name them)

Gastrosplenic

Splenorenal

Splenocolic

Splenophrenic

400

A patient with gastric varices may have this as the primary cause which was caused by inflammation of a neighboring organ

Splenic vein thrombosis secondary to pancreatitis

500

These vaccines help prevent OPSI (overwhelming post splenectomy infection)

Pneumococcal vaccine

Meningococcal vaccine

Haemophilus Influenzae Type B (Hib) vaccine

Operative Technique

100

This important anatomical structure can abut the splenic hilum necessitating ligation of the splenic vessels within this many centimeters of the hilum.

Pancreatic tail

1 cm

200

This is a major cause of post operative instability due to blood loss after a splenectomy

Short gastric bleeding

300

This/these technique(s) can be utilized for splenic preservation 

Argon beam coagulator

Absorbable mesh wrap

Suture splenorrhaphy (+/- pledgets)

Fibrin glue placement

400

These FOUR criteria must be met in order to proceed with non-operative management of splenic trauma

1) Hemodynamic stability

2) Documented CT classification of injury

3) Absence of additional injuries requiring operative intervention

4) Transfusion <2u PRBC in 24 hr period

500

These two post operative vaccines require re dose at 8 weeks and 5 years

Pneumovax (Strep pneumoniae)

Meningovax (neisseria meningitidis)

Benign Hematologic Conditions

100

This is the most common hematologic condition that is an indication for splenectomy and is characterized by ______.

Surgical indication(s) is/are

Immune Thrombocytopenia (ITP)

Platelets <100k with no other identifiable cause

Plt count <10k for 6 weeks despite max medical therapy

Pregnancy in second trimester who fail medical therapy

200

Hereditary anemic syndromes can require splenectomy fi the following condition is met.

For extra points: name some of these syndromes

Severe, refractory anemia

Hereditary spherocytosis, hereditary elliptocytosis, hereditary pyropoikilocytosis, hereditary xerocytosis, hereditary hydrocytosis

300

This condition can co-exist with hereditary anemias requiring this further surgical procedure (along with splenectomy)

Pigmented gallstones 

If present, cholecystectomy at time of splenectomy is indicated

400

Hemolytic anemias caused by two enzymatic deficiencies were mentioned in your reading. This one causes CHRONIC hemolysis and is a recommendation for splenectomy to decrease transfusion requirements

Bonus points- name the other deficiency

Pyruvate kinase deficiency

(the other is G6PD deficiency)

500

Splenic red blood sequestration can cause rapid drop in hemoglobin levels and life threatening hypovolemic shock in these congenital blood disorders

Sickle cell disease

Beta thalassemias

(Splenectomy "usually" indicated after first attack)

Tumors of the Spleen

100

The spleen can be involved in both Hodgkin and non-Hodgkin lymphomas under this/these conditions

Symptomatic splenomegaly

(non-Hodgkin can also have anemia, neutropenia, and thrombocytopenia)

200

Hairy Cell Leukemia can also require splenectomy under this/these conditions

Cytopenias +/- splenomegaly refractory to medicine and immunotherapy

300

This leukemia historically has splenomegaly as part of its treatment algorithm, but now is rarely indicated or performed

Chronic lymphocytic leukemia (CLL)

400

Though it does not provide a survivial benefit, splenectomy can be performed for symptomatic hypersplenism or splenomegaly in this malignant disorder

Chronic myelogenous leukemia (CML)

500

This rare tumor can occur in the spleen in those exposed to thorium dioxide or vinyl chloride

Angiosarcomas

Grab Bag

100

If you preserve this percentage of the spleen, it is reported to retain enough function to prevent OPSI

~30%

200

This/These features distinguish a parasitic splenic cyst apart from a benign cyst

Bonus points- this is the main, endemic hydatid species that causes parasitic cysts

Wall calcifications

Daughter cysts

Echinococcus species

300

This Holy Trinity of Classic Rock make up the Band Rush

Geddy Lee

Alex Lifeson

Neil Peart

400

Overwhelming post splenectomy infection (OPSI) has many associated risks factors. Between a trauma population and a pediatric population, this group has a lower risk.

Trauma population

500

Accessory spleen has been identified in these ELEVEN locations

State 5 (bonus points for more)

1) Gastrosplenic ligament 2) Splenic Hilum 3)Tail of Pancreas 4) Splenocolic Ligament 5) Left transverse mesocolon 6) Greater omentum 7) Mesentery 8) Left mesocolon 9) Left ovary 10) Douglas Pouch 11) Left testis