Path-Splenomeg/Hyper
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| The clinical picture of hypersplenism is dominated by what specific causal condition of the splenomegaly? | Liver cirrhosis
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| What are the SS of chronic liver disease-cirrhosis? | jaundice, dark urine, esophageal varices, peritoneal fluid, results of blood chemical studies showing hepatocellular injury and dysfunction
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| What are the SS of splenomegaly and hypersplenism? | mass in the left hypochondrium tender to palpatation, bruises, decreased platelet count, decreased wbc count, decreased rbc and decreased hemoglobin
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| Hypersplenism is | a syndrome in which circulating cytopenia is associated with splenomegaly.
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| The cardinal features of hypersplenism are: | splenomegaly; reduced levels of one or more blood cell elements, resulting in anemia, leukopenia, thrombocytopenia or any combination, iaw hyperplasia of the marrow precursors of deficient cell type; correction of cytopenia by splenectomy.
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| A normal spleen weighs ___g, and is approximately ____cm | 150g, 11-12cm
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| The splenic artery enters the capsule at the hilus and branches into __________ arteries, which then branch into _______arteries and enter the _______ | trabecular, central, white pulp
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| White pulp is composed of? | Lymphoid tissue
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| Red pulp consists of? | vascular sinusoids, the splenic cord (the cords of Bilroth) and the terminal branches of the penicillary arteries.
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| The endothelial lining of the sinusoid is | of the open or discontinuous type
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| What is the benefit of slow circulatin through the red pulp? | macrophages lining the cord remove damaged or aged cells.
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| What is the wt of a palpable spleen? One that is in splenomegaly? And a massive splenomegaly? | 750-1000 g, 400-500 g, than 1000 g
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| What are the functions of the spleen? | Hematopoeisis, removal of damaged and aged red blood cells and platelets, immunologic function, storage of cells
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| What is Extramedullary hematopoiesis? | It is the use of the spleen hematopoiesis, it is a significant cause of splenomegaly in bone marrow diseases and chronic hemolytic anemias.
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| What are the four etiologic groups of splenomegaly considered important? | congestive, inflammatory, hyperplastic, and infiltrative
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| Describe Congestive splenomegaly | This form develops as a result of liver cirrhosis with portal vein hypertension and splenic vein thrombosis.
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| Describe Inflammatory splenomegaly. | develops iaw various infections, inflamm or immuno processes (malaria, SLE). Inc. antigen clearance from blood leads to inc. macrophagal cells in spleen and stimulates accelerated production w/ resultant lymphoid hyperplasia and splenomegaly.
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| Describe Hyperplastic splenomegaly. | Thought to reflect hypertrophy from work overload resulting fropm the removal of abnormal red blood cells from the circulation (hereditary spherocytosis, thalassemia) or, in some cases as the result of extramedulary hematopoiesis.
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| Describe Infiltrative splenomegaly. | This condition develops as a result of engorgement of macrophages with indigestible materials (e.g., Gaucher disease).
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| What is important in determining the degree of red blood cell sequestration? | It is the size of the spleen not the portal pressure.
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| Splenomegaly (splenic hypertrophy) results in ... | both sequestration of formed elements and premature destruction of blood cells by splenic macrophages. Because normal function of splenic macrophages is removal of senescent rbcs, this is an exaggeration phys process for splenic macrophages.
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| enlarged spleen can also trap and remove platelets and white blood cells, so that anemia may be associated with what? | varying degrees of thrombocytopenia and leukopenia.
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| The most common symptoms of splenomegaly with hypersplenism are: | Enlarged spleen (palpation); vague Abd pain -lt hypochondrium; Low granulocyte count, infections when <1000/mm3 (norm 4,500 – 11,000); Low plat count manifested as bruises (purpura) or mucosal bleeding; Low rbcs manifested as pallor, dyspnea or fatigue.
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| How is hypersplenism treated? | Successful tx of underlying disorder can lead to regression of splenomegaly /hypersplenism w/o surgery, splenectomy may be best tx and helps to control basic disease, life-threatening infections represent a major sequela after splenectomy.
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| What is liver cirrhosis? | damage to liver cells from hepatitis viruses, alcohol, metabolic derangements or other. Dead cells are replaced by fibrous tissue -fibrosis scarring. Remaining cells regenerate in abnormal pattern, forming nodules that are surrounded by fibrous tissue.
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| How is liver cirrhosis characterized? | by widespread nodules in the liver combines with widespread fibrosis; fibrosis and nodule formation causes distortion of the normal liver architecture which interferes with blood flow through the liver.
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| Dec blood flow through cirrhotic liver causes what organ to becom enlarged? | spleen
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| What is the difference in appearance between normal spleen and splenomegaly? | slate gray w/ red perenchyma vs tan-white fibrous plaques over purple surface
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