CC May 2016 Complications of Splenectomy

echoecho's version from 2016-07-31 14:47


Question Answer
Define the spleen?1) the largest lymphoid organ in the body 2) located in the posterior left upper quadrant of the abdomen
List the spleen's functions?1) hematopoietic during fetal development and throughout life 2) mechanical filtration (eliminating aging and deformed erythrocytes and their fragments and encapsulated bacteria) 3) immunologic (identfying and processing antigens, generating antibodies and opsonins) 4) reservior actions (segregates 30-40% of platelets 5) source of clotting factor VIII and von Willebrand factor
Suspected splenic injury is best evaluated how?with carefula nd repeated abdominal exams and imaging studies
While US is often the first study and can be performed quickly in the urgent care setting, what is the optimal imaging modality for identification of splenic abnormalities?CT scan
The spleen is the most commonly injured organ in the blunt abdominal trauma, accounting for ____% of cases where a single intraabdominal organ is involved?46
While accidental (predominantly blunt) or iatrogenic splenic trauma are the most common indications for therapeutic splenectomy, current surgical recommendations include what?non-operative approaches when the patient remains hemodynamically stable during a period of clost monitoring with clinical evaluation, lab testing and imaging studies
Splenic artery _________ may be used as an adjunct to the non-operative approach?embolization
In adadition to traumatic indications, splenectomy is curative for ____ and ______ involving the spleen?cysts; tumors
Additionally, splenectomy is indicated in hereditary spherocytosis, idiopathic or thrombotic thrombocytopenic purpura and autoimmune hemolytic anemia, where it leads to improvement in _____ counts and diminishes need for transfusions?blood
List the less common indications for splenectomy?1) chronic or severe hypersplenism (lymphomas, leukemia, myelofibrosis, sickle cell disese, hemoglobin SC disease, storage disorders, amyloidosis, sarcoidosis and Felty's syndrome)
In portal HTN due to splenic vein thrombosis, is splenectomy therapeutic?yes
In portal HTN due to hepatic cirrhosis, what does splenectomy do?it decreases variceal bleeding and through a porta-systemic (splenorenal) shunt, decompresses the portal system
With innovations in imaging techniques, is lapartomy and splenectomy rarely indicated in patients with Hodgkin's lymphoma?yes
*** What shoulder patient undergoing elective splenectomy receive 2 weeks prior to surgery, if not previously received?1) pneumococcus vaccine 2) meningococcus vaccine 3) Haemophilus influenza vaccine
Complications of splenectomy may be intra-operative or postoperative, related to what?the pathology indicating splenectomy OR complications resulting from asplenia
Complications are seen in a significant percentage of all patients undergoing splenectomy; most are what?pleuropulmonary
A high rate of postoperative complications occurs in patients with what?1) hematologic disorders 2) cancer 3) pre-operative chemotherapy 4) steroid use 5) larger splenic size
What is the most common operative complication?acute (especially in patients with splenomegaly)
List the sources of hemorrhage?1) splenic bed 2) short gastric vessels 3) tail of the pancreas 4) the splenic pedicle 4) operative trauma to liver, kidney or bowel
Significant hemorrhage following splenectomy is rare, true or false?true (<1%)
Describe how long the bleeding may last?it may be self-limiting or it may persist and require re-exploration
What s/s indicate continued bleeding?1) worsening tachycardia 2) hypotension 3)abdominal pain and distention 4) oliguria 5) falling hgb values 6) persisting sanguinous drainage
List the risk factors for post-splenectomy bleeding?1) splenectomy for thrombocytopenic disorders or portal HTN 2) injury to the tail of the pancreas during the procedure 3) the use of antiplatelet agents and anticoagulants after surgery
The tail of the pancreas (close to the splenic hilum) may be damaged during splenectomy (1-3%) resulting in what symptoms and requiring re-exploration, repair and drainage?1) bleeding 2) pancreatitis 3) pancreatic fistula
What symptoms may develop within the first postoperative week?1) abdominal pain and distention 2) vomiting and ileus 3) elevated amylase and lipase
What s/s can occur following devascularization of the greater curve of the stomach, what is this due to?1) gastric distention and fistula 2) due to ligation of the short gastric vessels too close to the gastric wall
What other injuries may occur during splenectomy resulting in hemorrhage and fecal fistula, requiring re-exploration and repair?1) injury to the splenic flexure of the colon 2) injury to the left lobe of the liver 3) injury to the left dome of the diaphragm
Splenectomy may also trigger a transient hypercoaguable state involving the arteriovenous circulation, especially in what medical conditions?1) myeloproliferative and lymphoproliferative disorders 2) hereditary spherocytosis 3) thalassemia
True or false? Arterial events such as coronary and cerebral ischemia and lower extremity occlusion are increased following splenectomy, but frequency rates have not been well studied?true
What events may result from splenectomy and are more common than arterial events?1) portal thrombosis (DVT) involving the extremities 2) pulmonary embolism (PE)
What 2 conditionsmay follow splenectomy in hematologic disorders such as sickle cell disease?1) priapism 2) leg ulcers
Can both DVT and PE occur concurrently with splenic or portal vein thrombosis?yes
*** What medications administered for 2-4 weeks after splenectomy reduce the risk of thrombotic vascular complications?1) antiplatelet agents 2) anticoagulants
Patients developing splenic or portal vein thrombosis or distal DVT should be anticoagulated for ____ to ____ months, proximal DVT and PE for ____ months?3 ; 6; 6
Apart from PE, list the pleuropulmonary sequelae of splenectomy?1) atelectasis 2) pneumonia 3) pleural effusion (all more common on the left)
What procedures can be used to mitigate the above pleuropulmonary complications?1) incentive spirometry 2) early mobilization 3) respiratory therapy 4) drainage of large effusions
List the rare wound-related complications of splenectomy?1) hematoma 2) seroma 3) infection and dehiscence
How are the wound-related complications managed?1) aseptic surgical techniques 2) meticulous wound closure 3) antibiotics 4) wound drainage 5) primary or staged secondary closure may be necessary in wound dehiscence
Subphrenic collections (0.5%) are minimized by what?postoperative drainage of the subphrenic recesses
*** SUMMARY = Splenectomy (when performed in the treatment of _______ disease or ______) is associated with a higher risk of intraoperative, postoperative and long-term complications?1) hematologic 2) malignancy
*** SUMMARY = What is the most common operative complication of splenectomy?hemorrhage
*** SUMMARY = Splenectomy may increase the risk of thrombotic vascular complications, list 4?1) deep vein thrombophlebitis 2) portal vein thrombosis 3) coronary ischemic events 4) cerebral ischemic events