SPLEEN
Structure
Left Upper Quadrant
Lymphoid organ (White pulp)
100g-150g
Capacity for phagocytosing particulate matter in circulation & reducing no. of old RBCs. (Red Pulp)
Encapsulated
Disorders
Hypersplenism
Congenital Abnormalities
Splenomegaly
Congenital asplenia / polysplenia
Accessory spleens / splenunculi
Overactive spleen
Can be Primary / Secondary
Peripheral blood pancytopenia & splenic enlargement
Primary
Massive splenomegaly & pancytopaenia
Treated by Splenectomy
Enlarged spleen
Aetiologies
RBC abnormalities
Immune disorders
Congestion
Primary / Metastatic neoplasms
Infection
Storage disorders
Amyloidosis
Splenic atrophy
Rupture of spleen
Splenic infarction
Spleen is small weighing less than 50g
Also sickle cell disease
Associated with intestinal malabsorption states e.g. Coeliac Disease
Sickle RBC obstruct vessels
This causes multiple splenic infarcts
Size reduction reduces function
Can also be due to local thrombi
Secindary to emboli from heart
Occlusion of splenic artery or its branches
Myeloproliferative disorders
Malignant infiltrates
Sickle cell anaemia
Caused by blunt abdominal trauma
Treated with emergency splenectomy
This leads to massive intraperitoneal haemorrhage which is life threatening
Can be spontaneous
e.g. Infective mononucleosis
Gaucher's Disease
Niiemann Pick disease
Mucopolysaccharidoses
Accumulation of lipids in spleen, liver, lungs, bone marrow & brain
Genetic disorder where there is deposition of glucocerebroside in cells of macrophage-monocyte system
Red pulp expansion by macrophages whose cytoplasm is distended with abnormal storage product
Acute & chronic leukemia
Myeloproliferative disorders
Haemangioma
Hodgkin's Lymphoma
Non-Hodgkin's lymphoma
Beningn
Collection of small blood vessels that form a lump under the skin
Bone marrow makes too many abnormal RBCs, WBCs / platelets which accumulate in blood.
Sickle cell anaemia
Hereditary Spherocytosis
Systemic Lupus Erythematosus
Fenty's syndrome
Rheumatoid arthritis & splenomegaly
Viral Disease
Bacterial Infection
Chronic Malarial Infection
Systemic Infection
Granulomatous Inflammation
Fungi
Protozoal
Bacteria
TB
HIstoplasmosis & Cryptococcus
Toxoplasmosis
Splenic capsule is thickened & fibrotic
Cut surface is grey due to malarial pigment
Massive splenomegaly
Produces sudden & therefor more severe splenomegaly
Susceptible to rupture
Infectious Mononucleosis
Neutrophils accumulate in the sinuses & medullary cords
If extreme can lead to Acute Septic Splenitis
In response to infections like bacterial endocardititis or localised abscesses
Spleen becomes soft bcoz of proteolytic enzymatic action
Congestion & macrophage hyperplasia
White pulp prominent
Moderate splenomegaly
Capsule is thickened and fibrotic
Cut surface:
Enlarged spleen which reach kg
Caused by persistent elevation of splenic venous blood pressure
Due to:
Hepatic
Post-Hepatic
Pre-Hepatic
Thrombosis of the extrahepatic portion of the portal vein / splenic vein
Cirrhosis
(+) pressure in IVC
Asso. with ascites & hepatomegaly
Causes:
Decompensated heart failure
Pulmonary/tricuspid disease
Scattered firm brown nodules
Beefy red color with unnoticeable white pulp
Composed of fibrous & elastic tissue with abundant haemosiderin & dystrophic calcification
Gamna Gandy bodies
These represent areas of healed infarction
Which is neutrophilic infiltrate & congestion within the red pulp accompanied by splenomegaly
When spleen is overactive, it removes RBCs too early & quickly.
Many blood cells are being polled and destroyed in the spleen reticulo -endothelial system