Q1 Which is not an indication of spleenectomy in idiopathic thrombocytopenia ( ITP)
A) asymptomatic patients with platelet count between 30000-50000 mm3
b) refractory thrombocytopenia
c) relapse after glucocorticoid therapy
d) platelet count of 10000 despite management for 6 weeks but no bleeding.
Q2. The most common cystic disease of the spleen is
a) Hydatic cyst of spleen
b) Pseudo cyst of the spleen
c) Columnar lined cyst of spleen
d) Cystic lymphangioma
Q3 ) True regarding splenic abscess are all except
a) Majority of splenic abscess result from hematogenous spread from other sites
b) Both Gram positive and gram negative organisms are responsible for splenic abscess
c) Splenomegaly is present in most of the patients.
d) 2/3rd of the splenic abscess are solitary in adults
Q4 Which of the following is not true regarding splenorrhaphy
a) Use of Argon Beam coagulator is superior to other techniques.
b) Grade II and III injuries can be managed by suture repair
c) At least One third of the spleen should be preserved to maintain immunological function.
d) Mesh wrapping is recommended for Grade IV injuries
Answers
1) a
Indication of splenectomy in ITP are
1.ITP diagnosed for 6 weeks still platelet count is less than 10000 with or without bleeding.
2. ITP diagnosed for 3 months with platelet count of less than 30000
2. b
Pseudocyst of the spleen are 4 times more common than the true cysts. Pseudocyst spleen is mostly acquired after trauma.
True cysts of the spleen are lined by a layer of epithelium. True cysts like columnar lined cyst of spleen are rare. The epithelial cells are rich in CEA (Carcino embryonic Antigen) and CA19- 9 but they are benign. Management is required if the cyst is more than 8 cm or causing symptoms.
3. c
Splenic abscess result from haematogenous spread from foci such as endocarditis, osteomyelitis and IV drug abuse. It also results from spread from surrounding structures like colon and kidneys.
Both gram positive and gram negative organisms are responsible.
Splenomegaly is present in only a minority of patients. In adults 2/3rd of splenic abscess are solitary where as in children only 1/3rd are solitary.
4. a
Argon beam coagulator and other superficial coagulation devices are generallt preferred to the conventional techniques but studies have not shown a definite superiority.
In grade II and III injuries pledget suturing is advised .
Grade IV injuries are mangaed with polygalactin mesh.
Advantage of splenorrhaphy over splenectomy are
1. Immunological competence
2. Prevention of Left Subphrenic abscess.
