Q1. Which of the following is not an indication for splenectomy in Non Hodgkin Lymphoma?
a) Massive splenomegaly
b) Signs of hypersplenism
c) Diagnosing and staging of isolated splenic disease
d) All are indications for splenectomy
Splenectomy is indicated for NHL patients with massive splenomegaly leading to abdominal pain, early satiety, and fullness. It may also be indicated for patients who develop anemia, neutropenia, and thrombocytopenia associated with hypersplenism. Splenectomy may also be instrumental in the diagnosis and staging of patients with isolated splenic disease.
2. The most common cystic disease of the spleen is
a) Hydatid cyst of spleen
b) Pseudo cyst of the spleen
c) Columnar lined cyst of spleen
d) Cystic lymphangioma
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.
Classification of Splenic cysts
True Cyst- Congenital, epidermoid, or epithelial cysts. Or Parasitic and non parasitic
Splenic cysts are most common in the 2nd and 3rd decade of life, although they have been noted in all age groups, including infants. An asymptomatic painless abdominal mass is the presenting feature in approximately 30% to 45% of cases.
Treatment options include
Pseudocyst- Aspirations, Catheter drainage, Partial splenectomy, Splenectomy or a recent technique of partial splenic decapsulization (marsupilization)
Q3 Which is not an indication of splenectomy in idiopathic thrombocytopenia
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.
Indication of splenectomy (removal of spleen) in ITP are
1.ITP has been 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
Q4 ) True regarding abscess of the spleen 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 abscess of spleen
c) Splenomegaly (enlargement of spleen) is present in most of the patients.
d) 2/3rd of the splenic abscess are solitary in adults
Abscess of spleen 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.
Q5 Which of the following is not true regarding splenorrhaphy (Repairing of Spleen)
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
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.
Q6 OPSI is commonest in splenectomy done for
c) Hereditary Spherocytosis
One consistent observation is that the risk for OPSI is greater after splenectomy for malignancy or hematologic disease than for trauma
S. pneumoniae is the most frequently involved organism in OPSI and is estimated to be responsible for between 50% and 90% of cases. Other organisms involved in OPSI include Haemophilus influenzae, Neisseria meningitidis, Streptococcus species and other pneumococcal species, Salmonella species, and Capnocytophaga canimorsus
Q7 Which of the following is not true regarding wandering spleen?
a) The spleen is attached to a long vascular pedicle without the usual mesenteric attachments.
b) Torsion and infarction of the spleen are common complications
c) There is congenital atresia of the dorsal mesogastrium in children
d) Splenectomy is required in all cases
A “wandering spleen” occurs when the spleen is attached only by a long, loose vascular pedicle without the usual peritoneal attachments. Wandering spleen in children arise from congenital atresia of the dorsal mesogastrium. When found in women between 20 and 40 years of age, wandering spleens result from an acquired tissue laxity associated with pregnancy.
The condition is complicated by acute torsion around the vascular pedicle, which manifests with acute abdominal pain, fever, vomiting, acute pancreatitis, and gastric compression. Without detorsion, splenic infarction and gangrene ensue. Chronic torsion typically causes venous congestion and splenomegaly.
In children without splenic infarction, the procedure of choice is splenopexy, suturing the spleen to the diaphragm, abdominal wall, or omentum.
Splenectomy is preferred in adults
Q8.What is true about splenic abscess
a) Most of the abscess in spleen occur through local spread such as from kidneys, colon
b) Unilocular splenic abscess has a high mortality rate more than 50%
c) Splenomegaly is typically seen in splenic abscess
d) In one third of adults splenic abscess is multilocular
Haematogenous route is the most common route for acquiring splenic abscess (70%). Risk factors inculde polycythemia vera, malignancies, IV drugs etc. Unilocular splenic abscess has mortality rates of 15-20% and multiloculated abscess about 80%. Typical symptoms are fever, pain abdomen, pleuritic chest pain. Splenomegaly is uncommon. In 1/3rd adults abscess is multilocular.