DMS 211 - Ch. 8 (Speen) WB

The average spleen measures _____ cm in length, _____ cm in width and _____ cm in thickness.

-12 cm -7 cm -3-4 cm

When imaging the spleen in the sagittal plan, views should always include the left _____ to evaluate for ascites or pleural fluid and the interface with the _____.

-diaphragm -left kidney

The red pulp is responsible for _____ the peripheral blood. These functions include removal of _____ or _____ blood cells and the storage of _____.

-filtering -worn-out -defective -platelets

In patients with both Hodgkin disease and non-Hodgkin lymphoma, the spleen may contain focal _____ or ______ masses, may exhibit diffuse ______ or may appear sonographically _____.

-hypoechoic -hyperechoic -splenomegaly -normal

The white pulp is part of the _____ system as it is a source of lymphocytes, macrophages, and antibodies. In addition, the white pulp can _____ bacteria that have bypassed the lymph nodes.

-immune -phagocytose

Patients who are _____ are more susceptible to fungal and bacterial abscess of the spleen.

-immunocompromised

The splenic vein joins with the _____ and can be seen posterior to the tail and body of the pancreas.

-inferior mesenteric vein

The most common malignant disease that affects the spleen is _____. Sonographically, _____ may be present if the spleen is diffusely infiltrated.

-lymphoma -splenomegaly

You are asked to perform an abdominal sonogram to rule out splenomegaly. What are the most common causes of splenomegaly and how does the anatomy of the spleen allow for such an increase in seize?

-most common cause: portal hypertension -anatomy: ligaments that hold it in place allow it to get bigger; nothing anchors it to a fixed position

Posterior to the _____ of the pancreas, the splenic vein joins the _____ to form the main portal vein.

-neck -superior mesenteric vein

The spleen is located in the _____ cavity and is covered by the peritoneum except at the splenic _____.

-peritoneal -hilum

Acquired splenic cysts are _____, _____ or _____ in origin.

-post-inflammatory -traumatic -parasitic

The spleen is located posterior to the _____, lateral to the _____, _____ and _____. It is anterior to the _____.

-posterior to the stomach -lateral to the LK, splenic flexure of the colon & pancreatic tail -anterior to the diaphragm

The spleen is made up of _____ and _____ pulp.

-red -white

Patients with splenic infarcts are at risk for splenic _____. Signs to watch out for include increasing _____ hemorrhage, free _____ blood and expanding _____ area within the infarct.

-rupture -sub-capsular -peritoneal -liquefaction

Three ligaments help hold the spleen in its position in the left upper quadrant.

-splenorenal -gastrosplenic -phrenicocolic

The most common varice to occur in cases of portal hypertension is the _____ collateral, which diverts blood from the splenic vein to the _____ vein and finally into the _____.

-splenorenal -left renal -IVC

The spleen is commonly affected in patients with sickle cell anemia. Describe the variation in sonographic appearance that can occur with the disease.

-the spleen may appear normal -in children w/ acute splenic sequestration crisis, a large amount of blood pools within the spleen and the spleen may enlarge quickly -splenomegaly may be present and hypoechoic areas may be seen within the parenchyma due to hemorrhage -w/ repeated crisis, splenic infarcts may occur and over time the spleen becomes shrunken

A 10 year old patient presents for abdominal us following blunt abdominal trauma that occurred during a bicycle accident. What would be an unusual finding in this patient? What would be an expected finding in this patient?

-unusual: varices in the splenic hilum -expected: subcapsular hematoma, free fluid in the peritoneum, hematoma w/in the splenic parenchyma

The spleen is the most frequently damaged organ in blunt abdominal trauma. Why is the spleen so common injured? Describe the appearance of spleen in a trauma situation.

-vulnerable location in LUQ; contains large amount of blood, so trauma can cause hemorrhage -evaluate for free fluid looking at the pelvis, both flanks and posterior right subhepatic space

The _____ pulp is composed of lymphatic tissue and the _____ pulp is composed of venous sinuses capable of storing more than 300 mL of blood.

-white -red

_____ is a very rare condition that leads to a congenital absence of the spleen.

Aslplenia

T/F The falciform ligament helps to stabilize the spleen.

False

T/F The red pulp is responsible for erythropoiesis throughout our lives.

False

T/F The spleen is a retroperitoneal organ.

False

Your patient presents with a history of bacterial endocarditis now complaining of left upper quadrant pain, fever and leukocytosis. Splenic abscess is suspected. Describe the sonographic appearance of splenic abscess. What characteristics can help confirm the diagnosis?

Sono appearance: multiple and complex with mixed echogenic properties; gas is frequently present in abscesses and will appear as a highly echogenic area with ring-down artifact or dirty shadowing; an air-fluid level may also be observed.

T/F In cases of severe hemorrhage, the red pulp may release its reservoir into the blood stream.

True

T/F Red pulp is responsible for the removal of worn-out RBCs.

True

T/F The lienorenal, gastrosplenic and phrenicocolic ligaments help to stabilize the spleen.

True

T/F The red pulp removes defective cells such as sickle and thalassemic cells from circulation.

True

T/F The spleen is located in the left hypochondrium.

True

T/F The spleen is surrounded by a fibrous capsule.

True

T/F The spleen lies posterior to the stomach.

True

Following a splenectomy, an ______ may enlarge and assume the functions of the removed spleen.

accessory spleen

While scanning the spleen, you notice a small round mass that appears to be separate from the spleen in the region of the splenic hilum. The echotexture of the mass is similar to that of the spleen. What is the most likely diagnosis?

accessory spleen

Leukocytosis is the typical response to what condition?

bacterial infection

The removal of defective and worn-out red blood cells occurs in the cords of _____.

billroth

The splenic artery branches off which artery to supply blood to the spleen?

celiac axis

Sonographically, what is the splenic echogenicity when splenomegaly occurs?

could be hyper or hypoechoic but does NOT correlate with the cause of the enlargement

leukopenia

decreased WBC count, possibly the result of viral infection or leukemia

leukocytosis

elevated WBC count, usually due to infection

splenomegaly

enlarged spleen

Cysts, Infarcts & Granulomas are included as _____ of the spleen.

focal lesions

What is leukopenia?

frequently a side effect of chemotherapy

The _____ ligament attaches the spleen to the stomach.

gastrosplenic

Splenic calcifications usually result from what disease?

granulomatous

The most common benign vascular lesion of the spleen is ______.

hemangioma

What is the normal echogenicity of the spleen?

isoechoic to the liver

hematocrit

lab value of the % of blood volume made up of red blood cells

The spleen is considered enlarged when?

length measurement is > 13 cm

The _____ ligament, although not directly attached to the spleen, helps support its inferior end.

phrenicocoic

What is the most common cause of splenomegaly?

portal hypertension

While scanning the spleen, you notice multiple enlarged tortuous vessels in the splenic hilum. Color Doppler confirms that they are vascular in nature. Dilated vessels are also noted within the splenic parenchyma. What is the most likely cause of these findings?

portal hypertension with collateral varices

erythropoiesis

process of red blood cell production

phagocytosis

process used by the red pulp to destroy old red blood cells

erythrocyte

red blood cell; contains hemoglobin

What may cause a small, shrunken spleen?

sickle cell anemia

A patient with sickle cell dx presents for an abd ultrasound complaining of recent left upper quadrant pain. A hypoechoic wedge shaped lesion is seen in the spleen. What is this typical of?

splenic infarct

What is the most common sonographically visualized abnormality of the spleen?

splenomegaly

The _____ ligament attaches the spleen to the left kideny.

splenorenal

infarct

tissue death caused by an interruption of the blood supply

A wandering spleen is at an increased risk of acquiring what condition?

torsion and infarction

A fibrous capsule surrounds the spleen and _____ project from the capsule into the organ, dividing the spleen into several compartments.

trabeculae

While performing an abdominal scan, you are having difficulty locating the spleen in its normal location (left upper quadrant). As you scan the entire left side, you locate what appears to be the spleen in the lower left quadrant. What is the most likely explanation for this finding?

wandering spleen

leukocyte

white blood cell; protects and fights against infection in the body