The spleen

Created by ldnelson 

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The spleen is part of the ... system?

Retculoendothelial (RE)

The spleen performs hematopoiesis during what time line and what takes over that process?

(blood cell formation) fetal thru 5-6 months when the bone marrow takes over.

The spleen lies in what part of the abdomen?

left hypochondrium. It is an intraperitoneal organ

The adult spleen is usually what size?

8-13 cm

What part of the spleen can be seen and confused as a cyst or mass in tail of pancreas?

medial portion of the spleen

What is a common site to visualize pleural effusion?

superior margin

The spleen is held in place by what ligaments?

lienorenal ligament
gastrosplenic ligament
phrenocolic ligament

The arterial supply of the spleen is what artery and where does it lie?

Splenic artery lies along the superior border of the pancreas

The arteries of the spleen are subject to what process?

infarction (interruption in the blood supply)

What vein drains the spleen and where does it lie?

Splenic vein lies along the posteromedial border of the pancreas

The splenic vein joins what to form the what?

joins the SMA to form the Portal vein

lymph vessels emerge from what part of the spleen? What other vessels emerge?

emerge from the hilum along with the splenic artery and vein

White pulp is made up of what tissue and what is it AKA?

lymphatic tissue aka Malpighian corpuscles

Red pulp is made up of?

venous sinuses and splenic cords

the white pulp surrounds what and what surrounds the white pulp?

white pulp (consisting of splenic nodules and malpighian corpuscles) surround an artery, the white pulp is surrounded by the red pulp

Red pulp consists of what?

RBCs, lymphocytes, macrophages, splenic sinuses alternating with splenic cords and blood capillaries

The debris of the ruptured blood cells are removed by what?

Phagocytic macrophages

Lymphocytes help with what?

Defend the body against infections

The red pulp is an ?

Intense filter system

The main function of the spleen is what?

Filters blood
Body defense against disease

The minor function of the spleen is what?

Hematopoiesis
Blood reservoir

The spleen plays an important role in what?

Defense and pigment and lipid metabolism

Functions of the spleen can be divided into what groups?

RE system (reticuloendothelial) and the organ itself

What are the functions of the RE system?

Production of lymphocytes
Production of antibodies
Storage of iron
Storage of other metabolites
Phagocytosis

What are the functions of the spleen itself?

Maturation of erythrocytes
Reservoir
Culling
Pitting
Disposal of senescent eryth.
Functions related to platelet and leukocyte lifespan

The process By which the spleen removes the nuclei from RBC?

Pitting

Process by which the spleen removes abnormal RBC?

Culling

Under normal conditions the spleen holds how much erythrocytes?

20-30 ml

The spleen also pools what in large numbers?

Platelets

In splenomegaly the splenic pool can become very large and produce what?

Thrombocytopena

An enlarged spleen leads to what?

Leukopenia

Leukocytosis is an increased number of?

WBC

Leukocytosis is a typical finding of what?

Infection

Hematocrit is defined as?

% of RBC per volume of blood

Low hematocrit reading means what?

Not enough RBC per volume

High hematocrit reading means what?

Too many RBC per volume

You will get a low hematocrit reading with?

Hemorrhage
Internal bleeding

Sepsis is defined as?

Bacteria in the blood stream

Bacteremia is defined as?

Test that indicates the presence of bacteria in the body

Leukopenia is defined as?

Abnormal decrease in the white blood corpuscles

Leukopenia may be secondary to?

Certain meds
Bone marrow disorder
Autoimmune disorders
Overwhelming infection

Abnormal decrease in platelets is?

Thrombocytopenia

Thrombocytopenia could be due to ?

Internal hemorrhage
Chemo
Radiation therapy
Increased trapping by the spleen
Increased destruction of platelets

How should the spleen look sonographically?

Fine, homogeneous, low level echoes, similar to the liver

What should you look for in the spleen?

Size
Shape
Echo texture
Normal vascular patterns
At least two images

Nonvisualization of the spleen can be a result of?

Displacement
Asplenia
Polysplenia
Wandering spleen
Atrophy

Caudal displacement of the spleen can occur due to?

Subclavian abscess
Splenic cyst
Left pleural effusion
Mass in LUQ

Cranial displacement of the spleen may be due to?

Volume loss in left lung
Left lobe pneumonia
Paralysis of the left hemidiaphragm
Large abdominal mass

Complete absence of the spleen is?

Splenic agenesis

Multiple spleens is called?

Polysplenia

Polysplenia can occur with what syndromes?

Complex cardiac malformations
Bronchopulmanary abnormalities
Visceral heterotaxis

A spleen that has migrated from it's normal position is?

Wandering spleen

When evaluating a wandering spleen it is important to look for?

Changes in velocity
Torsion

This is a result of a wasting disease, chronic hemolytic anemia, sickle cell anemia?

Atrophy of spleen

Can also be referred to as autosplenectomy?

Atrophy of the spleen

An accessory spleen is also known as ?

Splenule
Supernumerary spleen

This can be a result from failure of fusion of separate splenic masses?

Accessory spleen

This may be mistaken for a mass in the pancreas, suprarenal mass or retroperitoneal tumor?

Accessory spleen

Of the following, which is not a function of the spleen?
A. part of the reticuloendothelial system
B. Largest single mass of lymphoid tissue
C. Plays a role in the synthesis of blood pressure
D. preforms hematopoiesis until 5-6 months
E. Plays a role in the synthesis of blood proteins

C. plays a role in the synthesis of blood pressure

The spleen is an organ of which of the following?
A. retroperitoneum
B. intraperitoneal
C. thorasic
D. pelvic
E. introperitoneal

B. intraperitoneal

The arteries of the spleen are subject to what?
A. stenosis
B. thrombus
C. infarction
D. aneurysm
E. embolysm

C. infarction

At what measurement is the spleen considered enlarged?
A. 9 cm
B. 11 cm
C. 13 cm
D. 15 cm
E. 17 cm

C. 13 cm

What is phagocytosis?
A. red pulp destroying degenerating RBC's
B. an occlusion of the splenic artery
C. fluid around the spleen
D. abnormal function of the white pulp
E. inflammation of the red pulp

A. red pulp destroying degenerating RBC's

Name the 3 splenic ligaments.

leinorenal, gastrosplenic, phrenicocolic

What do the Malpighian corpuscles surround?
A. white pulp
B. red pulp
C. small veins
D. small arteries
E. splenic cords

D. small arteries

Which of the following can not cause caudal displacemnt of the spleen?
A. Splenic cyst
B. subclavian abscess
C. left pleural effusion
D. LUQ mass
E. left lobe pneumonia

E. left lobe pneumonia

Which of the following can not cause cranial displacement of the spleen?
A. Left pleural effusion
B. volume loss in the left lung
C. left lobe pneumonia
D. paralysis of the left hemidiaphragm
E. large, intra-abdominal mass

A. left pleural effusion

Is the spleen an intraperitoneal or retroperitoneal organ?

intraperitoneal

The normal shape of the spleen is ___ superiorly and ___ inferiorly.
A. concave, convex
B. Ovoid, round
C. crescent, concave
D. Convex, concave

D. Convex, concave

What is the name of the ligament which connects the spleen to the stomach?

gastrosplenic

The splenic artery is a branch of what larger artery?

celiac artery

The ___ vein, which drains the spleen, joins the ___ to form the ____.

splenic, SMV, portal

Splenic capillaries are contained in the
A. Red pulp
B. White pulp
C. Malpighian corpuscles
D. Cortex
E. Sinus

A. Red pulp

Large numbers of RBC's are macrophages are contained in the
A. Red pulp
B. White pulp
C. Malpighian corpuscles
D. Cortex
E. Sinus

B. Red pulp

What is the most important function of the spleen?
A. Hematopoiesis
B. Blood reservoir
C. defense mechanism
D. filter peripheral blood
E. pigment and lipid metabolism

D. filter peripheral blood

Define Hematocrit
A. Abnormal decrease in platelets
B. percentage of RBC's per blood volume
C. A condition of sepsis
D. Decrease in white blood corpuscles
E. Increase in WBC's

B. percentage of RBC's per blood volume

Define Bacteremia
A. Abnormal decrease in platelets
B. percentage of RBC's per blood volume
C. A condition of sepsis
D. Decrease in white blood corpuscles
E. Increase in WBC's

C. a condition of sepsis

Define Leukocytosis
A. Abnormal decrease in platelets
B. percentage of RBC's per blood volume
C. A condition of sepsis
D. Decrease in white blood corpuscles
E. Increase in WBC's

E. Increase in WBC's

Define Leukopenia
A. Abnormal decrease in platelets
B. percentage of RBC's per blood volume
C. A condition of sepsis
D. Decrease in white blood corpuscles
E. Increase in WBC's

D. Decrease in white blood corpuscles

Define Throbocytopenia
A. Abnormal decrease in platelets
B. percentage of RBC's per blood volume
C. A condition of sepsis
D. Decrease in white blood corpuscles
E. Increase in WBC's

A. Abnormal decrease in platelets

A small lobule of splenic tissue often located near the splenic hilum is called what?

Splenule, supernummary, or accessory spleen

Lymphatic tissue is contained in the
A. Red pulp
B. White pulp

B. White pulp

Malpighian corpuscles are contained in the
A. Red pulp
B. White pulp

B. White pulp

Spread throughout the spleen in tiny islands in the center of splenic lobules are
A. Red pulp
B. White pulp

B. White pulp

Tissue consists of splenic nodules and large number of lymphocytes
A. Red pulp
B. White pulp

B. White pulp

Surround a small artery
A. Red pulp
B. White pulp

B. White pulp

A small nodular masses of lymphoid tissue is called

Malpighian corpuscles

Contain a large number of RBC's, lymphocytes and macrophages.
A. Red pulp
B. White pulp

A. Red pulp

fills the remaining spaces of the lobules and surrounds an island of pulp
A. Red pulp
B. White pulp

A. Red pulp

Consists of Splenic sinuses
A. Red pulp
B. White pulp

A. Red pulp

Contain blood capillaries
A. Red pulp
B. White pulp

A. Red pulp

Part of the lobule that is very permeable
A. Red pulp
B. White pulp

A. Red pulp

Red blood cells squeeze through the capillaries and enter the venous sinuses
A. Red pulp
B. White pulp

A. Red pulp

Older blood cells rupture when making this pass, resulting in debris
A. Red pulp
B. White pulp

A. Red pulp

The debris is removed by phagocytic macrophages that are in the splenic sinuses
A. Red pulp
B. White pulp

A. Red pulp

After the blood leaves the vascular sinuses it passes through the reticular cords and goes through a complex filter
A. Red pulp
B. White pulp

A. Red pulp

What is the main function of the spleen?

Filter peripheral blood
Body's defense against disease

You are performing an abdominal US and are having difficulty identifying the spleen. Which of the following structures is in contact with the spleen?
A. Left hemidiaphragm
B. Stomach
C. Pancreas
D. Splenic flexure of the colon
E. All of the above

E. All of the above

You are examining the spleen during routine US. What view provides the best long axis image of the spleen?
A. Sagittal view from anterior position with patient supine
B. Intercostal coronal view with patient supine
C. Coronal view with patient in LLD position
D. Anterior sagittal view with patient in LLD position
E. Posterior sagittal view with patient in a prone position

B. intercostal coronal view with patient supine

Which of the following would be most helpful in improving diagnostic confidence of evaluating a wedge shaped lesion in a patient?
A. Have the patient perform a Valsalva maneuver
B. Evaluate the lesion in both inspiration and expiration
C. Evaluate the lesion with color Doppler
D. Have the patient drink 48 oz of water and rescan
E. Rescan the patient in an upright position

C. Evaluate the lesion with color Doppler (The spleen is a highly vascular organ. An area of infarction will not show color signals and can therefore be differentiated from the surrounding splenic parenchyma

During splenic sonography, you detect moderate splenomegaly and dilated, tortuous vessels at the splenic hilum. What additional information should you provide?
A. Evaluate the liver and portal vein
B. Look for signs of pancreatitis
C. Check for evidence of hematoma surrounding the spleen
D. Evaluate the periaortic area for lymphadenopathy
E. Check for an ipsilateral pleural effusion

A. Evaluate the liver and portal vein (the liver should be evaluated for cirrhosis. The portal vein should be evaluated for increased size and flow direction.)

Which structure will you detect at the splenic hilum?
A. Diaphragm
B. Splenic vein
C. Left kidney
D. Duodenum
E. Left lobe of the liver

B. Splenic vein

You have been asked to evaluate the tail of the pancreas. What is the relationship of the pancreatic tail to the spleen?
A. Superior and lateral
B. Superior and medial
C. Anterior
D. Inferomedial
E. Posterior

D. Inferomedial (The pancreatic tail approaches the spleen at the splenic hilum. The pancreatic tail lies posterior to the stomach and lesser sac)

Which term can be used to describe the normal sonographic appearance of the splenic parenchyma?
A. Heterogeneous with mid to low level echogenicity
B. Homogenious with mid to low level echogenicity
C. Homogeneous with echogenicity exceeding that of the liver
D. Heterogeneous with mixed echogenicity
E. The normal spleen has a varied appearance on US

B. Homgeneous with mid to low level echogenicity

An average sized male patient has been referred for US evaluation of splenomegaly. What transducer would provide the highest resolution images of the spleen?
A. 2.25 MHz linear array
B. 3.5 MHz phased array
C. 5.0 MHz curved linear array
D. 3.5 MHz curved linear array
E. 2.25 MHz phased array

C. 5.0 MHz curved linear array

Which of the following statements is not true regarding the spleen?
A. the spleen is located in the LUQ
B. the spleen is a retroperitoneal structure
C. The spleen lies btw the fundus of the stomach and the diaphragm
D. the average adult spleen measures 12 cm in length
E. the normal spleen decreases in size and wt with advancing age

B. The spleen is not a retroperitoneal structure

Which of the following is a pitfall you might encounter in US scanning of the spleen?
A. Intercostal scanning may produce rib shadows obscuring the splenic parenchyma
B. In hepatomegaly, the left lobe of the liver may be mistaken for the spleen
C. A mass in the tail of the pancreas may be confused with a splenic mass
D. An accessory spleen may be confused with an enlarged lymph node
E. All of the above

E. All of the above

The splenic vein drains into what vein?
A. IMV
B. SMV
C. Portal vein
D. Left renal vein
E. IVC

C. Portal vein

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