Spleen

Spleen
– an ovoid, purplish, pulpy mass about the size of one’s fist
– located in the left upper quadrant
– protected by the 9th – 11th ribs
– functions:
1. prenatal: haematopoietic organ
2. site of lymphocyte proliferation, immune surveillance and response
3. identifying, removing and destroying expended red blood cells and broken-down platelets
4. recycling iron and globin
5. serves as a blood reservoir, storing RBCs and platelets
– most vulnerable organ: a sudden marked increase in intra-abdominal pressure (eg. impalement on the steering wheel of a car) can cause the thin capsule and overlying peritoneum of the spleen to burst, rupturing the spleen, leading to intraperitoneal haemorrhage.
– NOT NECESSARY TO SUSTAIN LIFE

Splenectomy
Definition: surgical removal of a diseased or damaged spleen

When do you need splenectomy?
1. Emergency – trauma to the spleen with uncontrolled bleeding
– spontaneous rupture (extremely rare)
2. Elective – idiopathic thrombocytopenia purpura
– congenital or acquired haemolytic anaemia
– thrombosis of the splenic blood vessels
– portal hypertension and hypersplenism
– hereditary spherocytosis
– lymphoma (enlarged spleen)

2 methods:
1. Open surgery – an abdominal incision of almost 12 inches is made, cutting through muscle
and tissue. Spleen is located and removed. Hospitalization following the
surgery may be up to a week, with a 3-4 week recuperation period.
2. Laparoscopic surgery – 3-4 small incisions are made, one for insertion of the laparoscope and
the others for specially designed surgical instruments. Patients are
usually hospitalized for 1-2 days, have less postoperative pain, and a
shorter recovery time.

Effects and prognosis of splenectomy:
1. no serious effects because most of its functions are assumed by other reticuloendothelial organs (eg. the liver and bone marrow)
2. greater susceptibility to infections (bacteria) – reduced by giving special vaccinations at least 2 weeks prior to the elective surgery (pneumococcal pneumonia, meningococcal A and C). Booster vaccinations may be needed. Children usually take daily doses of penicillin until they are 16 years old. If surgery is an emergency, vaccines are given after the operation.
3. complete recovery is anticipated in the absence of other severe injuries and medical conditions, usually 4-6 weeks
4. patients should seek medical attention even for minor illnesses such as sinus infections or sore throats, because antibiotics may be required

Sources:
http://www.nlm.nih.gov/medlineplus/ency/article/002944.htm
http://www.theuniversityhospital.com/cdtv/html/videosurgeryprocedures/spleen.htm

(Posted by: Vivian)