Ebook The washington manual of surgery: Part 2
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Ebook The washington manual of surgery: Part 2
> lahlS-QtContents > 23 • Spleen23SpleenTimothy M. NyweningMaria B. DoyleA.Anatomy. The spleen is derived from the mesoderm and resides in the left up Ebook The washington manual of surgery: Part 2pper quadrant of the abdomen, where it is protected by the ninth to eleventh ribs. The average adult spleen is 12 cm long X 7 cm wide X 4 cm thick and weighs between 1,000 and 1,500 g. The spleen is highly vascularized, receiving up to 5°/o of cardiac output. The splenic artery, a branch of the celi Ebook The washington manual of surgery: Part 2ac axis, runs posterior to the pancreas and most commonly arborizes into multiple small arteries to enter the hilum of the spleen. The inferior mesentEbook The washington manual of surgery: Part 2
eric vein drains into the splenic vein, which ultimately joins with the superior mesenteric vein to form the portal vein. Accessory spleens are found > lahlS-QtContents > 23 • Spleen23SpleenTimothy M. NyweningMaria B. DoyleA.Anatomy. The spleen is derived from the mesoderm and resides in the left up Ebook The washington manual of surgery: Part 2stology of the spleen reveals highly vascularized red pulp interspersed with areas of white pulp. Red pulp consists of branching, thin walled sinuses and splenic cords filled with red blood cells (erythrocytes) and phagocytic cells. White pulp consists of T-cell rich periarteriolar sheaths, B-cell c Ebook The washington manual of surgery: Part 2ontaining lymphoid nodules, and the marginal zone that serves as an interface between the lymphoid-dominant white pulp and erythrocyte-rich red pulp.Ebook The washington manual of surgery: Part 2
These two histologies constitute the two major functions of the spleen:1Reticuloendothelial system: The red pulp serves to cull senescent erythrocytes> lahlS-QtContents > 23 • Spleen23SpleenTimothy M. NyweningMaria B. DoyleA.Anatomy. The spleen is derived from the mesoderm and resides in the left up Ebook The washington manual of surgery: Part 2 may be a site of erythrocyte production in some disease states (i.e., myelofibrosis).2Immune system: The spleen is involved in both the innate (opsonization) and adaptive (antigen presentation) immune system. Opsonization of pathogens by the complement system results in enhanced phagocytosis and cl Ebook The washington manual of surgery: Part 2earance in the spleen. The white pulp also acts as a site of antigen presentation to lymphocytes that, along with an appropriate cytokine milieu, leadEbook The washington manual of surgery: Part 2
s to effective T-cell mediated cytotoxic activity and B-cell antibody responses.c. Indications for Splenectomy (Table 23-1)1. Hematologic conditionsa.> lahlS-QtContents > 23 • Spleen23SpleenTimothy M. NyweningMaria B. DoyleA.Anatomy. The spleen is derived from the mesoderm and resides in the left up Ebook The washington manual of surgery: Part 2 that results from autoar..r..glycoprotein and results in immune mediated thrombocytopenia. The spleenP.408is both the major site of production of these antibodies as well as the principal site of platelet destruction.Gastrosplenic ligamentSplenic hilumTail ol the pancreasSplenocolic ligamentLett tr Ebook The washington manual of surgery: Part 2ansverse mesocolonGreater omentum along the greater curvature of the stomachMesenteryLeft mesocolonLeft ovaryDouglas pouchLett testisFigure 23-1 LocatEbook The washington manual of surgery: Part 2
ion of accessory spleens. Usual location of accessory spleens: (1) Gastrosplenic ligament, (2) Splenic hilum, (3) Tail of the pancreas, (4) Splenocoli> lahlS-QtContents > 23 • Spleen23SpleenTimothy M. NyweningMaria B. DoyleA.Anatomy. The spleen is derived from the mesoderm and resides in the left up Ebook The washington manual of surgery: Part 2 ovary, (10) Douglas pouch, and (11) Left testis.(a) Children: Most commonly present with acute ITP, in 70% to 90% of cases symptoms will remit regardless of therapy (NEJM. 2002;346:995). In refractory cases a waiting period of 12 months is recommended, especially in children below 5 years of age wh Ebook The washington manual of surgery: Part 2ere risk of postsplenectomy sepsis is increased (Blood. 1996.88:871-875).UnitedVRG(b) Adults: Usually present with chronic ITP. First-line treatment wEbook The washington manual of surgery: Part 2
ith ste. VIVO ICOUIW III a W7U to 75% response rate and may be combined with other modalities such as intravenous immune globulin (IVIG) and/or anti-R> lahlS-QtContents > 23 • Spleen23SpleenTimothy M. NyweningMaria B. DoyleA.Anatomy. The spleen is derived from the mesoderm and resides in the left up Ebook The washington manual of surgery: Part 2e treatment of choice in patients with platelets less the 30,000/mm3 or with a high risk of bleeding. Most patients will achieve a response to splenectomy withinP.40910 days postoperatively (Am J Surg. 2004;187:720-723). Alternatives to splenectomy includeRituximab (anti-CD20 monoclonal antibody) an Ebook The washington manual of surgery: Part 2d thrombopoietin receptor antagonists which have shown efficacy as second-line agents (Blood. 2012;120:960-969). Rituximab has also been shown to haveEbook The washington manual of surgery: Part 2
some efficacy in patient failing to respond to splenectomy (Am J Hematology.2005;78:275-280) (Fig. 23-2).> lahlS-QtContents > 23 • Spleen23SpleenTimothy M. NyweningMaria B. DoyleA.Anatomy. The spleen is derived from the mesoderm and resides in the left up> lahlS-QtContents > 23 • Spleen23SpleenTimothy M. NyweningMaria B. DoyleA.Anatomy. The spleen is derived from the mesoderm and resides in the left upGọi ngay
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