Dr. Mezjda Ismail Rashaan, consultant surgeon University of sulaymania Faculty of medical sciences School of medicine Kurdistan

Anatomy:- -origin -location & surface anatomy -its ligaments ; (gastrosplenic, splenocolic, phrenicosplenic, splenorenal) -arterial and venous supply

-white and red pulp( cords & sinuses),marginal zone -trabeculae art., central art., pencillar artery -skimming effect -defense spleen & storage spleen

1-immune function.specific like igM production. Nonspecific( opsions tuftin,properdin) to phagocyte the bacteria, fungi. 2-filter function. macrophages catch bacteria specially pnumoccocci, H. influnzie, noncellular materials. 3-removal of effecte platelets, RBC bu Culling 4-Pitting, removing particular inclusions from RBCs like parasite of malaria, nucleated RBCs

5-iron reutilization 6-pooling 30-40% platelet. In splenomegaly may reach 80% 7-reservoir function in dogs 8-haematopoiesis up to 5monthes of intrauterine life

Depend on the type of the disease which causing splenomegaly, like : -blood disease …blood investigation -liver cirrhosis causing portal hypertention …LFT,OGD for esophageal variesis -associated with lymphadenopathy do LN biopsy

1-plain abdomen -calcification(s)( hydatid cyst, haemangioma, spleenic anurysm, TB, old infarct of SCA…etc.) -soft tissue shadow at upper lt. hypochonderial area -descending colonic gas shadows -obliteration of the psoas shadow

-size and consistency -cystic or solid ? -rapture.. -haematoma -therapeutic i.e abscess drainage or aspiration of the cyst, biopsy!!!!

4- MRI 5-radio-isotop scans Te 99 -recurrent disease? -position & site -RBC life duration and place of their destruction 6- angiography -embolization of selected cases of splenic hge. -liver schirosis -before splenectomy to decrease its size

1- absence -rare and it is usually associated with congenital heart disease and fatal sepsis. 2- accessory spleen ( splenuculi) -20% of population & 30% of pts. with haemolytic disease -no more than 2cm -80% found in splenic hilum and vascular pedicle -omentum,gastrosplenic ligament,splenocolic ligament,stomach greater curvature, small & large bowel mesetery,in left broad ligament and spermatic cord…etc. -if not removed after splenectomy,it cause recurrent of the disease

4- cysts -rare a-true one, non-parasitic -may be dermoid, mesenchymal inclusion cysts, epithelial cysts.

B- false cysts.parasytic –echinococcus.seroma Clinical features: -asymptomatic -symptomatic.mass in lt. upper hypochonderial area Diagnosis: sonography of the abdomen Treatment:.depend on symptomes. if asyptomatic……observation and follow up by sonography. if symptomatic … depend on its size small one do excision large one unroofed if or do aspiration, drainage, sclerosing

Etiology; -direct trauma -without trauma in diseased spleen duo to malaria, infectiouse mononucleosis -iatrogenic during operation It is suspected when there is # ribs at lt hypochonderial area.

3 groups: 1- patient sccumbs rapidly from massive he. 2-initial shock,recovery and later sings of internal bleeding. Kehrs sings, shifting dullness in flanks, rectal examination fullness in pelvis 3- delayed case

-plain abdomen -sonography of abdomen -CT-abdomen Treatment: Surgical options -splenectomy( total or partial) - splenorraphy -mesh net pressure compression

-rare -cause spontaneous rapture of spleen -duo to: - infectious mononucleosis, CMV -malaria -fungal infection -amylodosis, pregnancy, lymphoma, Q-fever…

-duo to myloproliferative syndrome -vascular occlusion in sickle cell anemia, infected heart valves bacterial endocarditis -may be asymptomatic or causing abdominal pain in left hypochondrium, gaurdening, friction rub

-uncommon,most common in tropical area -occurs with thrombosis of vessels or infarct of SCA. - Splenic thrombosis infected - Metastatic abscess duo to typhoid, paratyphoid, oestiomylitis, otitis media, pureperal sepsis -mechanism:-.haematological.contagious.haemoglobinopathy.trauma.immunosuppression

-delayed -fever, pain left hypochondria, increase WBC, splenomegaly in 1/3 of the patients Diagnosis:- u/s or CT of abdomen Treatment:- drainage

-rare,< 1% -female : male is 2:1 -involve main trunk - May be single or multiple -asymptomatic unless ruptured -occasionally palpable in epigastrium with bruit in left hypochonderial area -incidentally on plain abdomen with calcified ring -usually < 45 years, ¼ pregnant at 3 rd trimester. -in young females asymptomatic -maternal mortality high( 70 %) -treatment usually surgery by splenectomy