Aproach to the Aproach to the patient withpatient with

SplenomegalySplenomegaly::

اعمال اعمال طحالطحال

1-Filtration2-Immunologic3-Reservoir4-hematopoieticDr.Azarm

Dr.Azarm

The presence of The presence of HowellJolly bodies in the HowellJolly bodies in the peripheral blood indicates peripheral blood indicates that the patient has had a that the patient has had a splenectomy or has a splenectomy or has a process that has rendered process that has rendered the spleen nonfunctionalthe spleen nonfunctional

Dr.Azarm

The white pulp of the spleen The white pulp of the spleen contains macrophages, B contains macrophages, B lymphocytes, and T lymphocytes, and T lymphocytes, participates in lymphocytes, participates in the recognition of the recognition of microorganisms and foreign microorganisms and foreign proteins, and is involved in the proteins, and is involved in the primary immune responseprimary immune response

Splenic functionSplenic function::

Cellular and humoral immiunityCellular and humoral immiunity Removal of senescent red blod Removal of senescent red blod

cells,bacteria and other particulates from cells,bacteria and other particulates from the circulationthe circulation

One third of circulating platelets are One third of circulating platelets are sequestered in the spleensequestered in the spleen

The spleen may become the site of The spleen may become the site of extramedullary hematopoisis,abnormallyextramedullary hematopoisis,abnormally

How could we diagnose splenomegalyHow could we diagnose splenomegaly??

Physical examination(the most important)X-rayNuclear medicineCT scanMRI

The splenic red pulp The splenic red pulp occupies more than half the occupies more than half the volume of the spleen and is volume of the spleen and is the site where senescent red the site where senescent red cells are identified and cells are identified and destroyed and red blood cell destroyed and red blood cell inclusions are removed by a inclusions are removed by a

process known as process known as pittingpitting

Anatomical information of the spleenAnatomical information of the spleen::It’s in posterior portion of the left upper It’s in posterior portion of the left upper

quadrant of peritoneal cavity.quadrant of peritoneal cavity.It’s below the diaphragm and adjacent to the It’s below the diaphragm and adjacent to the

99thth to the 11 to the 11thth ribs,stomach,colon,left kidney ribs,stomach,colon,left kidney and tail of pancreas.and tail of pancreas.

It weighs 80 to 200 gr in males and 70 to 180 It weighs 80 to 200 gr in males and 70 to 180 gr in females.gr in females.

It is It is not usuallynot usually palpablepalpable,except in ,except in children,adolescents and some adults children,adolescents and some adults especially those of asthenic build.especially those of asthenic build.

What happens if we remove spleenWhat happens if we remove spleen??

These patients are more susceptible to bacterial sepsis,especially with encapsulated organisms.

What happens if we remove spleenWhat happens if we remove spleen??

Without spleen, different abnormal red cells will be present in blood circulation:

senescent red cells red cells with nuclear

remnants(Howell-jolly bodies) insoluble globin

precipitates(Heinz bodies)

Symptoms of hyposplenism and aspleniaSymptoms of hyposplenism and asplenia::Sepsis with encapsulated

organisms,esp in childrenMild degrees of thrombocytosis and

leukocytosisHowell-jolly bodies in circulating red

cells,along with increased number of target cells ans misshapen red cells.

Increased number of erythrocyte and Heinz bodies.

SplenosisSplenosis::

It is caused by splenic It is caused by splenic implants which may result implants which may result from the spillage of cells from the spillage of cells from the splenic pulp from the splenic pulp following injury or following injury or splenectomy.splenectomy.

SplenosisSplenosis::

.

It can be located in peritoneal cavity and even in pleural or pericardial cavities.

These are normal splenic tissues and can be diagnosed via tissue biopsy techniques

The spleen is the largest lymphatic organ in the

body and is sometimes approached clinically as though it wer

e a very large lymph node.