Spleen.

Slides:



Advertisements
Similar presentations
GI12.  The liver has a dual blood supply, which comes from the hepatic artery ( 25% of vascularization) and the portal vein ( 75% of vascularization).
Advertisements

Case Report of patient RE Submitted by:Jesse M Proett, MS4 Faculty reviewer:Sandra Oldham, M.D Date accepted:29 August 2007 Radiological Category:Principal.
SPLEEN. I. Anatomy - weight – approximately grams - located in the left upper and protected by the lower portion of the rib cage - its position.
Anesthesia and Liver Disease E.A. Steele, MD May 4, 2005.
FAHAD AL ZAMIL Professor & Consultant Paediatric Infectious Diseases King Khalid University Hospital King Saud University, Riyadh.
NORMAL LIVER Bile duct Hepatic arteriole Portal vein.
Liver Function Tests (LFTs)
Cirrhosis Biol E-163 TA session 1/8/06. Cirrhosis Fibrosis (accumulation of connective tissue) that progresses to cirrhosis Replacement of liver tissue.
Liver carbohydrate metabolism lipid metabolism protein & AA metabolism synthesis of plasma proteins vitamin metabolism digestion (bile synthesis) detoxification.
Complications of Liver Cirrhosis Ayman Abdo MD, AmBIM, FRCPC.
Ayman Abdo MD, AmBIM, FRCPC
Liver pathology: CIRRHOSIS
Chronic hepatitis in childhood Modes of presentation Acute onset jaundice and persisting Gradual development of signs of liver disease Asymptomatic finding.
In the Name of GOD L iver Masses General Overview Behzad Nakhai, M.D.,FICS Fellowship in HepatoBiliary Surgery Asso Professor Iran University of Medical.
Pathophysiology of digestion. Pathophysiology of liver.
PORTAL HYPERTENSION & CHRONIC LIVER DISEASE SEAN CHEN ST GEORGE HEPATOBILIARY & PANCREATIC WORKSHOP 31/05/2014.
CASE PRESENTATION By: Dr. SHAMSHAD KHAN TMO Radiology HMC.
CIRRHOSIS OF LIVER PORTAL HYPERTENSION HEPATIC ENCHEPALOPATHY
Friday, December 5 th,  The patient was appropriately resuscitated with crystalloid fluid and blood products  Emergent endoscopy showed large.
Case Report Patient PP Submitted by:Matthew Clower, MSIV Faculty:Sandra Oldham, MD Date:29 August 2007 Radiological Category:Principal Modality (1): Principal.
Hepatic Failure-3 By Dr. Abdelaty Shawky Assistant Professor of Pathology.
Dr. Mezjda Ismail Rashaan, consultant surgeon University of sulaymania Faculty of medical sciences School of medicine Kurdistan.
Portal Hypertension portal venous pressure > 5 mmHg
Adult Medical- Surgical Nursing Gastro-intestinal Module: Liver Cirrhosis.
Spleen. Functions of the spleen 1. Haematopoiesis 2. Reservoir – storage or sequestration of plt and other cells 3. Phagocytosis 4. Immunity.
PORTAL VEIN THROMBOSIS
Hepatobiliary Tutorial. Normal Liver - Functions Synthesis –Proteins: albumin, clotting factors –Bile –Cholesterol & lipoproteins Storage and secretion.
PED17.  Caroli disease and caroli syndrome are congenital disorders to the intarhepatic bile ducts. They are both characterized by dilatation of the.
Faisal Al-Saif MBBS, FRCSC, ABS. - Acute Pancreatitis - Chronic Pancreatitis - Pancreatic Tumors - Pancreas Transplant.
Portal Hypertension Mazen Hassanain.
Complications of liver cirrhosis
CIRRHOSIS.
Complications of liver cirrhosis
LIVER DISEASES Shanghai Jiaotong University Medical School Renji Hospital Luo meng.
Complications of Liver Cirrhosis
Diseases of Spleen M K Alam.
PK 1 조 :: 조재완 DDx of jaundice. Jaundice: Introduction Jaundice - Yellowish discoloration : deposition of bilirubin – Serum hyperbilirubinemia – Liver.
Digestive system Diagnostic imaging department of xuzhou medical college of xuzhou medical college.
Portal Vein Thrombosis in Children and Adolescents
Bile ducts Caroli disease  Congenital  Dysplasia with focal dialatations.
LIVER Liver functions Bile pigment metabolism
Complications of liver cirrhosis. Recognize the major complications of cirrhosis. Understand the pathological mechanisms underlying the occurrence of.
Transjugular Intrahepatic Portosystemic Shunt (TIPS) R4 박철기.
SPLENECTOMY FOR DISEASE AND MANAGEMENT OF CONDITIONS OTHER THAN TRAUMA Douglas Slakey 2015.
Liver Function Tests (LFTs)
Liver Cancer.
Liver Function Tests (LFTs)
Dr Amit Gupta Associate Professor Dept of Surgery
Nodules & Tumors Nodular Hyperplasia non-cirrhotic liver nodules
Dr. Abdulwahhab S. Abdullah CABM, FICMS-G&H
Radiology of hepatobiliary diseases
Portal Hypertension.
Dr. Abdulwahhab S. Abdullah CABM, FICMS-G&H
Portal Hypertension.
Portal Hypertension Dr. HAMID HINDI.
Spleen and Thymus D S O’Briain, March 2009
Diseases of Spleen M K Alam MS; FRCSEd.
The Liver, Biliary System, and Pancreas
CIRRHOSIS Ahmed Salam Lectures Medical Student “TSU”
Gastrointestinal Pathology 3
General Surgery The Spleen
Option H4 Function of the Liver.
PORTAL HYPERTENSION Anatomy Definition Aetiology Pathophysiology
SUMMARY OF PORTAL VEIN IMAGING
Option H4 Function of the Liver.
Theresa Hydes, William Gilmore, Nick Sheron, Ian Gilmore 
Portal hypertension and common surgical diseases of the liver
A Child with Jaundice M Rawashdeh, MD, MSc, FRCP, FRCPCH
Presentation transcript:

Spleen

Central role: - Regulating the immune system - Influencing metabolic and endocrine functions

Anatomy: An encapsulated mass of vascular and lymphatic tissue The largest RES organ 9-11th ribs 4 impressions ligamentous attachments Related to pancreatic tail Blood supply

Embryonic anomaly: Accessary spleen Functions: Removal of RBCs ,WBCs and Platelets Extramedullary hemopoeisis Recycling Iron Immunological (T and B cell lymphocytes )

Splenomegaly: Weight 500 gms Average 15 cm Massive, > 1 Kgm > 15 cm

Imaging studies: - USS - CT …… Imaging studies: - USS - CT …….Trauma scoring - MRI - Angiography (embolization)

Indications for splenectomy: The commonest is trauma For elective ,the commonest is ITP 1. Benign disorders: Hereditary spherocytosis G6PD deficiency Auto immune hemolytic disease Sickle cell disease Thalassemia

Indications foe splenectomy…. continued 2 Indications foe splenectomy…..continued 2. Malignant diseases: WBCs disorders Hodgkins disease Non Hodgkins lymphoma Chronic lymphocytic lukemia Myeloproliferative disorders Acute myeloid lukemia Essential thrombocytopenia Polycythemia

Indications for splenectomy…. continued 3. Others: 3a Indications for splenectomy…..continued 3. Others: 3a. Infections: Infectious mononucleosis EB virus CMV ( spontaneous rupture ) 3b. Abscess 3c. Cysts: Parasitic Traumatic Dermoid 3d. Tumors: Primary (Sarcoma) Metastatic

Indications for splenectomy…. continued 3e Indications for splenectomy…..continued 3e. Storage diseases: Gauchers disease Niemann-Pick disease 3f. Splenic artery aneurysm 3g. Portal H.T 3h. Feltys syndrome 3i. Wandering spleen

Preoperative considerations: Patient Education Overwhelming sepsis Splenic vein thrombosis Vaccinations: Encapsulated pathogens More with hematological and malignant disorders More in children Greatest risk, 1st 2 years Timing

The Liver The largest organ (1500 Gm) Two lobes 8 segments Protected by rib cage Fibrous capsule (Glissons ) 8 ligaments Foramen of Winslow Dual supply Hepatic artery 25% Portal vein 75% Portosystemic anastomosis

Physiology: Storage Proteins ( AA) Glucose (Glycogen) Fat (Cholesterol) Production All plasma proteins All coagulation factors Secretion Detoxification

Bile: I litre per day Bilirubin metabolism Composition: water Organic molecules: Bile pigments Bile salts Phospholipids (Lecithin) Cholesterol Enterohepatic circulation

Jaundice: Bilirubin more than 2 Jaundice: Bilirubin more than 2.5 – 3 mgs/dl Causes: Prehepatic Intrahepatic, Gilberts syndrome Crigler-Najjar syndrome Dubin-Johnson syndrome Posthepatic…..extrinsic or intrinsic obstruction of the biliary tree

Imaging: - USS - CT - MRI - PET - Angiography

Liver cirrhosis: The final sequela of chronic hepatic insult Morphology Micronodular Macronodular

Liver Cirrhosis …..continued Etiology: Viral hepatitis Autoimmune hepatitis Drug induced Cholestasis Metabolic Hemochromatosis Wilsons disease Hepatic vein outflow obstruction Budd chiari syndrome Congestive cardiac failure Constrictive pericarditis

Portal Hypertension: Portal venous system contributes 75% of the blood supply 72% of the Oxygen Normal pressure 5-10 mmHg

Portal HT ……continued Etiology: 1 Portal HT ……continued Etiology: 1. Presinusoidal Extrahepatic Splenic vein thrombosis Splenomegaly Splenic A-V fistula Intrahepatic Schistosomiasis Congenital hepatic fibrosis Idiopathic portal fibrosis Myeloproliferative disorders Sarcoid

Portal HT etiology……continued 2. Sinusoidal Intrahepatic cirrhosis 3 Portal HT etiology……continued 2. Sinusoidal Intrahepatic cirrhosis 3. Post sinusoidal Intrahepatic Vascular occlusive disease Posthepatic Budd Chiari CCF IVC web Constrictive pericarditis

Varices: 30% of patients with compensated cirrhosis 60% of patients with decompensated cirrhosis 1/3 of all patients with varices will experience variceal bleeding Each episode 20-30% mortality if untreated 70% of patients who survive the initial episode will experience recurrent haemorrhage within 2 years

Prevention of variceal bleeding: Non selective Beta blockers Prophylactic endoscopic suveillance and band ligation

Acute Vareceal Bleeding: Admission to ICU Careful blood replacement FFP Platelets Antibiotics Vasopressin Luminal tamponade Blackmore-Sengstaken tube TIPS Surgery: Shunting Portocaval Mesocaval Distal lienorenal (Warren) Non shunting Sigiura Liver transplant

Budd Chiari syndrome: Congestive Hepatopathy Primary Thrombosis Secondary Compresion

Liver Abscess: Pyogenic Amebic

Hydatid Disease: 70% in the liver May be silent May become infected or may rupture Diagnosis: ELISA 80% Positive (Weinburg) Casoni Eosinophilia 30% Imaging

Hydatid disease ……continued Treatment: Albendazole Mebendazole Surgery E.multilocularis (in the west )

Ascariases: Retrograde locomotion into the bile ducts Treatment: Piperazine citrate Albendazole Mebendazole ERCP

Schistosomiasis: Perisinosoidal portal HT Education Hygiene Praziquantel Single dose 40-70 mg/kilo wt.

Liver Cysts: Congenital Benign cystadenoma Polycystic liver disease Caroli’s disease Biliary lithiasis 33% Cholangitis Biliary abscesses Cholangiocarcinoma 7%

Benign Liver Lesions: 1. Cysts Primary ( congenital) Secondary (traumatic) Seromas Bilomas 2. Hemangiomas 3. Adenoma Females OCP Significant risk of rupture Risk of malignant transformation to HCC

Benign Liver Lesions…….continued 4. Focal nodular hyperplasia

Malignant Liver tumors: 1. Primary 1a Malignant Liver tumors: 1. Primary 1a. From liver cells (HCC) Hepatocellular carcinoma 1b. From bile ducts (CC) Cholangiocarcinoma

Malignant Liver Tumors ……continued HCC: The 5th common malignancy High fatality Risk factors Viral hepatitis Alcoholic cirrhosis Hemochromatosis Aflatoxin

Malignant liver Lesions…… Malignant liver Lesions…….continued Cholangiocarcinoma An adenocarcinoma of the biliary tree Peripheral ( intrahepatic) Central(extrahepatic) Distal Proximal(hilar) Klatskin tumor

Questions ?