Splenic Damage
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Introduction
Splenic damage can include:
laceration
abscess
infarct
rupture
The Case of...
a simple case introducing clincial presentation and calling for a differential diagnosis to get students thinking.
Causes and Risk Factors
Pathophysiology
The spleen contains approximately 33% of the body's platelets.
Signs and Symptoms
- history
- physical exam
History
History of present illness
- mechanism of injury
- trauma in the preceding weeks
- abdominal pain
- L shoulder pain (Kehr's sign)
- neck tenderness (phrenic nerve compression)
Past medical history
- lymphoma
- idiopathic thrombocytopenic purpura (ITP)
- thrombotic thrombocytopenic purpura (TTP)
- splenic abscess
- Epstein-Barr virus infection
- heritary spherocytosis
Physical Exam
Assess the vital signs to ensure patient stability.
Abdominal exam
- skin changes
- peritoneal signs
- masses
- Castell's sign
- Traube's space
- Balance's sign (LUQ percussion dullness)
Investigations
- lab investigations
- diagnostic imaging
Lab Investigations
Bloodwork can include:
- CBC, differential
- electrolytes
- BUN, creatinine
- group and cross if unstable
diagnostic peritoneal lavage can reveal blood in the peritoneum
Diagnostic Imaging
FAST (focused assessment with sonography for trauma) ultrasound scanning can reveal blood suggestive of splenic rupture.
Differential Diagnosis
Treatments
Stable patient
A stable patient, in whom rupture is not suspected, can be managed with bedrest and close monitoring of vital signs and hematocrit.
Unstable patient
Management of the ABCs is paramount, with oxygen, IV fluids, and blood transfusions as required.
Laparotomy with splenorrhaphy or splenectomy is manadated. Splenic artery embolization may also be considered.
Consequences and Course
Splenic rupture is a life-threatening condition that can rapidly lead to death if not properly managed.
Delayed splenic rupture occurs approximately 2 weeks after the initial injury, after a subcapsular hematoma or pseudoaneurysm lets go.
Consequences of splenectomy are outlined here.
Resources and References
Topic Development
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