Question

1. Joe was in a sledding accident and believed to have ruptured his spleen.  What would be his signs and symptoms?  His treatment?  What is the danger in a spleen rupture?  Will Joe get a transplant for spleen replacement?  What is his possible prognosis?

Answer 1

SIGNS AND SYMPTOMS OF SPLEEN INJURY

highly variable depends upon the severity of the injury

Minor injury - left upper quadrant abdominal pain with reffered pain to the shoulder tip(kehrs sign)

Moderate injury with 5 - 10%intrperitoneal blood loss

left upper quadrant abdominal pain

kehrs sign positive

tenderness, guarding and rigidity of the left hypochondrium

pallor,tachycardia , low volume pulse , hypotension, cold cammy extremeties and dizziness

Sever injury with >10% blood loss

diffuse abdominal pain

kehrs sign positive

tenderness in the left hypochondrium

generalsied guarding and rigidity

severe pallor , achycardia , low volume pulse , hypotension, cold cammy extremeties and unconsciousness

TREATMENT

1)conservative treatment

maintain the fluid na d electrolyte status of the patient

transfuse blood as required

monitor carefully

2)splenic artery angioembolism

3)enmergency splenectomy

4)partial splenectomy

5)splenorrhappy

6) evaluation for OPSI and vaccination

3) danger from the spleen injury is the increased intraperitoneal bleed. When there is severe spenic injury it will result in large amount of blood loss. this will produce Hypovolemic shock in the person and if teh patient doesnt get immediate treatment it will lead to death

4)spelnic injury grade 4 and 5 requires splenectomy . in this case autotransplantation of the spleen is done.

spleen parenchyma is taken from the normal spleen and it is implanted in the gastrocolic omentum.

5) Grade 1 and 2 splenic injury have good prognosis. it can be treated conservatively

   Grade 3, 4, 5 are severe spleen injury which need emergency splenectomy

splenectomy have some complications, they are

   bleeding from short gastric vessels

hematemesis

damage to the pancreas tail causing pancreatitis

OPPURTUNISTIC POST SPENECTOMY INFECTION(OPSI) - after splenectomy the patient will be vulnerable to the organism like H . influenza, streptococcus pneumonia . this will lead to sepsis and meningitis