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A ORAL BOARDS 2016 > SPLEEN > Flashcards

Flashcards in SPLEEN Deck (6)
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1

Indications for splenectomy in patients with ITP

Fail to four – six weeks of medical therapy

toxic doses of immunosuppressive medication

relapse following an initial response to steroids

Massive bleeding

2

Suspensory ligaments of the screen

splenophrenic
splenocolic
splenorenal
gastrosplenic

3

Steps for laparoscopic splenectomy

Position: 45° modified right lateral decubitus

FIRST look for accessories (because hard to find once blood staining)

4

Where are accessories spleens found

14%

Around the splenic hilum

Gastrocolic lig

Omentum

LEFT Gonadal vessels

5

How are blood products administered for ITP perioperatively

Platelets are cross matched preoperatively
Decision to administer platelets is based clinically on whether clot formation is demonstrated during the operation.

Splenic ARTERY ligated FIRST

then

Platelets administered

(this way, that immunoglobulin antibody does not have a chance to attack the administered platelets)

For administration after this week if there is failure clot formation

6

Preoperative Consideration for patient who is going to undergo laparoscopic splenectomy and who has ITP

Two weeks prior immunization is given
Pneumovax - pneumococcus
I'm off list influenza
Neisseria meningitidis

SCDs

Crossmatch platelets
Cross matched blood

If patient has been on steroids over six months stress dose 100 mg hydrocortisone in preop holding