Practice Paper 6: Answers
Anthony B. Starr, Hiruni Jayasena, David Capewell, Saran Shantikumar in Get ahead! Medicine, 2016
Essential thrombocythaemia (ET) is a myeloproliferative disorder characterized by excessive production of defective platelets derived from abnormal megakaryocytes in the bone marrow. The main complications of ET are due to the formation of thrombi within the microcirculation. Symptoms include headache, digital ischaemia and abdominal pain secondary to splenic infarction. Many patients also suffer from erythromelalgia, i.e. aching and burning of the hands and feet secondary to ischaemia. Occasionally, there is paradoxical bleeding from the mucous membranes, such as the gastrointestinal tract and uterus. Investigation usually shows a platelet count in excess of 1000 × 109/L. The haemoglobin concentration and haematocrit are normal (unless there is significant blood loss, in which case there may be a microcytic anaemia). Definitive diagnosis requires bone marrow aspiration, which typically shows a hypercellular marrow with large numbers of megakaryocytes. Asymptomatic disease often requires no intervention. Severe and symptomatic disease can be treated with chemotherapy, usually with hydroxyurea or interferon-β, and low-dose aspirin.
Complications of open repair of splanchnic aneurysms
Sachinder Singh Hans, Mark F. Conrad in Vascular and Endovascular Complications, 2021
Results of an open surgical approach remain good with high survival and relatively low complication rates. Marrone et al. documented 1- and 5 year survival to be 100% and 92%, respectively.8 A large meta-analysis documented the outcomes of a large group of splenic aneurysms repaired via an open approach, documenting fewer long-term complications and reinterventions as compared to a catheter-based paradigm.9 Alternatively, the same review demonstrated endovascular repair to be the more cost-effective option with better quality-adjusted life years from the patient perspective.10 Complications from an open surgical approach can include overwhelming post-splenectomy infection, and thus it is important for surgeons to consider vaccination when a splenectomy occurs as part of the treatment approach. Thankfully, this remains a rare event. In addition, post-splenectomy left upper quadrant abscess formation is a possible, though rare, clinically observed complication. An open technique can additionally lead to pancreatitis as a sequelae if pancreatic manipulation or distal pancreatectomy is necessary during the operation. This can often lead to subsequent pseudocyst formation, which may require additional endoscopic or surgical management.11,12 Potential splenic infarction may occur if the aneurysm is ligated proximally and distally, though this remains unusual as the short gastric vessels will more commonly provide adequate collateral flow to justify a splenic preservation operative approach.
Physical activity and sickle cell disease
Roy J. Shephard in Physical Activity and the Abdominal Viscera, 2017
Splenic infarction typically presents as a severe mid-line or upper quadrant abdominal pain, followed by nausea, vomiting, respiratory splinting and collapse.[1, 6, 95] Infarction has sometimes occurred after only a few minutes of sprinting drills. Debate continues on the merits of splenectomy versus conservative treatment[87, 96](see Chapter 8). The infarct is usually self-limiting and often responds well to hydration, analgaesics, oxygen and antibacterial vaccines.[87] However, splen ectomy may be needed if there is evidence of extensive necrosis.[1]
Abstracts book
Published in Acta Clinica Belgica, 2020
Although the aetiology of splanchnic aneurism which includes SAA is not clear, two types were observed: dysplastic aneurisms present in women and atherosclerotic aneurisms that affect mostly men. A few autopsy series have found them to have an incidence of up to 10.4% in cadavers. The rupture rate is around 5% and more common in pregnant women. The mortality after rupture for a VAA is approximately of 25%. Ruptured SAA remain haemodynamically stable for 6 and up to 96 h, this is known as the ‘double-rupture phenomenon’. The causes at the origin of a splenic infarction are mostly malignancies especially pancreatic and haematological disorders, increased thromboembolic states, infectious diseases as endocarditis and hemoglobinopathies such as sickle cell disease. SAA especially are associated with splenic infarction. The presentation of this condition vastly depends on the aetiology underlying it. Treatment options for SAA consist of embolization, endovascular treatment with a stent, laparoscopic surgery, open repair surgery or splenectomy.
Preservation or Ligation of Splenic Vessels During Spleen-Preserving Distal Pancreatectomy: A Meta-Analysis
Published in Journal of Investigative Surgery, 2019
Bing-Qi Li, Yi-Xian Qiao, Jing Li, Wen-Qiang Yang, Jun-Chao Guo
The overall morbidity rate (SVP-DP vs WT, 34.07% vs 37.67%) (OR = 0.87; 95% CI: 0.59–1.30; p = 0.50), Clavien–Dindo I–V complications (SVP-DP vs WT, 33.83% vs 36.13%) (OR = 1.12; 95% CI: 0.69–1.82; p = 0.66) and Clavien–Dindo I–II complications (SVP-DP vs WT, 31.95% vs 29.68%) (OR = 1.21; 95% CI: 0.73-2.00; p = 0.46) were equal between the two procedures. On the contrary, the incidence of Clavien–Dindo III–V complications of WT is higher than that of SVP-DP without statistical significance (SVP-DP vs WP, 1.9% vs 6.5%) (OR = 0.75; 95% CI: 0.25–2.20; p = 0.60). This might be caused by a relative higher incidence of splenic infarction and more need for splenectomy. The mortality rate of WT group was higher than that of SVP-DP group (SVP-DP vs WT, 0% vs 2.44%).10 As spleen-preserving distal pancreatectomy is usually indicated in patients with low-grade malignancy, the surgical mortality should be avoided strictly. Easy introduction of WT cannot be accepted. Our analysis also showed that there was no significant difference in incidence of pancreatic fistulas (ISGPS Grade B and C) between both surgical procedures because pancreatic stump management remained the same in both procedures. This is in agreement with other previously published studies.51–54
Sickle cell disease in gulf cooperation council countries: a systematic review
Published in Expert Review of Hematology, 2022
Amani Abu-Shaheen, Doaa Dahan, Humariya Henaa, Abdullah Nofal, Doaa A. Abdelmoety, Muhammad Riaz, Mohammed AlSheef, Abdulrahman Almatary, Isamme AlFayyad
In contrast, in Africa, the mortality rates of children under 5 years old range from 50–80% [11]. The higher mortality rates in Africa are mainly influenced by limited resources, leading to pitiable access to care and the absence of comprehensive SCD management [12]. Patients with SCD often develop a vaso-occlusive crisis (VOC) and recurrent episodes of hemolytic anemia, causing hypoperfusion infarction and multiorgan dysfunction [13,14]. Other acute complications include acute chest syndrome, acute stroke, priapism, various hepatobiliary complications, cognitive impairment, vitreous hemorrhage, splenic sequestration, and acute renal failure [15]. Individuals with SCD suffer acute and chronic end-organ damage secondary to recurrent episodes of VOC and chronic ongoing hemolysis [16,17]. Splenic infarction and atrophy are very common and may lead to further complications, such as bacterial infections and functional asplenia [18]. Additionally, it had a significant effect on mortality rates and is associated with a substantial increase in health care costs.
Related Knowledge Centers
- Abscess
- Bleeding
- Infarction
- Pseudocyst
- Spleen
- Splenic Artery
- Thrombus
- Splenic Injury
- Infective Endocarditis
- Asymptomatic