BAZO

Which of the following could be performed to mitigate bleeding during splenectomy for a patient with severe splenomegaly?

• Preoperative angioembolization

• Preoperative platelet transfusion

• Intraoperative tranexamic acid infusion

• Insertion of a Sengstaken-Blakemore tube

Answer explanation

Preoperative splenic artery embolization before splenectomy for controlling intraoperative blood loss reduces the need for perioperative transfusion during splenectomy for splenomegaly.

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DIFICULTAD MEDIA

Splenectomy results in the loss of what immunologic protein?

• Tuftsin

• Immunoglobulin A

• Membrane attack complex

• C3 convertase

Answer explanation

Tuftsin and properdin are immunologic proteins produced by the spleen. After splenectomy these 2 immunologic proteins are absent, increasing the susceptibility to encapsulated organisms.

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FÁCIL

A 48-year-old female presents to your office to discuss splenectomy for idiopathic thrombocytopenic purpura. Which of the following is true?

• Nonrandomized comparative trials have demonstrated better outcomes from laparoscopic splenectomy compared to open splenectomy.

• Laparoscopic splenectomy is associated with an increased incidence of blood transfusion.

• The incidence of platelet transfusion is lower in open splenectomy compared to laparoscopic splenectomy.

• Randomized controlled trials have demonstrated improved outcomes from laparoscopic splenectomy compared to open splenectomy for ITP.

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DIFÍCIL

What is the optimal timing of platelet transfusion in a patient with ITP?

• Preoperatively

• After ligation of the splenic vein

• After ligation of the splenic artery

• Postoperatively

Answer explanation

The optimal time to give a platelet transfusion to a patient undergoing splenectomy for ITP is after ligation of the splenic artery. Be aware that a question like this on the ABSITE will describe a patient with low platelets and not bleeding preoperatively, making it tempting to transfuse prior to operation. If the patient is actively bleeding preoperatively, then a transfusion is required prior to surgery.

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DIFICULTAD MEDIA

What ligament contains the vascular supply to the spleen?

• Splenocolic ligament

• Gastrosplenic ligament

• Phrenosplenic ligament

• Splenorenal ligament

Answer explanation

The gastrosplenic ligament contains the splenic artery/vein and short gastric arteries. In the setting of portal hypertension, the splenorenal ligament may contain a vascular supply.

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FÁCIL

When should a patient be vaccinated prior to elective splenectomy?

• The day of surgery

• 7 days

• 14 days

• 21 days

Answer explanation

Patients should be vaccinated preoperatively if possible prior to a splenectomy. Two weeks prior to surgery is the preferred time frame for an adequate immune response to occur. Emergent splenectomy patients should be vaccinated prior to discharge. In the trauma population, recidivism is low, and therefore vaccination prior to discharge may help vaccinate patients who will not come back for vaccination 2 weeks post-op.

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FÁCIL

What is the embryologic origin of the spleen?

• Endoderm

• Mesoderm

• Ectoderm

• Neural crest cells

Answer explanation

The spleen arises from the primitive mesoderm and is evident by the fifth week of gestation.

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FÁCIL

What is the most common cause of splenic artery/vein thrombosis?

• Portal hypertension

• Pancreatitis

• Pancreatic cancer

• Factor V Leiden

• Antiphospholipid syndrome

Answer explanation

Pancreatitis is the most common cause of splenic artery/vein thrombosis.

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DIFICULTAD MEDIA

What type of bacteria does the spleen opsonize better than the liver?

• Encapsulated organisms

• Yeast

• Parasites

• Gram positives

Answer explanation

Encapsulated organisms are opsonized by the reticuloendothelial system, namely the spleen.

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FÁCIL

Which of the following conditions is an indication for splenectomy?

• Sickle cell anemia

• Myelofibrosis

• TTP

• Asymptomatic 1.5-cm mid-splenic artery aneurysm

Answer explanation

Myelofibrosis leads to extramedullary hematopoiesis and can be alleviated by splenectomy.

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DIFICULTAD MEDIA