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Surgical Aspects of Spleen:

Surgical Aspects of Spleen Dr.S.Easwaramoorthy MS FRCS(Glas) FRCS (Edin) FRCS(Eng)

Applied Anatomy :

Applied Anatomy 150 gms 9 th , 10 th ,11 th rib Tail of Pancreas, Stomach, Colon, Lt.Kidney, Diaphragm Blood supply Splenic A : Coeliac axis Splenic V : Portal System Histology White Pulp : Immune function Red Pulp : Filters abnormal red cells Splenunculi ( Accessory Spleen )

Functions of Spleen:

Functions of Spleen Immune function Culling & Pitting Pooling of Platelets

Rupture of Spleen Causes:

Rupture of Spleen Causes Trauma RTA / Fall/ Assault Iatrogenic Gastrectomy Colectomy Spontaneous Malaria Mononucleosis

Presentation ::

1. Exsanguination 2. Shock  Recovery  Shock 3. Delayed Case Presentation :

Clinical Signs :

Hypovolumic Shock Kehr Sign, Cullen’s Sign, Guarding, Tenderness, Shifting dullness Balance sign Clinical Signs

Investigations ::

* Hematological : FBC, Haematocrit * Biochemical : Amylase * Radiological : X ray abdomen / Chest U / S Abdomen CT Abdomen * Others : DPL, Laparoscopy Investigations :

Ultrasound in Abdominal Trauma:

Ultrasound in Abdominal Trauma Merits: quick ER procedure non-invasive identify the fluid and solid organ injury Demerits: operator dependent miss hollow organ injury ‘ S onography is the S tethoscope of the S urgeon’

Imaging in abdominal trauma:

Imaging in abdominal trauma US abdomen All cases Detects haemoperitoneum Could miss injuries Contrast CT abdomen Stable patient For detailed assessment and decide about treatment Active bleeding retro peritoneum

Blunt Injury Abdomen: CT Scan::

Blunt Injury Abdomen: CT Scan: Laceration of Liver Laceration of Spleen

Diagnostic Peritoneal Lavage:

Diagnostic Peritoneal Lavage Rare test to find out intra abdominal bleeding Indication: Equivocal US Difficult to assess the patient: Head/spinal injury Prior to transfer

Management ::

1. Non – Operative 2. Operative (open/Lap) a) Splenectomy b) Splenorrhaphy Management :

Indications for Splenectomy:

Indications for Splenectomy 1. Trauma 2. Haemolytic anaemia : Thalassemia Spherocytosis ITP 3. Part of radical surgery : Ca.Stomach Ca.Tail of Pancreas 4. Surgery for PHT

Technique of Splenectomy:

Technique of Splenectomy - Anesthesia - Position - Incision - Essential Steps - Intra – Operative Complications Bleeding Injury to ……..

Post Operative Complications:

Post Operative Complications General 1. Respiratory Specific Atelectasis Pneumonia 1. Gastric Dilatation Pleural effusion 2. Pancreatic injury& 2. Cardio Vascular Fistula Arrhythmias 3. OPSI MI DVT 3. Fluid, Electrolyte Imbalance 4.Sepsis 5. Post Operative fever

PowerPoint Presentation:

OPSI : 1. Why and Who gets it… 2. What Organisms Pneumococci H Influenza Meningococci 3. How to avoid Vaccine 2 wks prior

PowerPoint Presentation:

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