ABSITE - Spleen Questions and Answers

A 29-year-old female with hereditary spherocytosis is recommended to undergo splenectomy. At what time point is trivalent immunization recommended? A. 1-month pre-op B. 2-weeks pre-op C. 1-week pre-op D. 1-week post-op E. 2-weeks post-op  :-- 2-weeks pre-op Correct. Although rare, overwhelming post-splenectomy infection (OPSI) is a life-threatening complication that can occur weeks, months, or years following splenectomy. Encapsulated organisms such as Haemophilus, Streptococcus pneumoniae, and Meningococcus are most commonly responsible. The Centers for Disease Control and Prevention recommends vaccination against these three organisms 2 weeks prior to elective splenectomy. Elscores: Aug. 27, 24- 2024/2025 Exams and Correct Answers |Best Grades | Excellence | Success & Guaranteed Pass 2 The risk of dying from overwhelming post-splenectomy infection (OPSI) A. is greatest after splenectomy for trauma. B. decreases as the interval after splenectomy increases. C. is greatest in the elderly. D. eventually becomes identical to the risk in the normal population. E. is eliminated by taking prophylactic penicillin.  :-- decreases as the interval after splenectomy increases. Correct. An increased risk of sepsis and septic shock is directly related to splenectomy at any age. Children less than 15 years of age have a greater overall risk of developing overwhelming postsplenectomy infection (OPSI) compared with adults (0.13% to 8.1% versus 0.28% to 1.9%). Splenectomized infants and young children are even more susceptible for pneumococcal sepsis. The incidence of OPSI is related to the underlying disease. Historically the incidence of sepsis after splenectomy caused by trauma is lower than after splenectomy for hematologic disorders or malignancy. Increased mortality is also seen in patients with lymphoreticular disease, and in those undergoing extensive chemotherapy and radiation therapy. Published information indicates that most cases of OPSI present in the initial two years after splenectomy, with 50% to 80% within this period. The mortality of OPSI is 50% or greater. The Elscores: Aug. 27, 24- 2024/2025 Exams and Correct Answers |Best Grades | Excellence | Success & Guaranteed Pass 3 risk of OPSI is lifelong, and OPSI has been reported more than 40 years after operation. Prophylactic penicillin is of no proven benefit. You are consulted on a 55-year-old homeless woman admitted for sepsis with documented gram-positive bacteremia. A CT scan of the abdomen obtained today is shown below (multifocal abscesses). She has been started on broad-spectrum antibiotics. What is the most appropriate next step in her management? A. Mesenteric angiography and embolization B. Image-guided percutaneous drain placement C. Splenectomy D. Fine needle aspiration and culture of splenic lesions E. Administration of IgG  :-- Splenectomy Correct. The image demonstrates multiple splenic abscesses likely seeded from the patient's bacteremia producing septic emboli. Optimal treatment is splenectomy. Image-guided drain placement may be an option for a marginally stable patient with a single abscess, but is prone to failure and complication. IgG is typically used in the treatment of ITP, not splenic abscess. FNA and culture plays no role in the treatment of this disease process. Elscores: Aug. 27, 24- 2024/2025 Exams and Correct Answers |Best Grades | Excellence | Success & Guaranteed Pass 4 An otherwise healthy 55-year-old female underwent a routine lipoma removal of the back. The procedure was completed without difficulty. Cefazolin was given as antibiotic prophylaxis. Twenty four hours post-op, the patient is noted to develop jaundice, fatigue, and splenomegaly. Direct Coombs' test is positive. What is the most likely diagnosis? A. Sickle cell anemia B. Splenic abscess C. Splenic vein thrombosis D. Immune thrombocytopenic purpura E. Autoimmune hemolytic anemia  :-- Autoimmune hemolytic anemi