Rupture of the spleen

Definition

Rupture of the spleen: - Means burst of the spleen

Causes

1. Trauma e.g

a)      Traffic accident

b)      Falls e.g from height

c)      Direct blow to the abdomen

·         Enlargement spleen rupture easily because it comes from under cover of the protecting ribs

2. Pain in the left shoulder and flank
3. Tenderness rigidity and dullness in the spleenic area
4. Weakness due to blood loss

Management

Splenectomy

Treatment for shock and transfusion before and after surgery are essential

Care of patient undergoing splenectomy

Objectives

1. Describe the pre and post operative care of a patient undergoing splenectomy
2. Give appropriate pre and post operative care to a patient scheduled for splenctomy (clinical)

Definition

Splenectomy – Is surgical removal of the spleen

Indications

1. Rupture of spleen
2. a grossly enlarged spleen as it becomes the site of excessive destruction of blood cells e.g in autoimmune haemolytic anaemis, idiopathic thrombocytopenic purpura, sickle cell anaemia
3. Patient with rheumatoid arthritis with large spleen and destruction of granulocytes and agramullocytopenia
4. Very large painful spleen e.g in leukemia
5. Hemolytic jaundice

Pre-operative Care

1. The preparation is similar to that for a major abdominal operation
2. The spleen is situated in the left hypochondrium and acces to it isdifficulty if the stomach is distended
3. For this reasons ryles tube is passed preoperatively and left in situation as long as 24 hours post operatively

Post operative care

1. The usually post operative care
2. Thrombosis is the only special complication and measures to prevent it should be taken
3. Collapse or pneumonia of the lower lobe of the left lung can be prevented by deep breathing exercises
4. Acute dilatation of the stomach can be prevented by nasogastric tube aspiration until the stomach is emptying normally

NB: - Continue with all general measures for major abdominal operation