http://jacknaimsnotes.blogspot.com/2010/02/surgery

12 Years old Chinese Boy complaint of sudden onset abdominal discomfort when waking up from sleep 2/52 prior to admission. Later on, He notice that his abdomen become progressively distended with painless mass at the left upper quadrant. It is associated with shortness of breath. There was no history of trauma, fever or any family history of blood diso An elective laparotomy was performed on this boy and Organ abdomen. Below is the image of the Organ X

Surgery Osce Quiz 4 http://jacknaimsnotes.blogspot.com/2010/02/surgery-osce-quiz-4.html

12 Years old Chinese Boy complaint of sudden onset abdominal discomfort when waking up

2/52 prior to admission. Later on, He notice that his abdomen become progressively distended with painless mass at the left upper quadrant. It is associated with shortness of breath. There was no history of trauma, fever or any family history of blood disorder.

tomy was performed on this boy and Organ X was removed from his Below is the image of the Organ X

Picture A

Picture B

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12 Years old Chinese Boy complaint of sudden onset abdominal discomfort when waking up 2/52 prior to admission. Later on, He notice that his abdomen become progressively

distended with painless mass at the left upper quadrant. It is associated with shortness of breath.

X was removed from his

1) Identify the organ X 2) What is the function of organ X3) Name the blood supply to organ4) Name the venous drainage of organ X5) Name five ligament that holds organ X in place6) What is the common cause for removal of organ X7) What is the most common and worrisome complication when Organ X is removed and

how to prevent it. Answer

1) This is spleen that is enlarged due to cystic mass on the inferosecondary to infection.

2) The function of spleen includes- Antibody production - Initiation of cellular Immune response- Site of Red blood cell removal- Platelet storage

3) Blood supply of spleen includes

- Splenic artery (Major supply that divides itself into branches)- Short gastric artery - Left Gastro epiploic branches

Picture C

What is the function of organ X Name the blood supply to organ X Name the venous drainage of organ X Name five ligament that holds organ X in place What is the common cause for removal of organ X What is the most common and worrisome complication when Organ X is removed and

that is enlarged due to cystic mass on the infero-lateral part of it, possibly

includes

Initiation of cellular Immune response Site of Red blood cell removal

of spleen includes Splenic artery (Major supply that divides itself into branches)

Left Gastro epiploic branches

What is the most common and worrisome complication when Organ X is removed and

lateral part of it, possibly

4) Venous drainage

- It joins together with Superior Mesenteric vein to form Portal vein.

5) Ligaments that supports spleen in place - Splenogastric ligament - Splenophrenic ligament - Splenocolic ligament - Splenoomental ligament - Splenorenal ligament.

6) Common causes for removal of spleen includes

- Mostly because of blunt trauma - Hematological disorder - Immunological disorder

7) The most common and worrisome complication when Spleen is removed

a) Bacteria sepsis especially due to capsulated bacteria that could lead to death. - This could be prevented by given vaccination against capsulated bacteria two weeks

prior the surgery in elective cases or As soon as possible after the surgery in emergency cases. Vaccination needed includes i. Streptococcus pneumonia ii. Haemophilus influenza iii. Neiserria meningitides iv. Pneumococcal.

- In patient younger than six years old, he should be given Ampicillin until age 12

years old.

b) Other causes of complication but not really worrisome are post surgical hemorrhage secondary to slipped ligature, left basal atelectasis & pleural effusion and damage to the stomach and pancreas.

Reference

1. Norman S. Williams, Christopher J.K. Bulstrode & R. Ronan O’Connel, “Bailey & Love’s Short Practice of Surgery 25th edition”, Edward Arnold Publisher ltd, 2008

2. Danny O’ Jacobs, “First Exposure General Surgery”, Mc Graw Hill Company, 2007