NBME 22 Splenic vein (NBME Answers)

NBME 22 Answers

nbme22/Block 4/Question#28 (reveal difficulty score)
A 48-year-old man comes to the emergency ...
Splenic vein 🔍 / 📺 / 🌳 / 📖
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submitted by ∗aesalmon(95)

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When in doubt its probably the Splenic Vein ("play odds" - Goljan)

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jurrutia Also, what is causing the splenomegaly? Cross out gastroduodenal A/V, gastric A/V, and pancreatoduodenal A/V since they have nothing to do with the spleen. All that's left is the splenic vessels, and you know it's a vein... +1

psaucy Thrombosis of the splenic vein causes the spleen to get congested with blood. You see splenomegaly + thrombosis = splenic vein errry time. +1

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submitted by ∗k_tron_3000(35)

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Just a random factoid (as far as I know), in patients with pancreatitis the most likely vessel for thrombosis is the splenic vein due to close “anatomic ties” with the pancreas. This would also cause gastro-splenic varices, explaining the vomiting of blood.

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meningitis Also explains the splenomegaly. If you have thrombosed splenic vein, the blood will pool in the spleen, can also cause expansion of red pulp of spleen. +11

pg32 I picked splenic vein because of this ^^ association. However, why is the patient vomiting blood if there isn't a backup of blood into the left gastric/esophageal veinous system? +1

savethewhales The splenic vein drains the fundus of the stomach. So, splenic vein thrombosis can cause gastric fundal varices, which explains his bloody vomit. +4

medschooler1 how do you rule out arteries? +

ac3 @medschooler1 Just my guess, but when answering this I assumed that splenomegaly meant splenic congestion with blood which can only happen if its outflow tract (splenic vein) is blocked. +5

thrawn Arterial occlusion would be mesenteric angina - or the likes thereof. Venous occlusion leads to variceal bleed +

imgdoc You rule out arteries because if they are occluded its an infarction and if they are partially occluded you'll get angina. +

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submitted by ∗mattnatomy(46)

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Most common cause of splenic vein thrombosis is chronic pancreatitis, caused by perivenous inflammation.

Source: https://www.ncbi.nlm.nih.gov/pubmed/14502405

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hyperfukus great link! helps answer other qs too thank you :) +

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submitted by ∗almondbreeze(110)

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UW: the short gastric vv drain blood from the gastric funds into the splenic vein, pancreatic inflammation (e.g. pancreatitis, pancreatic ca.) can cause a blood clot w/i the splenic vein, which can increase pressure in the short gastric veins and lead to gastric varies only in the funds

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almondbreeze b/c pancreatic causes can form blood clot in splenic v, b/c splenic v runs behind pancreas +

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submitted by dysdiadochokinesia(2)

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Chronic alcohol-related hematemesis is associated with 2 possible sources: gastric varices or esophageal varices.

Gastric varices -> L. gastric vein or R. gastric vein (draining the gastric fundus into splenic vein)

Esophageal varices -> L. gastric vein

L. gastric vein can be ruled out because splenomegaly wouldn't be present in a L. gastric vein thrombosis, making the splenic vein the correct answer.

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submitted by ∗makinallkindzofgainz(315)

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Isolated gastric fundal varices are seen in splenic vein thrombosis.

Thrombosis increases pressure in the short gastric veins --> gastric varices only in the fundus

Seen in pancreatic inflammation (ex. pancreatitis, pancreatic cancer), which can cause a blood clot within the splenic vein, backing up blood into the short gastric veins (gastrocaval shunt - drained by the inferior phrenic vein) when ruptured causes gastric bleeding, hemoptysis (seen in stem), and melena

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