Exam 1: Lecture 4 - Surgery of the Spleen

Question 1

what is the definition of splenomegaly

Answer 1

enlargement of the spleen from any cause

Question 2

what is the definition of splenectomy

Answer 2

surgical removal of the spleen

Question 3

what is the definition of splenosis

Answer 3

congenital or traumatic presence of multiple nodules of normal splenic tissue in the abdomen

Question 4

what is the definition of siderotic plaques

Answer 4

brown or rust-colored deposits of iron and calcium on splenic surface

Question 5

what is the definition of splenorrhaphy

Answer 5

suturing of ruptured spleen

Question 6

what is this a picture of

Answer 6

splenosis

Question 7

what is this a picture of

Answer 7

siderotic plaques

Question 8

what is the definition of hemangiosarcoma (HSA)

Answer 8

malignant neoplasm arising from blood vessels

Question 9

what is the definition of hemangioma

Answer 9

benign tumors of dilated blood vessels

Question 10

what is the definition of hematoma

Answer 10

swelling or mass of blood (usually clotted) confined to an organ, tissue, or space caused by seepage of any resion

Question 11

what are the indications for splenic sx

Answer 11

1. mass
2. loss of vascularity secondary torsion (either GDV or splenic torsion)
3. trauma
4. refractive immune-mediated hematologic disorders in some individual cases

Question 12

T/F: incidentally found, non-ruptured splenic masses or nodules without associated hemoperitoneum are most commonly benign

Answer 12

true!!

Question 13

T/F: surgery is not warranted in dogs with incidentally found masses or nodules

Answer 13

false, it is warranted and prognosis is fair or good

Question 14

what causes diffuse (symmetric) splenomegaly

Answer 14

1. congestion (torsion, GDV, right sided heart failure, drugs)
2. infiltration due to infection
3. splenic FB
4. immune mediated disease
5. neoplasia

Question 15

what causes focal (asymmetric) splenomegaly

Answer 15

1. benign processes (nodular regeneration, hematoma, trauma)
2. neoplastic process (hemangiosarcoma)

Question 16

T/F: Infiltrative splenomegaly from neoplasia is one of the most common causes of spontaneous splenomegaly in dogs and cats

Answer 16

true

Question 17

what is the most common reason for splenic torsion

Answer 17

GDV

Question 18

T/F: isolated splenic torsion in dogs is common

Answer 18

false, it is rare

Question 19

what happens during splenic torsion

Answer 19

1. splenic vein becomes occluded
2. splenic artery is partially blocked (infarction)

Question 20

what causes splenic torsion

Answer 20

not really sure…. may be congenital abnormalities, traumatic disruption of the gastrosplenic or splenocolic ligaments, or partial GDV that resolved

Question 21

what da heck happen to this spleen!!

Answer 21

splenic torsion

Question 22

_____ _____ torsion may be life threatening requiring prompt diagnosis and treatment

Answer 22

acute splenic torsion

Question 23

should we do a prophylatic gastropexy with a splenectomy for splenic torsion

Answer 23

may be warranted but research has called this practice into question when splenectomy was not related to a GDV or torsion

Question 24

what are some other diseases associated with splenic infarction

Answer 24

1. liver disease
2. renal disease
3. hyperadrenocorticism
4. neoplasia
5. thrombus with cardiovascular disease

AKA anything that alters blood flow and coagulation

Question 25

what is the most common splenic tumor is dogs and cats

Answer 25

hemangiosarcoma

Question 26

what % of dogs with splenic HSA may have concurrent right atrial HSA

Answer 26

25%

Question 27

what is this splenic tumor...probaly

Answer 27

splenic hemangiosarcoma

Question 28

where do splenic hemangiosarcomas frequently met to

Answer 28

1. liver 2. omentum 3. mesentery 4. brain

Question 29

what is very important to remember about these 2 masses?

Answer 29

left is splenic hematoma and right is splenic hemangiosarcoma......they are often grossly indistinguishable so let the pathologist do their job!!

Question 30

what are some preop management things we may need to do for splenic surgery

Answer 30

1. may see anemia (acute with trauma, rupture of hematoma, or underlying disease) 2. coagulation profiles should be performed if trauma is not suspected 3. consider need for blood transfusion 4. assess for hydration 5. assess for DIC

Question 31

what are some considerations for anesthesia for splenic sx

Answer 31

1. anemic patients need O2 prior to induction and during recover 2. avoid barbiturates 3. avoid acetylpromazine (RBC sequestration, hypotension, and impact on platelet function) 4. hypotension due to volume depletion

Question 32

what things should we look at to decide if we need abx or not

Answer 32

case dependent so look at age, disease, length of sx, immune status, and state of debilitation

Question 33

what are the 7 instruments we need/should have for splenic sx

Answer 33

1. suction and sterile tubing 2. poole suction tip 3. laparotomy pads 4. balfour retractor 5. "spay pack" 6. LDS - ligating dividing stapler 7. TIA stapling device (transverse intestinal stapler)

Question 34

what is this

Answer 34

ligating dividing stapler

Question 35

what instrument has this tip

Answer 35

ligating dividing stapler

Question 36

what is this

Answer 36

TIA stapling device (transverse intestinal stapler)

Question 37

T/F: realistically, the spleen can be found almost anywhere in the abdominal cavity

Answer 37

true!!

Question 38

T/F: Arterial supply of the spleen is the splenic artery which is a branch of the celiac which is a branch of aorta

Answer 38

true!! very important

Question 39

T/F: First branch is usually to the left limb of the pancreas and its main arterial blood supply....its important to ID it but you dont have to ligate distal to it

Answer 39

false... first part is true but you DO have to ligate the splenic artery distal to it

Question 40

what type of approach do we do for splenic sx

Answer 40

ventral midline approach from xyphoid to a point caudal to the umbilicus

Question 41

when is a partial splenectomy indicated

Answer 41

with trauma or focal lesions to preserve splenic function

Question 42

what are some functions of the spleen that we lose when we do a total splenectomy

Answer 42

1. RBC reservoir 2. hematopoiesis 3. important phagocytic function 4. help with immunocompetence

Question 43

what are the 4 major techniques to a total splenectomy

Answer 43

1. ligation at splenic hilus 2. splenic artery ligation 3. bag of rochester carmalts 4. laparoscopic??

Question 44

what is a thompson quote that is important to remember for splenectomy sx

Answer 44

dont piss off the pancreas!

Question 45

what are some post op care things we should do after splenectomy

Answer 45

1. 24 hour observation for hemorrhage 2. hematocrit every few hours until stable 3. nasal O2 for anemic patients 4. fluid therapy until self hydration 5. electrolyte correction (PRN) 6. acid-base correction (PRN)

Question 46

T/F: we should monitor for cardiac arrhythmias post op splenectomy

Answer 46

true!

Question 47

should we monitor for DIC post op splenectomy

Answer 47

yes, esp for HSA!!

Question 48

what are the complications of splenic sx

Answer 48

1. hemorrhage 2. traumatic pancreatitis 3. gastric fistulation due to impairment of gastric blood flow 4. previous infection with hemoparasites may become apparent after splenectomy