Exam 1: Lecture 4 - Surgery of the Spleen Flashcards
what is the definition of splenomegaly
enlargement of the spleen from any cause
what is the definition of splenectomy
surgical removal of the spleen
what is the definition of splenosis
congenital or traumatic presence of multiple nodules of normal splenic tissue in the abdomen
what is the definition of siderotic plaques
brown or rust-colored deposits of iron and calcium on splenic surface
what is the definition of splenorrhaphy
suturing of ruptured spleen
what is this a picture of
splenosis
what is this a picture of
siderotic plaques
what is the definition of hemangiosarcoma (HSA)
malignant neoplasm arising from blood vessels
what is the definition of hemangioma
benign tumors of dilated blood vessels
what is the definition of hematoma
swelling or mass of blood (usually clotted) confined to an organ, tissue, or space caused by seepage of any resion
what are the indications for splenic sx
- mass
- loss of vascularity secondary torsion (either GDV or splenic torsion)
- trauma
- refractive immune-mediated hematologic disorders in some individual cases
T/F: incidentally found, non-ruptured splenic masses or nodules without associated hemoperitoneum are most commonly benign
true!!
T/F: surgery is not warranted in dogs with incidentally found masses or nodules
false, it is warranted and prognosis is fair or good
what causes diffuse (symmetric) splenomegaly
- congestion (torsion, GDV, right sided heart failure, drugs)
- infiltration due to infection
- splenic FB
- immune mediated disease
- neoplasia
what causes focal (asymmetric) splenomegaly
- benign processes (nodular regeneration, hematoma, trauma)
- neoplastic process (hemangiosarcoma)
T/F: Infiltrative splenomegaly from neoplasia is one of the most common causes of spontaneous splenomegaly in dogs and cats
true
what is the most common reason for splenic torsion
GDV
T/F: isolated splenic torsion in dogs is common
false, it is rare
what happens during splenic torsion
- splenic vein becomes occluded
- splenic artery is partially blocked (infarction)
what causes splenic torsion
not really sure…. may be congenital abnormalities, traumatic disruption of the gastrosplenic or splenocolic ligaments, or partial GDV that resolved
what da heck happen to this spleen!!
splenic torsion
_____ _____ torsion may be life threatening requiring prompt diagnosis and treatment
acute splenic torsion
should we do a prophylatic gastropexy with a splenectomy for splenic torsion
may be warranted but research has called this practice into question when splenectomy was not related to a GDV or torsion
what are some other diseases associated with splenic infarction
- liver disease
- renal disease
- hyperadrenocorticism
- neoplasia
- thrombus with cardiovascular disease
AKA anything that alters blood flow and coagulation
what is the most common splenic tumor is dogs and cats
hemangiosarcoma
what % of dogs with splenic HSA may have concurrent right atrial HSA
25%
what is this splenic tumor…probaly
splenic hemangiosarcoma
where do splenic hemangiosarcomas frequently met to
- liver
- omentum
- mesentery
- brain
what is very important to remember about these 2 masses?
left is splenic hematoma and right is splenic hemangiosarcoma……they are often grossly indistinguishable so let the pathologist do their job!!
what are some preop management things we may need to do for splenic surgery
- may see anemia (acute with trauma, rupture of hematoma, or underlying disease)
- coagulation profiles should be performed if trauma is not suspected
- consider need for blood transfusion
- assess for hydration
- assess for DIC
what are some considerations for anesthesia for splenic sx
- anemic patients need O2 prior to induction and during recover
- avoid barbiturates
- avoid acetylpromazine (RBC sequestration, hypotension, and impact on platelet function)
- hypotension due to volume depletion
what things should we look at to decide if we need abx or not
case dependent so look at age, disease, length of sx, immune status, and state of debilitation
what are the 7 instruments we need/should have for splenic sx
- suction and sterile tubing
- poole suction tip
- laparotomy pads
- balfour retractor
- “spay pack”
- LDS - ligating dividing stapler
- TIA stapling device (transverse intestinal stapler)
what is this
ligating dividing stapler
what instrument has this tip
ligating dividing stapler
what is this
TIA stapling device (transverse intestinal stapler)
T/F: realistically, the spleen can be found almost anywhere in the abdominal cavity
true!!
T/F: Arterial supply of the spleen is the splenic artery which is a branch of the celiac which is a branch of aorta
true!! very important
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
false… first part is true but you DO have to ligate the splenic artery distal to it
what type of approach do we do for splenic sx
ventral midline approach from xyphoid to a point caudal to the umbilicus
when is a partial splenectomy indicated
with trauma or focal lesions to preserve splenic function
what are some functions of the spleen that we lose when we do a total splenectomy
- RBC reservoir
- hematopoiesis
- important phagocytic function
- help with immunocompetence
what are the 4 major techniques to a total splenectomy
- ligation at splenic hilus
- splenic artery ligation
- bag of rochester carmalts
- laparoscopic??
what is a thompson quote that is important to remember for splenectomy sx
dont piss off the pancreas!
what are some post op care things we should do after splenectomy
- 24 hour observation for hemorrhage
- hematocrit every few hours until stable
- nasal O2 for anemic patients
- fluid therapy until self hydration
- electrolyte correction (PRN)
- acid-base correction (PRN)
T/F: we should monitor for cardiac arrhythmias post op splenectomy
true!
should we monitor for DIC post op splenectomy
yes, esp for HSA!!
what are the complications of splenic sx
- hemorrhage
- traumatic pancreatitis
- gastric fistulation due to impairment of gastric blood flow
- previous infection with hemoparasites may become apparent after splenectomy
