Kapitel 83 - spleen Flashcards
Describe the blood supply to the spleen
Abdominal aorta-> first unpaired ventral branch-> celiac artery-> hepatic, left gastric
and splenic artery-> pancreatic artery-> hilus of the spleen-> cranially goes into the
short gastric arteries-> left gastric artery. After passing the middle of the spleen->
gastroeplipoic artery. Caudally supplies the rest of the spleen and angles back to the
greater curvature through the gastrosplenic ligament.
Veins collect blood from the hilar veins-> gastrsplenic vein -> portal vein.
A 10 year old Labrador retriever, intact female is brought in due to a haemoabdomen.
On presentation, the dog has a heart rate of 220 bpm, a respiratory rate of 60 bpm,
pale mucous membranes, a capillary refill time of over 2 seconds and a temperature of
37.40 Celsius. ECG demonstrate a ventricular arrhythmia.
What would you do?
Stabilise patient: O2 supplement, Lidocaine 2mg/kg bolus and then 25-
80mcg/kg/min, check BP->IVFT bolus to decrease HR and increase BP.
Colloid if crystalloid are not enough, dopamine/dobutamine if the rest is not
enough. Check PCV, TP-> transfusion if <20%
Once stabile
* U/S +/- PCV,TP on abdominal fluids to rule out active bleeding
* If the spleen is the problem, splenectomy + abdominal lavage
* Post-op ECG, BP
List some of the risk factors for perioperative death in case of splenectom
- Hemoabdomen-> respiratory issues
- Anemia
- Thrombocytopenia
- Ventricular tachycardia
when is gastropexy advised in addition to splenectomy?
- Large/giant deep chested breeds, intact male
- Splenic torsion
- Very large spleen
Describe the clinical findings of the liver that could be indicative for
malignancy (found during explorative celiotomy):
- Multiple liver lesions
- Actively bleeding nodules
- Dark-coloured hepatic nodules
What is the most likely diagnosis for the pathological lesion in spleen in cats? List two
specific differential diagnosis:
- Most likely neoplastic in cats
- Lymphoma and MCT
List at least three additional differential diagnoses of splenic lesions (that have been reported in the
veterinary literature)
- Myeloproliferative disease
- Hemangiosarcoma
- Undifferentiated sarcomas
- Metastatic carcinoma
- Adenocarcinoma
- Fibrosarcoma
- Lipoma
- Metastatic melanoma
- Malignant fibrous histiocytoma
- rabdomyosarcoma
Prognosis for a cat with splenic mast cell tumour?
- Guarded
- 2-34 months
List the potential postoperative complications after splenectomy:
- Haemorrhage
- Vascular compromise
- Infection
- Hypoxia/ischemia
- GDV
- Arrhythmias
- DIC, SIRS, acute respiratory distress syndrome, pulmonary thrombohembolism
What 4 mechanism can give rise to generalized splenomegaly?
Generalized splenomegaly can arise from four mechanisms: *inflammation, (bacteriemia, low grade septicaemia, chronic infectious dz, hypereosinophylic syndrome, eosinophilic gastroenteritis, FIP, mycotic or mycobacterial infection) *immune reaction = cellular hyperplasia, (IMHA, IMHT, leishmaniosis, histoplasmosis, chronic antigen stimulation (e.g. osteomyelitis, bact endocarditis), histiocytosis) *congestive enlargement, (congestive heart failure, portal hypertension, vascular outflow obstruction, or relaxation of the splenic capsule in response to chemical stimuli e.g. Barbiturates) *cellular infiltration (neoplasia, amyloidosis, lysosomal storage disease)
The spleen in dogs is seen more consistently on the right lateral or left lateral view?
Right lateral view. The spleen in dogs is seen more consistently on the right lateral view than the left lateral. In a lateral projection the silhouette of the splenic caudal extremity appears as a triangular, oval, or rounded structure slightly caudal and ventral to the pylorus or liver. Thinner and smaller, the feline spleen is seen in ventrodorsal and lateral projections in the same orientation as the dog spleen, although the caudal extremity may not be visible in the lateral view..
What are the most common forms of neoplasia in cats?
lymphosarcoma and mast cell tumors
What ulrasonographic abnormality is characteristic of splenic torsion?
a hilar perivenous hyperechoic triangle
Color-flow Doppler ultrasonography reveals absence of flow through the splenic hilar vessels.
What post-operative treatment is most recommended after a splenectomy for the treatment of splenic neoplasia?
continuous ECG monitoring
Ventricular arrhythmias were reported in 14 (23.7%) of 59 dogs undergoing splenectomy for hemangiosarcoma
What are the most common post-operative complications specific to splenic surgery? List five.
*Hemorraghe, *vascularcompromise of the left limb of the pancreas,
*portal vein thrombosis, *cardiac arrythmias, *disruption of normal coagulation and inflammatory pathways (leads to DIC,pulmonary thromboembolism, acute respiratory distress syndrome or SIRS)
* GDV
* higher risk for infection *higher risk for hypoxaemia and ischemia following acute blood loss
