Pancreas and Spleen Flashcards
Which part of the pancreas is best to biopsy?
right limb
- avoids duct system
What are the different techniques of a pancreatic biopsy?
- blunt dissection
- suture fracture
- laparoscopic
What are the indications for a partial pancreatectomy?
- pancreatic abscess
- pseudocyst
- isolated mass
- focal trauma
How much of the pancreas can you remove?
75-90%
- must maintain ducts
What is a pancreatic abscess?
pus and necrotic tissue in the parenchyma
What are the clinical signs associated with a pancreatic abscess?
- vomiting
- abdominal pain
- depression/lethargy
How is a pancreatic abscess diagnosed?
radiographs - soft tissue density
ultrasound - hypoechoic area
How is a pancreatic abscess treated?
drainage and debridement
What is the prognosis for a pancreatic abscess?
guarded
- septicemia
- peritonitis
- recurrence possible
What is a pancreatic pseudocyst?
pancreatic secretions and debris within a fibrous sac
How is a pancreatic pseudocyst diagnosed?
ultrasound - fluid filled mass
FNA - enzyme levels higher than serum
How are pancreatic pseudocysts treated?
asymptomatic, single cyst < 4cm: monitor, may resolve
symptomatic and > 4 cm: US guided aspiration
recurrent: resect, or debride and drain
What is the most common exocrine pancreatic neoplasm?
adenocarcinoma
What are the clinical signs associated with an exocrine pancreatic neoplasm?
- weight loss
- anorexia
- vomiting
How is an exocrine pancreatic neoplasm treated?
- surgical resection
- palliative (Billroth 2)
What is the prognosis for an exocrine pancreatic neoplasm?
poor
- highly metastatic to regional lymph nodes and liver
- little response to chemo
What is an insulinoma?
tumor of the pancreatic beta cells
What are the clinical signs associated with an insulinoma?
weakness and seizures
How is an insulinoma diagnosed?
- ultrasound may reveal mass
- exploratory
- Whipple’s triad: hypoglycemia, fasting BG < 40, relief of signs when feeding or given glucose
- high insulin levels with hypoglycemia
How is an insulinoma managed medically?
- frequent small meals of complex carbs and high protein
- restrict exercise
- glucocorticosteroids
- Diazoxide
- Streptozocin
How is an insulinoma treated surgically?
partial pancreatectomy
What is the prognosis for insulinoma?
poor
- metastatic to lymph nodes and liver
- 18 months without metastasis
What is a gastrinoma?
tumor of non-beta islet cells of the pancreas
What are the effects of a gastrinoma?
secretes excessive gastrin
- increased gastric acid secretion
- gastric ulceration
- vomiting and weight loss
What is the prognosis for a gastrinoma?
poor - metastatic
What are the functions of the spleen?
- reservoir for platelets, phagocytes, and RBCs
- lymphocyte production and storage
- hematopoiesis
- filtration of blood
What is the best diagnostic tool for the spleen?
ultrasound
- hyperechoic changes seen
What are the indications for a partial splenectomy?
- focal abscess
- focal injury
When is a partial splenectomy contraindicated?
for neoplasias
What are the indications for a total splenectomy?
- neoplasia
- torsion
- severe trauma
- IMHA refractory to medical treatment
What are the possible reasons for a symmetric spenomegaly?
- inflammation
- immune reaction
- congestion
- infiltration
What are the possible reasons for an asymetric spenomegaly?
- nodular hyperplasia
- segmental infarction
- siderotic plaques
- splenosis
- neoplasia
What are siderotic plaques?
- tan or rust colored plaques on the margins
- iron and calcium
- normal finding in aging animals
What is splenosis?
- multiple nodules of normal splenic tissue in the abdominal cavity
- congenital or traumatic
- purple “grapes”
- functional tissue
- not surgical
What are the signs associated with acute splenic torsion?
- acute abdomen
- abdominal pain and distension
- arrhythmias
- DIC
- collapse
What are the signs associated with chronic splenic torsion?
- lethargy, anorexia
- weight loss
- intermittent vomiting and diarrhea
How is a splenic torsion treated?
- splenectomy (do not de-rotate)
- gastropexy
What are the most common malignant tumors of the spleen?
dogs - hemangiosarcoma
cats - lymphosarcoma and mast cell tumor
What are the clinical signs associated with splenic hemangiosarcoma?
- decreased appetite
- anorexia, lethargy, weight loss
- abdominal distension
- acute collapse
Why should a benign splenic mass be removed?
- can compress vessels if it becomes too large
- can rupture and cause hemoabdomen
What is the treatment for splenic hemangiosarcoma?
total splenectomy
What is the prognosis for splenic hemangiosarcoma?
very poor
- most metastasize
What are the complications associated with splenectomies?
- hemorrhage
- vascular compromise
- infection
- arrhythmias
