Pancreas and Spleen

Question 1

Which part of the pancreas is best to biopsy?

Answer 1

right limb

- avoids duct system

Question 2

What are the different techniques of a pancreatic biopsy?

Answer 2

• blunt dissection
• suture fracture
• laparoscopic

Question 3

What are the indications for a partial pancreatectomy?

Answer 3

• pancreatic abscess
• pseudocyst
• isolated mass
• focal trauma

Question 4

How much of the pancreas can you remove?

Answer 4

75-90%

- must maintain ducts

Question 5

What is a pancreatic abscess?

Answer 5

pus and necrotic tissue in the parenchyma

Question 6

What are the clinical signs associated with a pancreatic abscess?

Answer 6

• vomiting
• abdominal pain
• depression/lethargy

Question 7

How is a pancreatic abscess diagnosed?

Answer 7

radiographs - soft tissue density

ultrasound - hypoechoic area

Question 8

How is a pancreatic abscess treated?

Answer 8

drainage and debridement

Question 9

What is the prognosis for a pancreatic abscess?

Answer 9

guarded

• septicemia
• peritonitis
• recurrence possible

Question 10

What is a pancreatic pseudocyst?

Answer 10

pancreatic secretions and debris within a fibrous sac

Question 11

How is a pancreatic pseudocyst diagnosed?

Answer 11

ultrasound - fluid filled mass

FNA - enzyme levels higher than serum

Question 12

How are pancreatic pseudocysts treated?

Answer 12

asymptomatic, single cyst < 4cm: monitor, may resolve

symptomatic and > 4 cm: US guided aspiration

recurrent: resect, or debride and drain

Question 13

What is the most common exocrine pancreatic neoplasm?

Answer 13

adenocarcinoma

Question 14

What are the clinical signs associated with an exocrine pancreatic neoplasm?

Answer 14

• weight loss
• anorexia
• vomiting

Question 15

How is an exocrine pancreatic neoplasm treated?

Answer 15

• surgical resection

- palliative (Billroth 2)

Question 16

What is the prognosis for an exocrine pancreatic neoplasm?

Answer 16

poor

• highly metastatic to regional lymph nodes and liver
• little response to chemo

Question 17

What is an insulinoma?

Answer 17

tumor of the pancreatic beta cells

Question 18

What are the clinical signs associated with an insulinoma?

Answer 18

weakness and seizures

Question 19

How is an insulinoma diagnosed?

Answer 19

• 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

Question 20

How is an insulinoma managed medically?

Answer 20

• frequent small meals of complex carbs and high protein
• restrict exercise
• glucocorticosteroids
• Diazoxide
• Streptozocin

Question 21

How is an insulinoma treated surgically?

Answer 21

partial pancreatectomy

Question 22

What is the prognosis for insulinoma?

Answer 22

poor

• metastatic to lymph nodes and liver
• 18 months without metastasis

Question 23

What is a gastrinoma?

Answer 23

tumor of non-beta islet cells of the pancreas

Question 24

What are the effects of a gastrinoma?

Answer 24

secretes excessive gastrin

• increased gastric acid secretion
• gastric ulceration
• vomiting and weight loss

Question 25

What is the prognosis for a gastrinoma?

Answer 25

poor - metastatic

Question 26

What are the functions of the spleen?

Answer 26

• reservoir for platelets, phagocytes, and RBCs
• lymphocyte production and storage
• hematopoiesis
• filtration of blood

Question 27

What is the best diagnostic tool for the spleen?

Answer 27

ultrasound

- hyperechoic changes seen

Question 28

What are the indications for a partial splenectomy?

Answer 28

• focal abscess

- focal injury

Question 29

When is a partial splenectomy contraindicated?

Answer 29

for neoplasias

Question 30

What are the indications for a total splenectomy?

Answer 30

• neoplasia
• torsion
• severe trauma
• IMHA refractory to medical treatment

Question 31

What are the possible reasons for a symmetric spenomegaly?

Answer 31

• inflammation
• immune reaction
• congestion
• infiltration

Question 32

What are the possible reasons for an asymetric spenomegaly?

Answer 32

• nodular hyperplasia
• segmental infarction
• siderotic plaques
• splenosis
• neoplasia

Question 33

What are siderotic plaques?

Answer 33

• tan or rust colored plaques on the margins
• iron and calcium
• normal finding in aging animals

Question 34

What is splenosis?

Answer 34

• multiple nodules of normal splenic tissue in the abdominal cavity
• congenital or traumatic
• purple “grapes”
• functional tissue
• not surgical

Question 35

What are the signs associated with acute splenic torsion?

Answer 35

• acute abdomen
• abdominal pain and distension
• arrhythmias
• DIC
• collapse

Question 36

What are the signs associated with chronic splenic torsion?

Answer 36

• lethargy, anorexia
• weight loss
• intermittent vomiting and diarrhea

Question 37

How is a splenic torsion treated?

Answer 37

• splenectomy (do not de-rotate)

- gastropexy

Question 38

What are the most common malignant tumors of the spleen?

Answer 38

dogs - hemangiosarcoma

cats - lymphosarcoma and mast cell tumor

Question 39

What are the clinical signs associated with splenic hemangiosarcoma?

Answer 39

• decreased appetite
• anorexia, lethargy, weight loss
• abdominal distension
• acute collapse

Question 40

Why should a benign splenic mass be removed?

Answer 40

• can compress vessels if it becomes too large

- can rupture and cause hemoabdomen

Question 41

What is the treatment for splenic hemangiosarcoma?

Answer 41

total splenectomy

Question 42

What is the prognosis for splenic hemangiosarcoma?

Answer 42

very poor

- most metastasize

Question 43

What are the complications associated with splenectomies?

Answer 43

• hemorrhage
• vascular compromise
• infection
• arrhythmias