SA 2021

Question 1

The shoulder joint of the dog is stabilised by passive (static) and active (dynamic) stabilisers.

List all stabilising structures of the shoulder and indicate if they are active or passive. The use of a table may facilitate your response.

(6 marks)

Answer 1

Passive (static) mechanisms (those for which muscle activity is not required);

• limited joint volume
• adhesion/cohesion mechanisms
• concavity compression
• capsuloligamentous restraints (defined as the glenohumeral ligaments, joint capsule, labrum, and the tendon of origin of the biceps brachii muscle)
• +/- A slightly negative intra-articular pressure exists in the normal shoulder joint but is considered to have little functional impact on joint stability during weight bearing.

Active (dynamic) stabilizers;

• infraspinatus & supraspinatus
• subscapularis
• teres minor muscles
• to a lesser extent, the biceps brachii
• long head of the triceps brachii
• deltoideus
• teres major muscles
• • These mechanisms are modulated, at least in part, by reflex arcs between nerve fibers in the joint capsule and periarticular muscles. Reflex arcs serve to promote synergistic activity between ligamentous structures of the joint and associated musculature to maintain joint stability.

Source: Tobias (2018)

Question 2

In your answer booklet, draw a labelled cross-sectional diagram showing the histological layers of adult articular cartilage.

(4 marks)

Answer 2

Question 3

Provide a brief definition of osteochondrosis. (2 marks)

Provide a brief definition of osteochondritis dissecans (OCD). (2 marks)

Answer 3

Osteochondrosis is a disturbance in endochondral ossification that leads to cartilage retention.

OCD, in which a flap of cartilage is lifted from the articular surface, is a manifestation of a general syndrome called osteochondrosis.

Detached pieces of articular cartilage are often referred to as joint mice.

Source: Fossum

Question 4

Describe the proposed aetiopathogenesis of osteochondrosis and OCD. Include in your answer the associated risk factors for OCD and the role of vasculature within the disease.

(12 marks)

Answer 4

The pathophysiology of OCD is multifactorial and poorly understood process. The most accepted theory involves the impediment of vasculature to a component of epiphysieal /subchondral bone during endochondral ossification resulting in an area of non-ossified bone remaining (a cartilage core). This is an OC.

The osteochondrosis leads to poor nutritional and basal support of the overlying articular cartilage inducing a rift between the two. The movement and chondromalacia results in vertical cracks in the articular cartilage which communicate with the underlying rift. This is further exacerbated by synovial fluid coming into contact with the subchondral bone and damaged articular cartilage, producing a pro-inflammatory state.

Risk factors for OCD in dogs;

• Breed (large and giant breeds) / Heritability
• Age (4-8 months)
• Gender (male)
• Rapid growth
• Nutrient Excess
• Over use/activity

Question 5

List the four (4) synovial joints commonly associated with OCD in dogs and name the anatomical region of each joint that is commonly affected.

(4 marks)

Answer 5

Shoulder – Caudal [medial to central] aspect of humeral head

Hock – Medial (or lateral) trochlear ridge of tallus

Elbow – The distal aspect of the medial humeral condyle

Stifle – The distal aspect of the medial or lateral femoral condyles

Question 6

Name and briefly summarise the phases of integration of a free mesh skin graft. Include in your answer the expected timeframes for each.

(10 marks)

Answer 6

See image:

• Plasmic imbibition (Day 0-3)
• Inosculation (Day 3-7
• Regeneration (Day 7+)
• Reinervation (Day 14+)

Question 7

Identify the anatomical features of canine and feline skin (in contrast to human skin) that allow for the creation of axial pattern flaps.

(1 mark)

Answer 7

“Axial pattern flaps incorporate a direct cutaneous artery and vein, terminal branches of which supply blood flow and drainage for the subdermal plexus.”

Source: Tobias

Canine and Feline skin has large direct cutaneous arterioles and loose subcutaneous connections allowing free movement of skin over the underlying structures with a dedicated blood supply. Additionally, across the trunk there are paniculi muscles which contain complex vascular connections.

Conversley, Human skin has multiple small arterioles and close subcutaneous connections preventing free movement of the skin over the underlying structures and direct cutanous blood supply.

Question 8

Name six (6) examples of axial pattern flaps in the dog.

(3 marks)

Answer 8

• Temoral
• Caudal auricular
• Omocervical
• Cranial epigastric
• Caudal epigastric
• Thoracodorsalus
• Dorsal superficial circumflex iliac
• Superficial brachial
• Medial genicular
• Reverse saphenous
• Caudal-lateral (‘tail’)

Question 9

List four (4) patient factors that may affect cutaneous wound healing and briefly describe how each factor affects healing.

(8 marks)

Answer 9

1. Endocrine diseases
2. Metabolic disease
3. Hypoalbuminaemia (malnutrition)
4. Sepsis
5. Hypothermia – reduced skin perfusion
6. Infection of skin with resistant bacteria
7. Immune suppression
8. Anaemia

Question 10

List four (4) intrinsic (local wound) factors that may affect cutaneous wound healing and briefly describe how each factor affects healing.

(8 marks)

Answer 10

1. Size
2. Location
3. Chronicity
4. Bacterial count
5. Perfusion
6. Moisture
7. Temperature
8. Necrotic tissue
9. Cause – Trauma vs Surgical

Question 11

List the basic principles of surgical arthrodesis.

(4 marks)

Answer 11

The best laid principles for achieving a successful joint fusion have been outlined by Glissan [9] in his article discussing ankle arthrodesis. These principles are

(1) complete removal of all cartilage, fibrous tissue, and any other material that may prevent the contact of raw bone surfaces;
(2) accurate and close fitting of the fusion surfaces;
(3) optimal position of the joint; and
(4) maintenance of the bone apposition in an undisturbed fashion until the fusion is complete.

Question 12

List four (4) indications for pancarpal arthrodesis.

(4 marks)

Answer 12

Carpal arthrodesis is commonly used as a salvage procedure for a joint that has been damaged as the result of a;

• collateral ligament injury
• hyperextension injury with or without luxation
• shearing injury
• articular fracture that is not repairable
• severe degenerative joint disease causing pain
• immune-mediated arthritis leading to joint collapse or pain
• neurogenic injury that affects only the distal limb.

Question 13

For each of the following modes of bone plate application, provide a brief description of the function of the plate, list the fracture configurations it is appropriate for and state whether it provides load sharing:

• (10 marks)*
  i. bridge plating
  ii. compression plating
  iii. neutralisation plating

Answer 13

i. bridge plating

• Function of the plate: To span the fracture gap. Often as the fracture gap cannot be reconstructed.
• List the fracture configurations: Comminuted fractures
• Load sharing: No

ii. compression plating

• Function of the plate: To apply axial compression over an anatomically reduced fracture. NB: ‘Pre-stressing’ the plate is improtant to achieve effective symettrical compression across the fracture gap.
• List the fracture configurations: Transverse.
• Load sharing: Yes

iii. neutralisation plating

• Function of the plate: To further stabalise an anatomically reduced fracture that has been stabalised with a trans-fracture screw (lag-screw) and/or cerclage wire.
• List the fracture configurations: Oblique
• Load sharing: Yes

Question 14

Describe the advantages of the locking compression plate (LCP) system compared to the dynamic compression plate system for fracture repair. Include in your answer a brief description of the likely mode of failure of each implant system.

(12 marks)

Answer 14

A LCP system functions like an external skeletal fixator as the apparatus functions as one unit. This is achieved by the ‘locking’ of the screw into the plate creating a more rigid fixation method.

In these systems ‘screw backout’ should not occur, preventing this mode of failure. For the screws to ‘backout’, all screws will simultaneously pull though the bone or fracture it.

DCP plates rely on the bone-screw interface

LCP plates rely on the core diametre of the screw and the screw-plate interface

Likely mode of failure:

• DCP:
  
  • Screw(s) backing out
  • Plate failure (undersizing the plate)
• LCP:
  
  • Plate failure
  • Bone fracture (bone pull out)
  • Screw breaking at the level of the plate due to small screw core diametre (i.e. in SOP system)

Question 15

List the anatomical components that comprise the common calcaneal tendon.

(3 marks)

Answer 15

Achillies tendon;

• Common tendon
  
  • Bicep femoris m.
  • Semitendinosus m.
  • Gracilis m.
• Gastrocnemius m.
  
  • Medial
  • Lateral
• Superficial digital flexor m.

Question 16

Partial disruption of the common calcaneal tendon is described most commonly in medium-to-large breed dogs. Outline the proposed pathophysiology of this condition.

(5 marks)

Answer 16

Strains result in disruption of the normal architecture of the muscle-tendon unit secondary to interstitial edema, hemorrhage, or overstretching.

With mild contusions and strains, cells and the endomysial sheath are not destroyed, and their preservation allows complete healing.

However, if the contusion is severe and causes extensive cell death and hemorrhage precluding muscle regeneration, healing occurs with fibrous interposition between muscle ends. Excessive scarring may impede muscle fiber regeneration and interfere with muscle contraction.

Question 17

Explain why the digits in the affected limb are flexed when there is hyperflexion of the tarsocrural joint, in a patient with disruption of the common calcaneal tendon.

(2 marks)

Answer 17

If the entire tendon complex is involved, the tarsus and the digits hyperflex

If the tendon of the superficial flexor muscle is not involved, the tarsus will hyperflex and the digits will flex

Source: Fossum

Question 18

List the two (2) main goals of tendon repair. Briefly describe the intra-operative and post-operative considerations that can optimise tendon healing.

(8 marks)

Answer 18

Surgical repair involves:

• Primary anastomosis of the tendon (tenorrhaphy) or
• Reinsertion of the tendon on the calcaneus.

Goals of tendon repair:

• Anatomical re-apposition of tendons
• Promote healing
• Support the ligament through to the remodelling phase

Post-operative:

The cast and transfixation pin, or external fixators are placed for 3 to 6 weeks, after which both may be removed. The limb should then be supported in a padded bandage to prevent full dorsal flexion of the tarsus. If an external fixator was used, it may be dynamized by the use of hinges or resistance bands. Hinges placed at the center of rotation of the joint can be adjusted to increase the range of motion and subsequently the tendon load. Elastic bands placed between the pins above and below the joint to replace the sidebars allow partial loading of the tendon.

Activity should be limited to leash walking for 10 weeks.

Question 19

Name and draw two (2) recommended suture patterns described for approximating tendon ends.

(5 marks)

Answer 19

• Near-far-near-far suture
• Bunnell-Mayer technique
• Three-loop pulliey
• Locking loop
• Krackow suture (Flat tendons)

Question 20

Identify the suture pattern recommended for apposition of round tendons.

(1 mark)

Answer 20

• Bunnell Mayer tendonsuture pattern
• Locking loop
• Three loop pulley suture

Question 21

With reference to tendon healing, describe the differences between tendons with a paratenon versus tendons with a tendon sheath. Include in your answer an example of each.

(4 marks)

Answer 21

True tendon sheaths are only found in areas with an increased friction or sharp bending of the tendons (e.g., flexor tendons of the hand).

A simple membranous thickening of the surrounding soft tissue, called the paratenon, usually surrounds tendons without a true synovial tendon sheath, such as the Achilles tendon.

Examples:

• Tendon with tendon sheath: Digitial flexors
• Paratenon; Achilles tendon

Question 22

State the expected strength (as a percentage of normal tendon strength) of a tendon that is primarily repaired:

i. at six weeks post-operatively (1 mark)
ii. at one year post-operatively. (1 mark)

Answer 22

At 6 weeks post repair, the tendon will have achieved 56% of its original strength

This slowly increases to a figure of 79% of normal strength at 1 year post repair

Source: Tobias

Question 23

You are presented with a five-year-old, male neutered Yorkshire terrier with a four-day history of lethargy and anorexia. His owner has witnessed two episodes of vomiting today and describes the vomitus as yellow liquid. You perform abdominal radiographs as part of your diagnostic process.

a) List four (4) findings on plain abdominal radiography that would support the diagnosis of a small intestinal foreign body obstruction.
* (4 marks)*

Answer 23

• Two distinct populations of SI
• Vistable foreign body in SI
• Tapering of gas in SI (around FB)
• SI gas dilation:
  
  • Dogs:
    • >1.6x L5 = Distension
    • > 2x L5 = Highly likely
  • Cats:
    • > 3x L2 endplate = Strongly associated with obstruction
    • > 4x L2 endplate = Nearly always obstruction.

Question 24

You are presented with a five-year-old, male neutered Yorkshire terrier with a four-day history of lethargy and anorexia. His owner has witnessed two episodes of vomiting today and describes the vomitus as yellow liquid. You perform abdominal radiographs as part of your diagnostic process.

You elect to perform an exploratory laparotomy for suspected small intestinal foreign body obstruction.

b) List four (4) methods by which viability of the small intestine can be assessed during surgery (4 marks). For each method, describe the features that should be assessed to indicate viability or non-viability
* (4 marks).*

Answer 24

• Colour
  
  • Pink and red = Viable
  • Black = Non-viable
• Peristalsis
  
  • Peristalsis = Viable
  • No-peristalsis = Questionable viability
• Bleeding when cut
  
  • Bleeding = Viable
  • Not-bleeding = Non-viable
• Palpable pulses:
  
  • Pulses = Good
  • No-bulses = Bad
• Capillary refil:
  
  • Present = Good
  • Delayed = Bad

Question 25

You are presented with a five-year-old, male neutered Yorkshire terrier with a four-day history of lethargy and anorexia. His owner has witnessed two episodes of vomiting today and describes the vomitus as yellow liquid. You perform abdominal radiographs as part of your diagnostic process.

You elect to perform an exploratory laparotomy for suspected small intestinal foreign body obstruction.

c) Name the layers of the small intestine and identify the strength-holding layer that should be incorporated into your closure.
* (3 marks)*

Answer 25

• [Lumen]
• Mucosa
• Sub-mucosa – Suture holding later
• Muscularis
• Serosa
• [Peritoneum]

Question 26

You are presented with a five-year-old, male neutered Yorkshire terrier with a four-day history of lethargy and anorexia. His owner has witnessed two episodes of vomiting today and describes the vomitus as yellow liquid. You perform abdominal radiographs as part of your diagnostic process.

You elect to perform an exploratory laparotomy for suspected small intestinal foreign body obstruction.

d) State two (2) methods for augmenting an enterotomy closure. Describe how each of these methods augments closure and, for each method, briefly describe one (1) enteric surgical scenario in which the method would be employed.
* (7 marks)*

Answer 26

• Tacking or draping the omentum over the site
  
  • The omentum brings new blood vessesl (neovascularisation), nutrients, and pluripotent cells to speed healing.
  • Scenario; Resection and anastymosis
• Serosal patch
  
  • The tacking of other small intestinal loops onto the enterotomy site so the adjasent serosa can contribute to the healing process
  • Scenario; Intersusception (debatable)

Question 27

You are presented with a five-year-old, male neutered Yorkshire terrier with a four-day history of lethargy and anorexia. His owner has witnessed two episodes of vomiting today and describes the vomitus as yellow liquid. You perform abdominal radiographs as part of your diagnostic process.

You elect to perform an exploratory laparotomy for suspected small intestinal foreign body obstruction.

e) Name a type of feeding tube that would be appropriate for post-operative nutritional support in this patient.
* (1 mark)*

Answer 27

Esophageal feeding tube. Although it is orad to the site of injury, if an appropriate soft food gastro-intestinal or recovery diet is fed, it should be able to pass the small intestinal enterotomy site without causing damage, in fact, the direct nutrition to the luminal enterocytes is protective.

Question 28

You are presented with a five-year-old, male neutered Yorkshire terrier with a four-day history of lethargy and anorexia. His owner has witnessed two episodes of vomiting today and describes the vomitus as yellow liquid. You perform abdominal radiographs as part of your diagnostic process.

You elect to perform an exploratory laparotomy for suspected small intestinal foreign body obstruction.

f) For the feeding tube type stated in 1 e), briefly describe the specific indications for its use, its contra-indications and the potential complications associated with its placement and use.
* (7 marks)*

Answer 28

• Indications:
  
  • Inappetant patients
  • Oral/maxillo facial surgery
• Contra-indications:
  
  • Oesophageal surgery
  • Most gastric surgeries
• Potential complications
  
  • Local dermatitis at tube site
  • Haemorrhage when placed
  • Aspiration
  • Inappropriate placement (placement into the fascia and mediastinum have been described).
  • Oesophageal trauma
  • Oesophageal sphincter obstruction resulting in gastric reflux
  • Oesophagitis
  • Thoraxic disease trom oesophageal trauma

Question 29

Name the most common surgical approach to the feline middle ear and identify the most commonly noted complication of this procedure.

(1 mark)

Answer 29

Approach - Ventral bulla osteotomy

Complication - Horners due to trauma of the sympathetic trunk

Question 30

Identify the anatomic difference between the feline and canine middle ear and describe its surgical relevance.

(2 marks)

Answer 30

1. The sympathetic trunk runs within the middle ear (at the promontory) in cats.
   * The dorso-medial aspect of the middle ear should be avoided in both dogs and cats due to the round and oval windows, however, the medial aspect of the middle ear in cats (the promontory) should also be avoided during curatage to prevent trauma of the sympathetic trunk
2. Cats have a osseous septum in their middle ear
   * This septum needs to be accounted for within the surgery to ensure complete clearance of the bulla
3. Cats have a more prominate and easily accessable ventral aspect of the bulla
   * This allows VBO’s to be more easily performed in cats

Question 31

List three (3) radiographic views that can be used to image the middle ear.

(3 marks)

Answer 31

1. Open-mouth (rostral 30-degree ventral–caudodorsal open-mouth oblique)
2. Two opposite obliques (left 20-degree ventral–right dorsal oblique and right 20-degree ventral– left dorsal oblique)
3. Ventrodorsal (VD) or dorsoventral (DV).
4. Lateral

Question 32

Name the imaging modality that is considered to be superior to radiographs for imaging the middle ear. Briefly justify your answer.

(2 marks)

Answer 32

CT - Computet tomography

• It allows multi-planar reconstruction of the complex osseous structures and visualisation of air, soft tissue, or osseous structures within the bulla.

Question 33

List three (3) indications for a total ear canal ablation and lateral bulla osteotomy (TECALBO) in the dog.

(3 marks)

Answer 33

• Neoplasia;
  
  • Middle ear neoplasia
  • +/- External ear (horisontal ear canal) neoplasia
    
    • e.g. Ceruminous gland adenocarcinoma
• Inflammation;
  
  • Primary secretory disease - CKCS
  • Feline inflammatory polyps
• Infection;
  
  • Otitis media,
  • Chronic Otitis externa

Question 34

In addition to TECALBO, name two (2) other external ear canal surgical procedures and provide an indication for each.

(2 marks)

Answer 34

• Lateral ear canal resection - Zepps procedure
  
  • Indication: Vertical ear canal stenosis with normal horisontal ear canal
• Vertical canal ablation
  
  • Indication: Chronic OE, Neoplasia

Question 35

List four (4) complications associated with TECALBO in the dog. Describe the steps that can be taken to avoid each complication, including a description of the relevant anatomy.

(15 marks)

Answer 35

• Wound dehiscence; Appropriate tissue handling, closure of dead-space and tension free closure
• Facial nerve deficits; Protect the facial nerve
• Vestibular disease; Preserve the
• Para-aural abscessation; Aseptic technique, copious lavage
• Fistula formation; Debride bulla
• Loss of ear carriage; Preserve cranial auricular artery

Source: Ronan S Doyle (2014)

Question 36

Justify samples that should be collected intra-operatively during a TECALBO.

(2 marks)

Answer 36

• Culture:
  
  • Most sources recommend an ‘exit culture’ which is a swab of the bulla after the curatage and lavage has been performed
  • This allows an assessment of what pathogens have been left and what treatment is needed to be performed
• Histopathology:
  
  • Histopathology of the epithelial lining of the tympanic bulla is important to (1) ensure no neoplasia is present and (2) to ensure the process was inflammatory or infectious and hence the treatment was appropriate.

Question 37

Discuss the options available for management of hyperkalaemia in a feline patient with a urethral obstruction. No dosages are required. Where relevant, justify parameters that should be monitored.

(10 marks)

Answer 37

Calcium gluconate is the treatment of choice for cats with severe hyperkalemia, bradycardia, and electrocardiographic instability. Calcium gluconate (10%) is administered at 0.5 to 1 mL/kg IV slowly over 2 to 3 minutes while continuously monitoring the electrocardiogram.

Rehydration

Cystocentesis

Release of blockage

IV dextrose (+/- insulin)

Sodium bicarbonate may be administered in cats with severe hyperkalemia to help translocate potassium from the plasma into the intracellular fluid in exchange for hydrogen ions.

Question 38

Name three (3) types of radio-opaque uroliths.

(3 marks)

Answer 38

Calcium oxalate

Struvite (magnesium sulphate)

Calcium phosphate

Silica

Question 39

With respect to feline perineal urethrostomy, describe the key intra-operative

techniques that reduce the risk of stricture formation.

(10 marks)

Answer 39

• Place a u-cath to confirm urethra lumen
• Ensure appropriate depth of urethrotomy
  
  • down the the bulbourethral glands
  • Transect the paired muscles
• Appropriate suturing of urethral epithelium to the skin
• MORE

Question 40

Other than placement of a cystostomy tube, name two (2) surgical procedures that could be performed if stricture occurs at a perineal urethrostomy site.

(2 marks)

Answer 40

• Repeat surgery
• Balloon dilation
• Permanent urinary diversion may be performed by anastomosing the ureters into the intact colon, jejunum, or ileum.

Useless:

• Scrotal urethrostomy
• Transpelvic urethrostomy

Question 41

Name one (1) drug that can be used to manage detrusor atony.

(1 mark)

Answer 41

Bethanechol chloride (Urocarb)

Bethanechol primarily affects the urinary and GI tracts. Its effect on the bladder results from stimulation of muscarinic receptors in the detrusor muscle. The detrusor contracts, decreasing bladder capacity and producing urination.

Question 42

Name four (4) post-operative complications, other than stricture formation, that can occur following perineal urethrostomy.

(4 marks)

Answer 42

• Self trauma
• SSI/UTI/Pyelonephritis
• Sterile Cystitis (FLUTD)
• Mechanical obstruction of urethrostomy site (commonly with litter)
• Haemorrhage
• Urinary retention
• Subcutaneous urine leakage
• Urinary (and faecal) incontinence

Question 43

A 10-year-old, female, spayed German shepherd dog is presented for its annual health check. Routine abdominal palpation reveals a mobile eight-centimetre mass in the tail of the spleen. The remainder of the full history and clinical examination reveal no other abnormalities.

a) List four (4) differentials for the palpable splenic mass. Identify the most common differential diagnosis in your answer.
* (2 marks)*

Answer 43

Splenic masses;

• Haemangiosarcoma - Most common
• Haemangioma
• Metastatic disease:
  
  • Mast cell tumour
  • Lymphoma
  • Histiocytic sarcoma (diffuse)
• Benign hepatic hyperplasia
• Non-neoplastic causes:
  
  • Abscess
  • Hematoma secondary to trauma
• Infiltrative/infectious disease (fungal, bacterial)

Plus non-splenic masses (mis-diagnosis)

Question 44

A 10-year-old, female, spayed German shepherd dog is presented for its annual health check. Routine abdominal palpation reveals a mobile eight-centimetre mass in the tail of the spleen. The remainder of the full history and clinical examination reveal no other abnormalities.

b) Discuss the diagnostic testing appropriate to further characterise this patient’s disease prior to definitive management. Justify each diagnostic test in relation to this particular case.
* (8 marks)*

Answer 44

Imaging:

• Ultrasound
  
  • aFAST; determine free fluid (abdominal fluid score)
  • Examination of other organs (mets)
• Radiographs
  
  • Thoracic radiographs; thoracic metastases
  • Abdominal radopgraphs;
• Advanced imaging (CT scan)
  
  • High sensitivity for acute haemorrhage (haematoma sign - hyperattenuating)
  • Further met search

Coags (APTT/PT +/- TEG);

• Monitoring for coagulopathy (hepatic, rodenticide, IMTP, etc)

CBC;

• Assessment of concurrent inflammatory disease - should be normal in acute disease (may be anaemic if 6+ hours post-bleed).
• Surveillance for thrombocytopenia

BCM;

• Monitoring for concurrent disease (most patients are middle to geriatric patients)
• BG
• Lactate
• Electrolytes

Blood gas;

• Important for goal oriented therapy prior to anaesthetic

Peritoneal fluid analysis:

• Colour analysis; Hemo-, uro-, chylo-
• Fluid-Lactate
• Fluid-BG
• Fluid-PCV/TP
• +/- Fluid-Urea/Crea/Ph (if uroabdomen)

Question 45

A 10-year-old, female, spayed German shepherd dog is presented for its annual health check. Routine abdominal palpation reveals a mobile eight-centimetre mass in the tail of the spleen. The remainder of the full history and clinical examination reveal no other abnormalities.

c) In this case, an exploratory laparotomy is performed to investigate the splenic mass and, intra-operatively, the liver is found to have multiple nodules throughout its parenchyma. Interpret this finding and describe the action(s) that should be taken by the surgeon.
* (6 marks)*

Answer 45

Multiple nodules within the liver;

• This indicates the potential for metastatic disease or a separate disease process (such as benign hepatic nodular hyperplasia)
• Metastatic disease should be considered.
• Samples should be taken from multiple hepatic masses and if possible, they could be resected (communication with the owner is important).

Note; the spleen (if diseased) should still be removed as per the initial goal of the surgery.

Perform full abdominal examination and biopsy abnormal tissue (such as Liver, Stomach, duodenum, ilium, local LNN)

All samples should be sent for histopathology. Additionally, hepatic culture and copper analysis should be performed to identify underlying hepatic bacterial infiltrates and copper storage diseases.

Question 46

A 10-year-old, female, spayed German shepherd dog is presented for its annual health check. Routine abdominal palpation reveals a mobile eight-centimetre mass in the tail of the spleen. The remainder of the full history and clinical examination reveal no other abnormalities.

d) In your answer booklet, draw a labelled diagram showing the gross vascular supply to the spleen. Note on your diagram where you would ligate these vessels for the rapid (non-hilar) splenectomy technique.
* (10 marks)*

Answer 46

Ligation for a rapid (non-hilar) splenectomy technique should be

• The tail of the spleen (where the spleen is attached to the greater omentum)
• The Splenic artery (distal to the left pancreatic arterial branch)
• The left gastroepiploic a./v.
• The short gastric a./v.

See image for anatomy

Question 47

A 10-year-old, female, spayed German shepherd dog is presented for its annual health check. Routine abdominal palpation reveals a mobile eight-centimetre mass in the tail of the spleen. The remainder of the full history and clinical examination reveal no other abnormalities.

e) Name two (2) surgical methods, other than suture ligation, that are appropriate to achieve haemostasis of the splenic blood vessels noted in part 4 d).
* (2 marks)*

Answer 47

• Vessel sealing devices (ligasure)
• Hemoclips
• TA staples (White - V30)

Question 48

A 10-year-old, female, spayed German shepherd dog is presented for its annual health check. Routine abdominal palpation reveals a mobile eight-centimetre mass in the tail of the spleen. The remainder of the full history and clinical examination reveal no other abnormalities.

f) Name the two (2) most common types of splenic neoplasia in cats. (2 marks)

Answer 48

Mastocytoma

Lymphosarcoma

Myeloproliferative disease

Hemangiosarcoma, in that order, accounted for the bulk of neoplasia

W L Spangler (1992)