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Lymphoreticular > Small Animal Splenic Disorders > Flashcards

Small Animal Splenic Disorders Flashcards

1
Q

Which ends of the spleen are fixed and free?

A
  • tail ventral and free

- head fixed by gastrosplenic ligament

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2
Q

What is the capsule of the spleen made from?

A

smooth muscle

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3
Q

Where does the splenic artery arise from? What does it divide into?

A

celiac artery -> 25 hilar arteries (small) enter the spleen on concave surface

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4
Q

Where does the splenic vein drain to?

A

portal vein

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5
Q

What are the important branches of the splenic artery/vein supplying?

A
  • left limb of pancreas (important as only blood supply)
  • greater curvature of the stomach (left hastroepiploic, less critical)
  • fundus of stomach (short gastrics, not too critical)
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6
Q

Which vessels are first to rupture in GDV?

A

short gastrics (in a healthy animal this doesn’t cause too much problem)

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7
Q

How is the pancreas associated with the spleen?

A

If spleen lifted up with mesentry, pancreas lies underneath

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8
Q

Where do the splenic a and v lie?

A

in the mesentry

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9
Q

Does splenectomy cause problems for animals?

A

-not as serious as in humans (septicaemia risk ^)

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10
Q

Outline 5 main fucntions of the spleen

A

> RBC maintainance
- filtration and phagocytosis, removing intraerythrocytic inclusions (eg. Heinz bodies)
Iron metabolism
- removal of old RBCs
Blood reservoir
- esp canine and feline (10-20% blood volume)
Haematopoiesis
- can resume haematopoietic functions if BM compromised
immune function

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11
Q

Where are the different functions carried out?

A
  • RBC maintainance, iron metabolism, blood reservoir and haematopoiesis = red pulp
  • immune function WBC
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12
Q

Can the spleen be biopsied pre-op?

A

Not really , will just get blood

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13
Q

What should be done before splenectomy if neoplasia is suspected?

A

Staging to adivise owner

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14
Q

Outline long procedure for total splenectomy

A
  • start tail end
  • double ligate and transect hilar vessels
  • reach head, try and preserve short gastric vessels
  • transect gastrosplenic ligament
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15
Q

Outline quick spelenctomy technique

A
  • ligate short gastric vessels
  • ligate left gastroepiploic a and v and splenic a + v distal to branch supplying pancreas
    > may be impossible if ruptured splenic mass or distorted anatomy present (torsion/GDV)
  • be careful not to ligate branch supplying pancreas ( lies close to hilar branches)
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16
Q

When is partial spleenectomy indicated?

A

localised, benign disease (hard to prove this)

17
Q

Outline partial splenectomy technique

A
  • hilar vessels ligated
  • leave to observe area of ischaemia
  • squeeze towards end being removed
  • place DOYEN intestinal forceps
  • remove disease porion
    > 2 rows mattress sutures in a continuous overlapping patern
  • close cut end using continuous (fine absorbable suture)
    > OR staple (quicker)
18
Q

What are dogs with splenic masses at higher risk of? How can these risks be managed?

A 
> cardiac arrhythmias
- ECG monitor
- fluid tx
- antidysrhythmics rarely
> DIC [neoplastic or torsion]
- pre-op coagulation tests (PT, APTT) 
- esp if intra-ab haemorrhage seen 
> people not sure why these links exist
19
Q

Considerations perioperatively for splenectomy

A
  • waterporroff drapes
  • haemostatic forceps and swabs
  • count in and out
  • measure blood suction bottle and weigh swabs (1ml blood = 1.3g)
  • gastropexy in pdf breeds for GDV (no evidence to support currently)
  • monitor vitals and PVC/TP postop ash ameorrhage main complication
20
Q

Main complications of splenectomy

A

> haemorrhage (technical failure or DIC)
cardiac arrhythmias
poss ^ risk infection (onlyif immunosuppressed)
previous subclinical infection with haemoparasites eg. Babesia, Ehrlichia, Mycoplasma may become evident

21
Q

Ddx of splenomegaly

A

> localised (dogs)
- neoplastic (benign: haemangioma, leiomyoma, fibroma, lipoma) (malignant: HS, fibroS, leimyoS, sarcomas in general)
-non-neoplastic (haematoma, abscess, nodular hyperplasia, cyst, infarction - infarction usually many concurrent medical problems)
diffuse (cats)
- infection (bacterial, fungal, viral, parasitic)
- congestion (drugs eg. barbituates, splenic torsion and/or GDV, RSHF)
- neoplasia (acute/chronic leukaemia, systemic MCT esp cats, lymphoma, multiple myeloma, malignant histiocytosis)
- immune-mediated thrombocytopaenia (splenectomy only performed if animal refrctory to tx with immunosuppressive drugs)

22
Q

What is the best method of differentiating splenomegaly? Which kind of splenomegaly is it best for?

A

FNA for DIFFUSE
- for localised haematoma/haemangiosarcoma often blood only
ULTRASOUND to differentiate spleen and liver and find mets

23
Q

What is the most comon malignant splenic tumour in the dog?

A

Hemangiosarcoma (esp GSD)

24
Q

Outline characteristics of splenic HS

A
  • aggressive, freq metastasise to liver, omentum, mesentry, brain, RA and subcut
  • 25% dogs with splenic HS have concurrent RA
  • grossly indistinguishable from haemangioma or haeatoma (and challenging even with histopath)
25
Q

What further diagnostics should be performed if a splenic mass is found?

A

> cannot distinguish haematoma, haemangioma and haemangiosarcoma
- thoracic rads or CT to look for pulmonary mets for staging

26
Q

When may a non-disease spleen appear enlarged?

A

Some sedative drugs can relax smooth muscle -> capsular swelling and enlargement

27
Q

Tx for HS with no evidence of metastasis? Prognosis?

A
  • splenectomy
  • only palliative
  • survival ~3-12weeks ( ~6months survival
28
Q

What 2 pathologies are failry rare for the spleen?

A
  • torsion

- trauma

29
Q

How does splenic torsion occour and how can it be dx?

A
  • deep chested dogs (think GDV)
  • spleen twists on vascular pedicle, ocluding hilar vessels
    > acute presentation with abdo pain, distenion, shock
    > chronic form intermittent and v hard to dx
  • US = enlarged spleen, unique pattern of linear echos (“SNOWSTORM”)
30
Q

Tx splenic torsion?

A
  • splenectomy
  • do NOT Untwist pedicle before removing (will cause reperfusion injury and release of vasoactive mediators)
  • divide and ligate the pedicle
31
Q

Px splenic torsion?

A

after successful splenectomy prognosis is EXCELLENT

32
Q

How does splenic trauma usually occour?

A
  • surgical trauma (accidental incision) or serious RTA etc.
  • if RTA related, other wounds usually more serious and haemorrhage will either self resolve while treating other things or they are so severe that the injuries are fatal
33
Q

Tx splenic laceration surgically?

A
  • suture sapsule
  • suture omentum over laceration
  • severe or persistnet haemorrhage -> splenectomy to deal with any ischaemia
34
Q

What may occour after rupture of the spleen?

A
  • multiple small splenic nodules called splenosis may be seen thorughtout the abdomen

Lymphoreticular (31 decks)

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