Spleen, Liver, Kidney Flashcards
What artery supplies the spleen?
Celiac to splenic artery
What are some functions of the spleen?
Hematopoiesis, reservoir for RBCs and platelets, immunologic function
What are some splenic surgeries that are used?
Splenorrhaphy (rare), partial splenectomy, complete splenectomy
How do you close for a splenorrhaphy?
interrupted horizontal mattress for capsule with 4 or 5-0 absorbable monofilament
When is a partial splenectomy indicated?
Focal, benign diseases : abscess, laceration, partial infarction
How do you close for a partial splenectomy?
Suture capsule with double continuous pattern, TA stapler, CO2 laser, electrosurgery device
When is a complete splenectomy indicated?
Severe trauma, torsion, neoplasia, diffuse disease, immune-mediated disease
In emergent cases, how do you ligate the hilar vessels associated with the spleen?
Rapid 3 clamp technique
How do you surgically approach the spleen?
Ventral midline celiotomy
What are some post-op complications with the spleen?
Cardiovascular compromise, DIC
T/F: Benign and malignant tumors of the spleen can be differentiated best by abdominal ultrasound
False
What are some CxS seen with splenic neoplasia?
Inappetence, weakness, non-specific
What is the most common splenic tumor in dogs?
Hemangiosarcoma. Locally invasive, highly metastatic
What is the best way to treat hemangiosarcoma?
Surgery with Chemotherapy
What will you see with splenic torsion?
Vomiting, CV signs, weakness, anemia, hematuria, icterus
What is the most used diagnostic imaging tool for splenic torsion? What do you see?
Ultrasound. Absence of blood flow in hilar region
T/F: Before removing the spleen in a splenic torsion case, you want to untorse the spleen before the splenectomy.
False. DO NOT UNTORSE
What is the most common source of splenic trauma?
Hit by car
T/F: Surgery is the most indicated source of treatment for splenic trauma
False. Most cases can be managed conservatively
What arteries supply the right lobe of the pancreas? The left? The body?
Right - cranial/caudal pancreaticoduodenol artiers
Left - splenic artery
Body - hepatic artery
Which part of the pancreas takes up 98% of its mass? What is its function?
Exocrine pancreas. Makes digestive enzymes
What are some surgical techniques done on the pancreas?
Partial/complete pancreatectomy, pancreatic drainage
What methods can you use to get a biopsy of the pancreas?
Guillotine
Lobar dissection
When is a partial pancreatectomy indicated?
To remove a tumor, biopsy a large lesion
How do you perform a partial pancreatectomy?
Incise the capsule, dissect between lobules
T/F: total pancreatectomies are never performed
True
What is a pancreatic pseudocyst?
Collection of secretions and debris in a non-epithelialized sac. Diagnosed with ultrasound
What are the 3 options for treating pancreatic pseudocysts?
US guided aspiration, surgical resection, debridement and drainage
What typically occurs as sequela to pancreatitis?
Abscesses
How do you treat pancreatic abscesses?
Emergency surgery - debridement and omentalization
What is the most common pancreatic cancer in dogs and cats?
Exocrine pancreatic adenocarcinoma
T/F: EPA is highly malignant, locally invasive, and early to metastasize
True. Extremely poor prognosis
Where can a gastrinoma originate from?
Pancreas, duodenum, peripheral lymph nodes, mesentery
what % of cases already have metastasis by the time gastrinomas are diagnosed?
70%
How do you diagnose gastrinoma
Fasting gastrin serum concentrations
What CxS will you see with insulinomas?
weakness, seizures, collapse
How can you identify an insulinoma to diagnose?
Ultrasound, CT
How do you surgically treat insulinomas?
Resect all affected tissue
How do you stage insulinomas?
Biopsy regional lymph nodes and liver
What complications can occur with treatment of insulinomas?
Persistent hypoglycemia, hyperglycemia, pancreatitis
How many lobes does the liver have?
6
What arteries supply the liver?
Hepatic (20%), portal vein (80%)
What are some surgical procedures done with the liver?
Biopsy, partial/complete lobectomy
T/F: Multiple samples from multiples lobes are ideal with the liver
True
What are some methods of obtaining liver biopsies?
Guillotine, punch, laparascopy, tru-cut, FNA
What suture material do you use for a guiliotine biopsy?
3-0 absorbable
What are the indications for a guillitine biopsy of the liver?
lesions at peripheral, generalized disease
What are the indications for a punch biopsy of the liver?
Superficial lesions, generalized disease
T/F: FNA of the liver has the best diagnostic yield
False. Poor
How do you perform a complete liver lobectomy?
Place a ligature at the base of the lobe and resect
T/F: Complete liver lobectomies are only good for small dogs and cats on their left lateral and medial liver lobes
True
Which technique, stapler or sutures, do surgeons most common use for liver lobectomies?
Stapler
What is the biggest complication with liver surgery?
Hemorrhage, accidental ligation of portal veins and ducts
What is the most common form of neoplasia in the liver?
Metastatic
What are the 3 forms of adenocarcinomas in the dog liver?
Massive, nodular, diffuse
Which of the 3 forms of adenocarcinomas in the dog liver has the best prognosis? Worst?
Best - massive
Worst - diffuse
Where are cholangiocellular tumors located?
Intrahepatic
What is the most common malignant liver tumor in cats?
Carcinoma
What CxS will you see with liver trauma?
Acute blood loss
What can the pringle maneuver be used to control?
Hemorrhage of the liver, but only for short spurts at a time
What are two biliary surgeries performed?
Cholecystectomy, biliary stenting
When is a cholecystectomy indicated?
Mucocele, necrosis, cholangitis, lithiasis, neoplasia, trauma
What can cause biliary mucoceles?
Hypothyroidism, hyperadrenocorticism
What are the most common CxS seen with biliary mucoceles?
Vomiting, anorexia, lethargy
What are some things to cover when doing a cholecstectomy?
Ensure the common bile duct is working, collect bile for a culture, save gallbladder for histo
What procedure is used to remove stones and sludge from the gall bladder?
Choledochotomy
What does bile duct stenting do?
Promotes patency to the common bile duct
When is bile duct stenting most indicated?
Severe pancreatitis
When is biliary diversion indicated?
Irreparable trauma to the common bile duct
How large does the stoma need to be for a cholecystoduodenostomy?
3 cm
What are the most common portosystemic shunt types in small animal patients?
Congenital, single, extrahepatic
What CxS will you see with PSS on a cat?
Aggression, pytalism
What will you see on cytology of the urine with PSS?
Ammonium biurate crystals
What will you see on rads with PSS?
Microhepatica, enlarged kidneys
What molecule is used or nuclear scintigraphy of the PSS?
technetium pertechnetate 99
T/F: CT angiography is the most recommended test to run for PSS
True
When should you give medically treat for PSS?
At least 2 weeks before surgery, reduce diet, lactulose, antibiotics
T/F: Poor medical response is a sign of poor prognosis with PSS
True
