Spleen Surgery Flashcards

1
Q

What are 5 functions of the spleen?

A
  1. blood filtration and phagocytosis
  2. immunity against blood-borne antagonists
  3. blood reservoir
  4. iron storage
  5. hematopoiesis
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2
Q

What are 3 indications for total splenectomies?

A
  1. solitary/diffuse neoplasia
  2. torsion
  3. uncontrolled IMHA
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3
Q

What 3 vessels require ligations prior to taking the spleen out in splenectomies?

A
  1. short gastric
  2. left gastroepiploic
  3. splenic
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4
Q

What are the 2 methods of ligating vessels in splenectomies?

A
  1. ligation of individual hilar vessels - not recommended, very time-consuming
  2. ligation of major splenic vessels

LDS ligating stapler, hemoclips, or Ligasure can be used

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5
Q

What 3 complications are associated with total splenectomies?

A
  1. hemorrhage/bleeders
  2. pancreatitis or pancreatic necrosis if vascular supply is damaged by aggressive handling
  3. gastric necrosis if vascular supply to greater curvature is damaged by aggressive handling
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6
Q

When are partial splenectomies indicated? When are they avoided?

A

preserving splenic function when only part of the organ is destroyed or damaged, commonly with injuries and focal abscesses

neoplasia

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7
Q

How do partial splenectomies compare to total splenectomies?

A

more technically challenging —> thick capsule is helpful compared to partial liver lobectomies

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8
Q

What are the 5 steps fo partial splenectomies?

A
  1. vascular ligation close to hilus
  2. hold for a few minutes to visualize line of demarcation
  3. finger tip pressure on the demarcation
  4. place GI, hemostatic, or vascular forceps along the proposed line of excision
  5. use mattress suture or staples through splenic parenchyma
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9
Q

Partial splenectomy:

A
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10
Q

What are siderotic plaques?

A

deposition of iron or calcium on the surface of the spleen, considered normal with age in dogs (NOT associated with neoplasia)

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11
Q

How is splenomegaly diagnosed?

A
  • abdominal palpation
  • radiographs and ultrasounds based on size, position, density, and visceral displacement
  • PCV, WBC, platelets
  • ultrasound guided FNA/biopsy
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12
Q

What are 3 causes of asymmetrical splenomegaly?

A
  1. neoplasia - HSA/hemangioma
  2. benign splenic nodular hyperplasia - splenoma
  3. hematoma (trauma)
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13
Q

What are 4 causes of symmetrical splenomegaly?

A

increased cellularity cause by…

  1. extramedullary hematopoiesis - regenerative reaction
  2. neoplasia - MCT in cats
  3. intravascular disease - Ehrlichiosis
  4. congestion secondary to torsion or venous occlusion
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14
Q

What is the most common primary tumor of the spleen? What are some other examples?

A

HSA

  • hemangioma
  • lymphoma
  • sarcoma
  • fibrosarcoma
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15
Q

Where do hemangiosarcomas arise from? In what dogs are they most common?

A

vascular endothelium

older male dogs, especially GSD, Golden Retrievers, Labradors, and Pitbulls

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16
Q

How do hemangiosarcomas commonly act?

A

early metastasis to the liver, omentum, LNs, skin, and lungs (good access to bloodstream)

17
Q

What is a common concurrent disorder seen in dogs with splenic hemangiosarcoma?

A

cardiac hemangiosarcoma, especially in the right atrium

18
Q

What are the most common clinical signs associated with hemangiosarcoma?

A
  • episodic weakness with fatigue
  • enlarged abdomen with discomfort
  • vague GI signs
  • malaise
  • hemoglobinuria
  • sudden collapse
19
Q

What are 3 common radiographic signs associated with splenic hemangiosarcomas?

A
  1. cranioventral spherical mass on the spleen
  2. displacement of viscera
  3. hemoperitoneum (seen on ultrasound too)
20
Q

What is the treatment for splenic hemangiosarcoma? What 4 perioperative considerations should be used?

A

total splenectomy

  1. fluid replacement
  2. CBC and chemistry
  3. coagulation profiles
  4. transfusions
21
Q

What is splenic benign nodular hyperplasia? What clinical significance does it have? How is it treated?

A

single or multiple small nodules on the spleen, commonly an incidental finding in older dogs

may rupture or undergo malignant transformation

total splenectomy

22
Q

What are the 3 severities of splenic trauma?

A
  1. SEVERE = deep lacerations, extensive crushing
  2. MODERATE = lacerations, vessel disruption
  3. MILD = small hematomas
23
Q

What are the 3 radiographic features of splenic trauma?

A
  1. loss of detail due to hemoperitoneum
  2. visceral displacement due to hematoma development or splenomegaly
  3. small or irregular spleen
24
Q

What are the most common clinical findings associated with splenic trauma?

A
  • severe blood loss can lead to hypovolemia and shock
  • abdominal discomfort or enlargement
25
Q

What is splenosis?

A

benign ectopic spleen found in the vasculature of the omentum

26
Q

How is hemorrhage confirmed in suspected cases of splenic trauma? How is it treated?

A
  • radiographs, ultrasound
  • abdominal paracentesis
  • diagnostic peritoneal lavage

blood/fluid replacement and/or partial/total splenectomy

27
Q

What are 3 causes of congestion that can lead to symmetrical splenomegaly?

A
  1. torsion and venous occlusion
  2. CHF, portal hypertension
  3. capsule relaxation
28
Q

What neoplasias in cats can cause symmetrical splenomegaly?

A

MCT and malignant lymphoma —> causes hyperplasia in the bone marrow and spleen

29
Q

What is splenic torsion? In what animals is this most common? How does it affect the spleen?

A

rotation of the spleen around the vascular pedicle

large and giant breed dogs —> gastropexy commonly done with surgery

congestive splenomegaly as a result of the venous occlusion and sequestration of RBCs

30
Q

What are the 4 clinical findings is cases of acute splenic torsion?

A
  1. physical discomfort
  2. salivation, gagging, retching (gastric torsion)
  3. tachycardia, tachypnea
  4. cardiovascular collapse, shock
31
Q

What are some differential diagnoses for splenic torsion?

A
  • GDV
  • rupture and hemorrhage from neoplasm (HSA)
  • intestinal strangulation/mesenteric torsion
  • pancreatitis
  • peritonitis
  • torsion of uterus or intrabdominal testicle
  • poisoning
32
Q

What are the 2 main treatments for splenic torsion?

A
  1. repositioning if there is no thrombosis seen in vessels of splenic pedicle
  2. splenectomy + gastropexy when thrombosis if present
33
Q

What should be monitored for following a splenectomy?

A
  • gastric torsion in at risk breeds (GSD, Great Danes) —> prophylactic gastropexy common
  • ventricular tachycardia