Spleen Surgery Flashcards
What are 5 functions of the spleen?
- blood filtration and phagocytosis
- immunity against blood-borne antagonists
- blood reservoir
- iron storage
- hematopoiesis
What are 3 indications for total splenectomies?
- solitary/diffuse neoplasia
- torsion
- uncontrolled IMHA
What 3 vessels require ligations prior to taking the spleen out in splenectomies?
- short gastric
- left gastroepiploic
- splenic
What are the 2 methods of ligating vessels in splenectomies?
- ligation of individual hilar vessels - not recommended, very time-consuming
- ligation of major splenic vessels
LDS ligating stapler, hemoclips, or Ligasure can be used
What 3 complications are associated with total splenectomies?
- hemorrhage/bleeders
- pancreatitis or pancreatic necrosis if vascular supply is damaged by aggressive handling
- gastric necrosis if vascular supply to greater curvature is damaged by aggressive handling
When are partial splenectomies indicated? When are they avoided?
preserving splenic function when only part of the organ is destroyed or damaged, commonly with injuries and focal abscesses
neoplasia
How do partial splenectomies compare to total splenectomies?
more technically challenging —> thick capsule is helpful compared to partial liver lobectomies
What are the 5 steps fo partial splenectomies?
- vascular ligation close to hilus
- hold for a few minutes to visualize line of demarcation
- finger tip pressure on the demarcation
- place GI, hemostatic, or vascular forceps along the proposed line of excision
- use mattress suture or staples through splenic parenchyma
Partial splenectomy:
What are siderotic plaques?
deposition of iron or calcium on the surface of the spleen, considered normal with age in dogs (NOT associated with neoplasia)
How is splenomegaly diagnosed?
- abdominal palpation
- radiographs and ultrasounds based on size, position, density, and visceral displacement
- PCV, WBC, platelets
- ultrasound guided FNA/biopsy
What are 3 causes of asymmetrical splenomegaly?
- neoplasia - HSA/hemangioma
- benign splenic nodular hyperplasia - splenoma
- hematoma (trauma)
What are 4 causes of symmetrical splenomegaly?
increased cellularity cause by…
- extramedullary hematopoiesis - regenerative reaction
- neoplasia - MCT in cats
- intravascular disease - Ehrlichiosis
- congestion secondary to torsion or venous occlusion
What is the most common primary tumor of the spleen? What are some other examples?
HSA
- hemangioma
- lymphoma
- sarcoma
- fibrosarcoma
Where do hemangiosarcomas arise from? In what dogs are they most common?
vascular endothelium
older male dogs, especially GSD, Golden Retrievers, Labradors, and Pitbulls
How do hemangiosarcomas commonly act?
early metastasis to the liver, omentum, LNs, skin, and lungs (good access to bloodstream)
What is a common concurrent disorder seen in dogs with splenic hemangiosarcoma?
cardiac hemangiosarcoma, especially in the right atrium
What are the most common clinical signs associated with hemangiosarcoma?
- episodic weakness with fatigue
- enlarged abdomen with discomfort
- vague GI signs
- malaise
- hemoglobinuria
- sudden collapse
What are 3 common radiographic signs associated with splenic hemangiosarcomas?
- cranioventral spherical mass on the spleen
- displacement of viscera
- hemoperitoneum (seen on ultrasound too)
What is the treatment for splenic hemangiosarcoma? What 4 perioperative considerations should be used?
total splenectomy
- fluid replacement
- CBC and chemistry
- coagulation profiles
- transfusions
What is splenic benign nodular hyperplasia? What clinical significance does it have? How is it treated?
single or multiple small nodules on the spleen, commonly an incidental finding in older dogs
may rupture or undergo malignant transformation
total splenectomy
What are the 3 severities of splenic trauma?
- SEVERE = deep lacerations, extensive crushing
- MODERATE = lacerations, vessel disruption
- MILD = small hematomas
What are the 3 radiographic features of splenic trauma?
- loss of detail due to hemoperitoneum
- visceral displacement due to hematoma development or splenomegaly
- small or irregular spleen
What are the most common clinical findings associated with splenic trauma?
- severe blood loss can lead to hypovolemia and shock
- abdominal discomfort or enlargement
What is splenosis?
benign ectopic spleen found in the vasculature of the omentum
How is hemorrhage confirmed in suspected cases of splenic trauma? How is it treated?
- radiographs, ultrasound
- abdominal paracentesis
- diagnostic peritoneal lavage
blood/fluid replacement and/or partial/total splenectomy
What are 3 causes of congestion that can lead to symmetrical splenomegaly?
- torsion and venous occlusion
- CHF, portal hypertension
- capsule relaxation
What neoplasias in cats can cause symmetrical splenomegaly?
MCT and malignant lymphoma —> causes hyperplasia in the bone marrow and spleen
What is splenic torsion? In what animals is this most common? How does it affect the spleen?
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
What are the 4 clinical findings is cases of acute splenic torsion?
- physical discomfort
- salivation, gagging, retching (gastric torsion)
- tachycardia, tachypnea
- cardiovascular collapse, shock
What are some differential diagnoses for splenic torsion?
- GDV
- rupture and hemorrhage from neoplasm (HSA)
- intestinal strangulation/mesenteric torsion
- pancreatitis
- peritonitis
- torsion of uterus or intrabdominal testicle
- poisoning
What are the 2 main treatments for splenic torsion?
- repositioning if there is no thrombosis seen in vessels of splenic pedicle
- splenectomy + gastropexy when thrombosis if present
What should be monitored for following a splenectomy?
- gastric torsion in at risk breeds (GSD, Great Danes) —> prophylactic gastropexy common
- ventricular tachycardia
