Spleen Sx-Exam 2

Question 1

Where does the spleen lie?

Answer 1

Greater omentum- L side

Question 2

What is the spleen attached to?

Answer 2

The stomach through the gastrosplenic ligament

Question 3

What is the method of blood flow into the spleen?

Answer 3

Celiac a. –> splenic a.

Question 4

What is the method of blood flow out of the spleen?

Answer 4

Splenic v. –> gastrosplenic v. –> portal v

Question 5

What is the purpose of red vs. white pulp?

Answer 5

White pulp: site of immune response

Red pulp: stores RBC/traps Ag

Question 6

Spleoniss

Answer 6

Seeding of cells after sx or trauma

Question 7

What are siderotic plaques made up of?

Answer 7

Ca/Fe deposits

Question 8

What is the stimulator of macrophages?

Answer 8

Tetrapeptid tuftsin

Question 9

What is considered symmetric enlargement of the spleen?

Answer 9

Splenomegaly

Question 10

What is considered an asymmetric enlargement of the spleen?

Answer 10

Mass

Question 11

What % of blood is sequestered to the spleen during anesthesia?

Answer 11

5-40%

Question 12

What type of enlargement does splenic infarction have on the spleen?

Answer 12

Symmetrical- splenomegaly

Question 13

What should be palpated when evaluating a splenic infarction to make sure the organ is adequately perfued?

Answer 13

Vasa recta

Question 14

This may be caused by stretching of the gastrosplenic ligament during previous GDV sx?

Answer 14

Splenic torsion

Question 15

What is the signalment for splenic torsion?

Answer 15

Large/Giant breed dogs

Great dane, greater swiss mountain dog, GSD, english bulldog

Question 16

What are CS seen with acute splenic torsion?

Answer 16

Acute abdominal pain/shock
Abdominal distension
CV collapse

Question 17

What CS are seen with chronic splenic torsion?

Answer 17

Vague/intermittent signs for up to 2 weeks

Question 18

What does a splenic torsion look like on rads?

Answer 18

C-shaped spleen

Question 19

What is the only treatment for splenic torsion?

Answer 19

Splenectomy

Question 20

Why should you not derotate the spleen prior to splenectomy?

Answer 20

Vessels are thrombosed- helping control the hemorrhage intraop

Question 21

What percentage of patients survive to discharge?

Answer 21

91%

Question 22

T/F: Neoplasia is a cause of splenic torsion

Answer 22

FALSE

Question 23

Nodular hyperplasia are sites of extramedullary hematopoiesis made up of single or multiple ____ nodules

Answer 23

Subcapsular

Question 24

What is the diagnostic dilemma for diffuse/nodular hyperplasia?

Answer 24

Can look like cancer

FNA/Cytology=poor sensitivity

Question 25

T/F: diffuse/nodular hyperplasia is incidentally found and most commonly benign

Answer 25

TRUE

Question 26

What is the most preferred and successful management for splenic trauma?

Answer 26

Conservative managment | Compression bandage, supportive care and transfusion if needed

Question 27

What is the most common splenic neoplasia in dogs and cats?

Answer 27

Dogs: HSA, sarcomas Cats: MCT

Question 28

What is the rule of 2/3 in relation to splenic neoplasia?

Answer 28

2/3 of dogs w/ splenic mass=malignant | 2/3 of those w/ malignancies will be HSA

Question 29

Presence of what increases malignancy of HSA to 80%

Answer 29

Hemoperitoneum

Question 30

T/F: Wheaten terriers are predisposed- but in small dogs hemoperitoneum is NOT associated w/ malignancy

Answer 30

TRUE- only true for large dogs

Question 31

T/F: Bigger splenic mass=more likely B9

Answer 31

True

Question 32

What is the prognosis for the following situations of HSA Sx Sx + chemo Sx + CT + Immunotherapy

Answer 32

Sx: 3 months Sx + CT: 6 months Sx + CT + immunotherapy: 425 days

Question 33

What are alternative tx used for HSA?

Answer 33

C versicolor mushroom | eBAT- bispecific urokinase angiotoxin designed to inhibit EGFR

Question 34

Sx + CT + eBAT MST is what

Answer 34

> 450days

Question 35

What are the two splenectomy techniques?

Answer 35

Ligation of individual hilar vessels- most common and preferred Ligation of splenic & short gastric a.

Question 36

Which technique has less risk for PO hemorrhage?

Answer 36

Ligation of individual hilar vessels

Question 37

Hilar dissection is when you isolate and double ligate vessels at the hilus- what does this preserve?

Answer 37

Branches to pancreas & stomach

Question 38

Where is the primary blood supply of the pancreas?

Answer 38

Left limb of pancreas

Question 39

What is the maximum diameter size that hemostatic clips can be used for in terms of ligation?

Answer 39

< 4 mm

Question 40

Ligasure allows ligation up to what size vessel?

Answer 40

7 mm

Question 41

What is the most common complication of splenectomy?

Answer 41

Hemorrhage

Question 42

If this is present- the risk of death is increased by 2x in HSA patients

Answer 42

Arrhythmias (ventricular)