Spleen Sx-Exam 2 Flashcards
Where does the spleen lie?
Greater omentum- L side
What is the spleen attached to?
The stomach through the gastrosplenic ligament
What is the method of blood flow into the spleen?
Celiac a. –> splenic a.
What is the method of blood flow out of the spleen?
Splenic v. –> gastrosplenic v. –> portal v
What is the purpose of red vs. white pulp?
White pulp: site of immune response
Red pulp: stores RBC/traps Ag
Spleoniss
Seeding of cells after sx or trauma
What are siderotic plaques made up of?
Ca/Fe deposits
What is the stimulator of macrophages?
Tetrapeptid tuftsin
What is considered symmetric enlargement of the spleen?
Splenomegaly
What is considered an asymmetric enlargement of the spleen?
Mass
What % of blood is sequestered to the spleen during anesthesia?
5-40%
What type of enlargement does splenic infarction have on the spleen?
Symmetrical- splenomegaly
What should be palpated when evaluating a splenic infarction to make sure the organ is adequately perfued?
Vasa recta
This may be caused by stretching of the gastrosplenic ligament during previous GDV sx?
Splenic torsion
What is the signalment for splenic torsion?
Large/Giant breed dogs
Great dane, greater swiss mountain dog, GSD, english bulldog
What are CS seen with acute splenic torsion?
Acute abdominal pain/shock
Abdominal distension
CV collapse
What CS are seen with chronic splenic torsion?
Vague/intermittent signs for up to 2 weeks
What does a splenic torsion look like on rads?
C-shaped spleen
What is the only treatment for splenic torsion?
Splenectomy
Why should you not derotate the spleen prior to splenectomy?
Vessels are thrombosed- helping control the hemorrhage intraop
What percentage of patients survive to discharge?
91%
T/F: Neoplasia is a cause of splenic torsion
FALSE
Nodular hyperplasia are sites of extramedullary hematopoiesis made up of single or multiple ____ nodules
Subcapsular
What is the diagnostic dilemma for diffuse/nodular hyperplasia?
Can look like cancer
FNA/Cytology=poor sensitivity
T/F: diffuse/nodular hyperplasia is incidentally found and most commonly benign
TRUE
What is the most preferred and successful management for splenic trauma?
Conservative managment
Compression bandage, supportive care and transfusion if needed
What is the most common splenic neoplasia in dogs and cats?
Dogs: HSA, sarcomas
Cats: MCT
What is the rule of 2/3 in relation to splenic neoplasia?
2/3 of dogs w/ splenic mass=malignant
2/3 of those w/ malignancies will be HSA
Presence of what increases malignancy of HSA to 80%
Hemoperitoneum
T/F: Wheaten terriers are predisposed- but in small dogs hemoperitoneum is NOT associated w/ malignancy
TRUE- only true for large dogs
T/F: Bigger splenic mass=more likely B9
True
What is the prognosis for the following situations of HSA
Sx
Sx + chemo
Sx + CT + Immunotherapy
Sx: 3 months
Sx + CT: 6 months
Sx + CT + immunotherapy: 425 days
What are alternative tx used for HSA?
C versicolor mushroom
eBAT- bispecific urokinase angiotoxin designed to inhibit EGFR
Sx + CT + eBAT MST is what
> 450days
What are the two splenectomy techniques?
Ligation of individual hilar vessels- most common and preferred
Ligation of splenic & short gastric a.
Which technique has less risk for PO hemorrhage?
Ligation of individual hilar vessels
Hilar dissection is when you isolate and double ligate vessels at the hilus- what does this preserve?
Branches to pancreas & stomach
Where is the primary blood supply of the pancreas?
Left limb of pancreas
What is the maximum diameter size that hemostatic clips can be used for in terms of ligation?
< 4 mm
Ligasure allows ligation up to what size vessel?
7 mm
What is the most common complication of splenectomy?
Hemorrhage
If this is present- the risk of death is increased by 2x in HSA patients
Arrhythmias (ventricular)
