Splenomegaly + Splenectomy (DeMonaco)

Question 1

Functions of the spleen (4)

Answer 1

1. Blood filtration
2. Blood storage (up to 20% of body’s blood volume, and store up to 50% of body’s platelets)
3. Extramedullar hematopoiesis
4. Immune function

Question 2

Splenomegaly

Answer 2

localized (mass) or diffuse splenic entrapment
- dogs: splenic masses more common
- cats: diffuse splenomegaly more commone

Question 3

How can splenomegaly be detected on physical exam?

Answer 3

• Pain or palpable mass on abdominal palpation
• abdominal distension
• palpable fluid wave (hemoabdomen– hemangiosarcoma)
• incidental finding on rads or u/s

Question 4

Differential groupings for splenomegaly

Answer 4

Localized versus Diffuse -> neoplastic versus non-neoplastic

Question 5

DDx for neoplastic diffuse splenomegaly

Answer 5

infiltrative round-cell neoplasia
- MCT (cats)
- lymphoma
- multiple myeloma
- malignant histiocytosis

Question 6

DDx for non-neoplastic diffuse splenomegaly

Answer 6

• Benign; response to things happening in the body
• Extramedullary Hematopoiesis (EMH): spleen = site of RBC producton -> can see splenomegaly in anemic patients
• Hyperplasia–IMHA (spleen inappropriately removes/filters hemolyzed RBCs from circulation)
• Inflammation (infectious like RMSF, histoplasmosis)
• Congestion (iatrogenic from sedative drugs; torsion)

Question 7

Main DDx for neoplastic localized splenomegaly

Answer 7

Malignant: hemangiosarcoma
Benign: hemangioma

Question 8

Main DDx for non-neoplastic localized splenomegaly

Answer 8

• Nodular Hyperplasia (reactive change in a focal area to a diffusely inflammed spleen)
• EMH (can also be focal)
• Hematoma

Question 9

DDx for animal that presents with hemoabdomen

Answer 9

Cavitated masses: Hemangiosarcoma versus Hemangioma versus Hematoma
- up to 75% = hemangiosarcoma
- non-bleeding: 50% benign vs. malignant in dog

histopath to determine malignancy status

removal of...hemagiosarcoma = palliative-only, hemangioma = curative

Question 10

diagnosing a splenic mass/splenomegaly

Signs of hypovolemic shock

Answer 10

acute collapse, weakness, tachycardia, weak pulses

Question 11

Clinpath findings for splenomegaly

Answer 11

• Anemia (regen.)
• Increased nRBC or immature WBCs
• Thrombocytopenia (immune-mediated

Question 12

Clinical signs of splenomegaly

Answer 12

Systemic signs of hypovolemic shock, anemia, DIC arrhythmias

Question 13

Splenectomy

Answer 13

1. Congestion
2. Neoplasia

Question 14

Spontaneous splenic rupture versus traumatic splenic rupture

Answer 14

Traumatic: don’t have to remove the spleen
Spontaneous: remove the spleen b/c you have no idea what the inciting cause iis

Question 15

Signs post-op for splenectomy

Answer 15

Ventricluar arrhythmia, bleeding (have blood transfusion ready), continuous ECG monitoring

Question 16

Blood supply of the spleen

Answer 16

Splenic a. from celiac a.

Question 17

Blood supply of greater curvature of the stomach

Answer 17

Left gastric epiploic a.

Question 18

3 types of splenectomy sx

Answer 18

• Hilar resection (farthest away from epiploic) -> have to ligate each individual vessel
• Modified splenic artery ligation (saves more vasc. supply for stomach - preserves left epiploic a.)
• Splenic artery ligation (ligate left gastric epiploic a.)