Surgery of the spleen and pancreas Flashcards
What are the canine surgical diseases of the spleen?
- Hemangioma
- Hemangiosarcoma
- Lymphoma
- Sarcomas
- Fibro
- Osteo
- Malignant fibrous histocytoma
- Mast cell tumors
What are the feline surgical diseses of the spleen?
Lymphosarcoma
Mast cell tumors
What are the clinical signs of splenic neoplasia?
- Non-specific
- General malaise
- Inappetance
- Abdominal distention
- Weakness
- Collapse
- Pale MM
What are the diagnostics for splenic neoplasia?
- Bloodwork
- CBC
- Chemistry
- +/- coag times
- Abdominal rads
- Thoracic rads
- Abdominal u/s
- (Cannot differentiate benign from malignancy)
When is a partial splenectomy indicated?
- Only indicated with a benign, focal disease process
- Abscess
- Laceration
- Partial infection
- Biopsy
T/F: A partial splenectomy is associated with significantly shortened surgery time compared to complete splenectomy
FALSE–significantly prolonged sx time
Increased risk of complications
When is a complete splenectomy indicated?
- Severe trauma
- Torsion
- Infarction
- Generalized infiltrative disease
- Immune-mediated diseases (refractory cases)
When is a splenorrhaphy indicated? What is it?
Rarely indicated–lacerations, punctures
Closure of capsule
What are the causes of generalized splenomegaly?
- Inflammation (uncommon)
- Cellular hyperplasia
- Congestion–torsion
- Infiltration–lymphoma
What are the causes of focal splenomegaly?
- Nodular hyperplasia
- Neoplasia–HSA, histiocytic sarcoma, other sarcoma, mast cell tumor
- Pseudotumor
- Hemangioma
- Hematoma–benign, focal malformation
- Abscess
- Cysts
- Segmental infarction
What main vessels are double clamped and transected when performing an emergency splenectomy in a patient that has active splenic hemorrhage?
- Splenic artery and vein
- Left gastroepiploic artery and vein
Why is the histopathic diagnosis of hematoma or hemangioma still concerning for longterm prognosis?
Sometimes if hemangiosarcomas are present and the cells aren’t well-differentiated yet they can be misdiagnosed as hemangiomas or hematomas
What are the general guidelines for predicting the malignancy of splenic tumors in dogs?
- Given a population of dogs with splenic masses:
- 50% of masses are malignant
- 50% of malignant masses will be hemangiosarcomas
- 60-75% of hemoabdomen cases will be hemangiosarcomas
What are the general guidelines for predicting the malignancy of splenic tumors in cats?
~75% of splenic diseases (splenomegaly or masses) are malignant
What is the prognosis for a hemangiosarcoma?
- Varies with treatment
- Sx alone
- MST may be affected by tumor stage, # of lesions, and age at time of diagnosis
- Stage I and II: MST = 86days
- 1yr survival rate of 6%
- Sx + chemo
- MST range of 140-202days
- Immunotherapy and intraperitoneal chemotherapy are other options
- Sx alone
What are the possible complications following splenic surgery?
- Hemorrhage
- Vascular compromise of pancreas
- Arrhythmias
- VPCs
- Ventricular tachycardia
- DIC
- Assoc. w/ ruptured neoplastic masses
- GDV (?)
- Infections not commonly seen in animals (common in people), unless possibly if highly endemic area
T/F: You should NEVER biopsy the pancreas unless indicated
TRUE
What are the various biopsy techniques for the pancreas?
- Guillotine–use a loop of suture, free up a tag of pancreas and dissect a piece out leaving the suture in place
- Lobar–remove a portion of the pancreas
- Pinch (laparascopic)–insert probe and grab little bites and pull them off
How would you change your approach to obtaining biopsies change with focal vs. multifocal vs. generalized pancreatic lesions?
- Right distal limb for diffuse disease
- Decreased risk for damaging nearby structures
- More mobile, farther from blood supply
- Multifocal disease: multiple biopsies
What is the anatomy/blood supply to the pancreas?
- Right lobe = cranial and caudal pancreaticoduodenal arteries
- Left lobe = splenic artery
- Body = hepatic artery
- Pancreatic ducts
- Dogs
- Accessory duct (minor duodenal papilla)
- Pancreatic duct (major duodenal papilla)
- Cats
- Single duct that fuses with bile duct–major duodenal papilla
- Dogs
What is the most common pancreatic tumor of dogs and cats?
Exocrine pancreatic adenocarcinoma
What is the treatment and prognosis of an exocrine pancreatic adenocarcinoma?
- Might be resectable if small and no obvious metastases
- Extremely poor prognosis
- Highly malignant, locally invasive, early to metastasize
What is the treatment/prognosis for a gastrinoma?
- Surgical resection of primary tumor may be warranted
- Metastasis present at diagnosis in 70% of patients
- Prognosis: unknown–low occurrence
What is the treatment for an insulinoma?
- Surgical resection of all abnormal tissue
- Includes primary tumor and all the resectable metastases
- Must biopsy regional LN and liver for staging
What is the prognosis for insulinomas?
- Depends on clinical stage of disease at time of diagnosis
- Sx w/o mets = normal glu for ~14mo
- MST = 18mo
- Sx w/ mets = normal glu for 2mo
- MST 7-9mo
- Sx w/o mets = normal glu for ~14mo
- Newer studies support longer survival time with partial pancreatectomy
What are pancreatic pseudocysts? What is the signalment?
- Collection of pancreatic secretions and debris in a non-epithelialized sac
- Middle aged to older males
- Dogs >> cats
How are pseudocysts diagnosed?
- U/S
- Fluid-filled mass assoc. w/ pancreatitis
- Debris may appear hyperechoic
- Difficult to differentiate from abscess
- Cytology
- Best method of diagnosis
- Conc. of pancreatic enzymes in fluid >> serum
How are pseudocysts treated?
- 3 options:
- U/S-guided percutaneous aspiration
- Might need multiple treatments
- Surgical resection
- Debridement and drainage
- Omentalization
- U/S-guided percutaneous aspiration
- Include supportive care for pancreatitis
- 75% success rate regardless of treatment
How do pancreatic abscesses occur? What is the typical history?
- Occur as sequela to pancreatitis
- Release of digestive enzymes –> inflammation, fibrous tissue formation
- Bacterial contamination less common
- History consistent with diagnosis of acute abdomen
- Lethargy, vomiting, abdominal pain
How are pancreatic abscesses diagnosed?
- Rads
- +/- gas in region of pancreas
- Loss of abdominal detail (esp. in cranial abdomen)
- U/S–mass lesions vs. hypoechoic structures
- U/S-guided FNA and cytology
- High cellularity
- Degenerative neutraphils
- Lab data may support dignosis of pancreatitis
How are pancreatic abscesses treated?
- Emergency surgery
- Debridement and omentalization vs. resection of affected tissue
- Debridement carries significantly decreased morbidity compared to resection
- +/- placement of active suction drain
- Culture/histo must be obtained
- Debridement and omentalization vs. resection of affected tissue
What is the prognosis for pancreatic abscesses?
- Guarded
- 50-86% mortality rate
- Risk of recurrence
- No single clinical findings associated with poorer prognosis
