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Small Animal Surgery > Unit 2: 1 - Spleen, Pancreas > Flashcards

Unit 2: 1 - Spleen, Pancreas Flashcards

1
Q

What is the most common surgery involving the spleen?

A

splenectomy

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2
Q

What are 3 indications for a splenectomy?

A
  1. Diffuse splenomegaly
  2. Focal splenomegaly
  3. Trauma
  4. Immune-mediated disease
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3
Q

What are the 4 components to a splenectomy?

A
  1. Ligation and division at 4 or 5 sites
  2. Need to enter omental bursa
  3. Need to locate vessels to the greater omentum
  4. Preserve pancreatic blood flow
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4
Q

What 3 vessels need to be located when entering the omental bursa during a splenectomy?

A
  1. Splenic artery distal to last branch to pancreas
  2. Left gastroepiploic artery
  3. Short gastric arteries
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5
Q

What types of splenic masses can occur?

A

Hematoma, nodular hyperplasia, hemangiosarcoma

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6
Q

What clinical signs are associated with a splenic mass?

A

Abd distenstion, weight loss, inappetance, lethargy, weakness, fainting, shock

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7
Q

How can we get a definitive Dx for a splenic mass?

A

Histopathology

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8
Q

What diagnostics can be done as part of a pre-op workup for a splenic mass?

A
  1. CBC, chem, UA
  2. Chest rads
  3. Abd rads, ultrasound
  4. Abdominocentesis
  5. Coag profile
  6. Echo - R auricular mass
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9
Q

What % of acute non-traumatic hemoabdomen with splenic mass is made up of malignant disease?

A

63-80%

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10
Q

What % of malignant hemoabdomen cases were due to HSA?

A

70-88%

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11
Q

How many splenic mass cases are malignant without hemoabdomen?

A

50%

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12
Q

What is the % of small dogs vs. large dogs that have splenic hemorrhage with a splenic mass?

A

43% small dogs

62% large dogs

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13
Q

What is the % of benign vs. malignant splenic masses in dogs?

A

Benign = 15%

Malignant = 85%

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14
Q

What dog breeds is HSA more common/likely in?

A

large breeds

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15
Q

What is the most common splenic tumor?

A

hemangiosarcoma

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16
Q

Why is HSA aggressive when discovered?

A

At the time of diagnosis it is likely to already have a high rate of metastasis

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17
Q

HSA makes up to 25% of _____ masses.

A

R atrial

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18
Q

What 3 biopsies should always be obtained when HSA is suspected (or any splenic mass)?

A
  1. Hepatic
  2. +/- LN
  3. Other organs if abnormal appearance
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19
Q

How should the spleen be submitted to the lab when a splenic mass is suspected?

A

Entire spleen or multiple sections

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20
Q

T/F: It is easy to differentiate grossly between hemangiosarcoma and hemangioma

A

False

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21
Q

What are common areas of metastasis for HSA?

A
  1. Lungs
  2. Liver (portal blood flow)
  3. Peritoneum (cells from hemoabdomen)
  4. Heart (R auricle)
  5. CNS (most common metastatic tumor to the CNS)
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22
Q

What is a stage 1 splenic tumor?

A

Tumor localized to spleen

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23
Q

What is a stage 2 splenic tumor?

A

Ruptured tumor

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24
Q

What is a stage 3 splenic tumor?

A

Tumor with metastasis

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25
Q

What is the survival time for an animal that is diagnosed with a stage 3 splenic tumor?

A

3.5 month survival (surgery + chemo)

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26
Q

What is the most common diagnosis (stage) for a splenic tumor and what is the prevalence?

A

Stage 3 - 95% of dogs have metastasis at the time of diagnosis (macro or micro metastatic disease)

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27
Q

What are 4 complications that can occur from a splenic mass?

A
  1. High incidence of cardiac arrythmias (vent. tachyarrhythmias)
  2. Hemorrhage
  3. DIC
  4. Increased risk of GDV?
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28
Q

What is the general prognosis for HSA?

A

Poor long term prognosis (95% have mets)

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29
Q

What is the prognosis for HSA with surgery alone?

A

1-3 months MST

(<31% @ 2 months, <7% @ 12 months)

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30
Q

What is the prognosis for HSA with surgery + chemo?

A

3-6 months MST

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31
Q

What is the prognosis for splenic masses that are benign, or for splenic torsion?

A

Good long term prognosis

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32
Q

What are the 6 anatomical components of the pancreas that we must be aware of for surgery?

A
  1. L limb
  2. R limb
  3. Central body
  4. Accessory pancreatic duct (minor duodenal papilla)
  5. Pancreatic duct (major duodenal papilla)
  6. Blood supply
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33
Q

What is the endocrine function of the pancreas?

A
  1. Insulin (beta cells)
  2. Glucagon (alpha cells)
  3. Somatostatin (delta cells)
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34
Q

What cells make insulin?

A

beta

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35
Q

What cells make glucagon?

A

alpha

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36
Q

What cells make somatostatin?

A

delta

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37
Q

What is the exocrine function of the pancreas?

A

Secretion of enzymes to digest CHO, fat, proteins

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38
Q

What vessels are associated with the left limb of the pancreas?

A

Splenic artery

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39
Q

What vessels are associated with the right limb of the pancreas?

A
  1. Hepatic artery
  2. Cranial pancreatico-duodenal artery
  3. Caudal pacreatico-duodenal artery
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40
Q

Where does the hepatic artery branch from?

A

Celiac artery

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41
Q

Where does the cranial pancreatico-duodenal artery branch from?

A

Celiac artery

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42
Q

Where does the caudal pancreatico-duodenal artery branch from?

A

Cranial mesenteric artery

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43
Q

Where does the splenic artery branch from?

A

Celiac artery

44
Q

What are the pancreatic ducts present in the dog and where do they enter the duodenum?

A

Pancreatic duct (@ major duodenal papilla) and accessory pancreatic duct (@ minor duodenal papilla)

45
Q

What % of dogs have one duct from each pancreatic limb?

A

68%

46
Q

What is the main pancreatic duct in dogs and where does it terminate? What is it AKA?

A

Accessory pancreatic duct - terminates @ minor duodenal papilla

AKA Duct of Santorini

47
Q

What is the secondary pancreatic duct in dogs and where does it terminate? What is it AKA?

A

Pancreatic duct - terminates @ major duodenal papilla

AKA Duct of Wirsung

48
Q

What % of cats have a single pancreatic duct?

A

80%

49
Q

What pancreatic duct is the main one in cats?

A

Pancreatic duct (duct of Wirsung)

50
Q

The pancreatic duct of cats terminates at the _____ duodenal papilla with the _____.

A

major, common bile duct

51
Q

What does it mean when we say that cats are prone to “triaditis”?

A

Pancreatitis + IBD + cholangiohepatitis

52
Q

What are exocrine pancreatic cells called?

A

acinar cells

53
Q

What are the 4 cell types of the endocrine pancreas?

A

Pancreatic polypeptide cells, alpha cells, beta cells, delta cells

54
Q

What pancreatic “structure” contains the cells in the endocrine pancreas?

A

Islet of Langerhans

55
Q

What is insulin release primarily triggered by?

A

Increased in blood glucose

56
Q

What does insulin release stimulate?

A

Anabolic reactions involving CHO in the liver, muscle, and adipose tissue

57
Q

What are the short term counter-regulatory hormones?

A

Glucagon and epinephrine

58
Q

What does glucagon do?

A

Stimulates hepatic glucose production by increasing glycogenolysis, gluconeogenesis, and lipolysis;

Primarily acts to increase BG levels

59
Q

What does epinephrine do?

A

Increases hepatic glucose production and promotes hyperglycemia.

60
Q

Epinephrine _____ insulin secretion.

A

inhibits

61
Q

Epinephrine _____ liver glycogenolysis.

A

stimulates

62
Q

Epinephrine _____ glucagon secretion.

A

stimulates

63
Q

What are the long term counter-regulatory hormones?

A

Glucocorticoids (cortisol) and growth hormone

64
Q

What do glucocorticoids (cortisol) do?

A

Promotes increased hepatic glucose production, impairs glucose uptake

65
Q

What does growth hormone do?

A

Stimulates ketogenesis, impairs glucose uptake

66
Q

What is the extent of a pancreatic surgical procedure?

A

Can do partial pancreatectomy at the limbs;

It is difficult or impossible to resect the central body (focal lesions can be excised)

67
Q

What are the 3 indications for pancreatic surgery?

A
  1. Neoplasia
  2. Non-neoplastic disease
  3. Pancreatic biopsy
68
Q

What are the 3 common types of pancreatic neoplasia?

A
  1. Insulinoma
  2. Gastrinoma
  3. Adenocarcinoma
69
Q

What are the 2 types of non-neoplastic disease that can be an indication for surgery?

A

Pancreatic abscess, pancreatic pseudocysts

70
Q

Pancreatic abscesses/pseudocysts are usually a consequence of _____.

A

pancreatitis

71
Q

T/F: Pancreatic abscesses/pseudocysts are almost always sterile

A

True

72
Q

What are 3 steps to surgically treat pancreatic abscesses/pseudocysts?

A
  1. Drainage
  2. Debridement
  3. Omentalization
73
Q

How is pancreatitis managed?

A

Aggressively managed medically

74
Q

Pancreatitis may lead to _____ obstruction.

A

biliary tract

75
Q

How can biliary obstruction due to pancreatitis be repaired?

A

Biliary diversion or stent placement

76
Q

What may have to be placed in a patient with pancreatitis?

A
  1. Jejunostomy tube - bypassing duodenal papilla
  2. Esophagostomy tube
77
Q

What is a consequence/disadvantage of taking a pancreatic biopsy?

A

Can cause pancreatitis

78
Q

What are the more common clinical signs associated with insulinomas?

A

Neurological signs

79
Q

What is an insulinoma and what does it cause?

A

Insulin-secreting mass; –> hypoglycemia due to excess insulin

80
Q

What are 3 specific clinical signs for an insulinoma?

A

Seizures, general weakness, dull mentation

81
Q

What are the 3 requirements for diagnosis of an insulinoma and what is it called?

A

Whipple’s Triad:

  1. Hypoglycemia <70 mg/dL
  2. CS consistent with low BG
  3. Resolved CS after admin of dextrose/glucose
82
Q

What diagnostic tests can be performed to look for an insulinoma?

A

CBC, chem, UA, chest/abd rads, insulin levels, ultrasound, triple phase contrast CT

83
Q

What diagnostic test has the most sensitivity when looking for an insulinoma?

A

triple phase contrast CT

84
Q

Why is fructosamine used as a diagnostic?

A

Indicator of chronic hyper/hypoglycemia

85
Q

What levels of insulin are inappropriate when a patient has a BG <60 mg/dL?

A

Normal to high - suggestive of an insulin-secreting tumor

86
Q

Fructosamine values below the RI suggest chronic _____.

A

hypoglycemia

87
Q

How is the amended insulin : glucose ratio measured?

A

(Insulin/BG) - 30

88
Q

When is an AIGR suggestive of insulinoma?

A

When the ratio is >30

89
Q

What is the specificity of the AIGR?

A

Poor due to other causes of hypoglycemia

90
Q

When is pre-op stabilization/medical management for insulinomas indicated?

A

Always

91
Q

What should be avoided when acutely managing a hypoglycemic crisis?

A

dextrose boluses

92
Q

What can be done when acutely managing hypoglycemic crisis?

A

Get patient to eat small, frequent meals, 2.5-7.5% dextrose in fluids, +/- glucagon

93
Q

Why don’t we bolus with dextrose for insulinomas?

A

Insulinomas retain some sensitivity to plasma glucose concentrations;

Spikes in BG/dextrose will stimulate insulin release worsening the hypoglycemia;

Causes unpredictable, dangerous, and potentially fatal fluctuations in [BG]

94
Q

What is the ideal diet for a patient with an insulinoma?

A

High protein, low fat, complex CHO

(Hill’s w/d, Purina OM)

95
Q

What things can be added to the diet when there is hypoglycemic crisis?

A

Corn syrup, honey, maple syrup

96
Q

How often should patients with insulinomas be fed?

A

every 4-8 hours;

should NOT be fasted

97
Q

When can insulinoma patients be fed prior to surgery?

A

2-3 hours before surgery

98
Q

What is the outcome and prognosis for an insulinoma patient on medical therapy alone?

A

MST = 74-124 days;

Use pred and diazoxide

99
Q

What is the outcome and prognosis for an insulinoma patient with a partial pancreatectomy?

A

MST = 12-14 months;

(Enucleation instead will give MST of 11.5 months)

100
Q

How many insulinoma petients will have gross metastasis at the time of surgery?

A

31-50%

101
Q

How many insulinoma patients will have reoccurrence of CS suggesting microscopic metastasis?

A

Nearly 100%

102
Q

What is a negative prognostic factor for insulinoma patients post-op?

A

Post-op hypoglycemia

103
Q

What age and [insulin] are associated with shorter survival in insulinoma patients?

A

Young age and high [insulin]

104
Q

What is a stage 1 insulinoma?

A

Dz limited to pancreas (no metastasis)

105
Q

What is a stage 2 insulinoma?

A

Tumor spread to local LNs

106
Q

What is a stage 3 insulinoma?

A

Tumor with distant metastasis with or without local LNs

Small Animal Surgery (17 decks)

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