E2: Spleen, Pancreas and Peritonitis Flashcards Preview

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Flashcards in E2: Spleen, Pancreas and Peritonitis Deck (54)
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1

The spleen lives within the leaf of the ______ _______and is attached to the stomach via the ______ _______. It's main blood supply is the  ______ artery whose parent is the _______ artery. Blood leaves the spleen via the  ______ vein, which flows into the   _______ vein and finally out of the  ______ vein. 

The spleen lives within the leaf of the GREATER OMENTUM and is attached to the stomach via the GASTROSPLENIC LIGAMENT.  It's main blood supply is the SPLENIC  artery whose parent is the CELIAC  artery. Blood leaves the spleen via the  SPLENIC vein, which flows into the  GASTROSPLENIC vein and finally out of the  PORTAL vein. 

2

What are these called? What are they made of?

Sidertoic plaques 

Deposits of irona and calcium in the splenic surface

3

What is splenomegaly and what are some causes ?

Splenomegaly: symmetric enlagement of the spleen

Drugs: Thiopental, acepromazine 

Congestion/Torsion

Infiltrative diseases

Immune-mediated diseases 

4

What can cause splenic torsion? What is the most common cause? What dog breeds are predisposed?

Most common: With GDV

Stretching of gastrospenic ligament during previous GDV or trauma

Congenital absence of GSp ligament

Breeds: Large and Giant- Great Dane, Greater Swiss Mnt Dog, German Shepherd, English Bulldog

5

How can you diagnose a splenic torsion?

Rads

US + doppler (Mottled/diffuse hypoechoic areas, no flow through vessels

CT (overkill)

6

What should you perform in conjunction with a splenectomy following a splenic torsion?

Gastropexy 

7

You have removed the spleen from a Great Dane,  but the owner cannot afford to send the spleen in for biopsy. They are worried about this because they fear it may be cancer. What can you tell them?

It is not crucial to send it because neoplasia is very rarely the cause of splenic torsion and this breed is prediposed to the condition 

8

What main vessels are double clamped and transected when peforming an emergency splenectomy in a patient that has active splenic hemorrhage?

Splenic artery and vein

Left gastroepiploic artery and vein

(All vessels at the splenic hilus)

9

A dog comes in following a HBC incident. You are fairly certain due to various diagnostics you have run that there has been trauma to the spleen and it is bleeding. The dog is overall stable, including the PCV. What is your course of action?

Compression bandage and monitor closely (esp PCV)

10

What is the most common splenic neoplasia in dogs? Cats? 

Dogs: HSA

Cats: MCT

11

What is the rule of 2/3rds?

2/3 of dogs with a splenic mass will have a malignancy

2/3 of those malignancies will be HSA

12

What does a non-traumatic hemoperitoneum in a large breed dog with a splenic neoplasm indicate? Small breed?

Large: That the mass is likely malignant 

Small breed: Not associated with malignancy 

13

What small breed dog is predisposed to splenic neoplasia?

Wheaten Terrier 

14

What relationship does the size of a splenic mass have with malignancy?

Larger heavier masses are more likely to be benign 

15

Why is the prognosis for splenic HSA so poor? What is the prognosis with surgery alone? Surgery and chemo? 

In nearly all cases microscopic metastasis is present at the time of diagnosis

Sx: 1-3 months

Sx + Chemo: 5-6 months

16

What is eBAT?

Biospecific urokinase angiotoxin designed to inhibit Endothelial Growth Factor Receptor (which is overexpressed in splenic HSA)

(i.e. it is a drug that prevents neoangiogenesis within the HSA)

Not available commercially yet 

6 months survival (this drug followed by DOX)

17

Will performing a splenectomy alter the progression of HSA? Why or why not?

No, probably has already metastasized 

However, it may provide SHORT TERM relief to allow the owner time for a proper good-bye. 

18

What are the 2 techniques to consider for a complete splenectomy? What are advantages and disadvantages of each?

Ligation of individual hilar vessels (Conventional)

(+): Preserve branches to stomach and pancreas, lower risk of post-op hemorrhage

(-): Time consuming 

 

Ligation of the splenic and short gastric arteries 

(+): No compromise of blood flow to the greater curvature of the stomach, faster

(-): Higher risk of hemorrhage, more challenging if large mass or omental adhesions distorty anatomy 

19

What vessels are imperative to preserve when performing the splenic artery ligation technique to remvoe the spleen?

The branches to left limb of the pancreas (primary blood supply)

20

What are indications for performong a partial splenectomy?

Trauma

Focal abscess

Partial infarction

(ONLY in dogs that are NOT at risk for splenic disease)

21

What are some complications post-splenectomy? What should you monitor post-op?

Ventricular arrythmias (monitor EKG, Holter monitor is best)

Hemorrhage (montior PCV)

Iatrogenic: Pancreatitis/necrosis, Gastric wall compromise (be gentle when handing organs and ligating)

Subclinical hemoparasite infection (Babesia, Bartonella) -rare in animals, common in ppl

Portal vein thrombosis

 

22

What is the main duct system in the pancreas of the cat? Dog?

Cat- Pancreatic duct (drains right lobe, enters duodenum via major D papilla)

Dog-Accessory Pancreatic duct (drains left lobe, enters at minor D papilla)

23

What pancreas biopsy technique is indicated if dffuse disease is present? Which part of the pancreas is easiest to biopsy?

Guillotine (suture fracture) Technique 

Sample distal aspect of right limb

24

What pancreas biopsy technique is indicated for tumor removal? How much of the pancreas can you remove if the ducts are patent? 

Partial pancreatectomy 

80% with patent ducts 

25

What are the complications associated with partial removal of the pancreas? 

Most common complication= Pancreatitis 

EPI (if drainage obstructed)

Endocrine pancreatic insufficiency (e.g. Diabetes mellitus) (if remove >90%)

Devitalization to duodenum (if damage the  caudal pancreaticoduodenal artery branches that supply the duodenum) - prevent by making sure you have good visualiztion, dissect omentum, and isolate and ligate vessels right on the pancreatic parenchyma) 

26

What is Dr. Cavanaugh's preferred dissection/resection tool for pancreatic surgery?

Ligasure 

27

_______ ________ are a collection of purulent material and necrotic tissue within and extending from the pancreatic parenchyma.

_______ ________are collections of pancreatic secretions and cellular debris enclosed within a wall of granulation tissue or fibrous sac that lacks an epithelial wall.

Pancreatic abscesses

Pancreatic pseudocysts/cysts 

28

What is the test of choice for diagnosing pancreatic pseudocysts? Can it be used to differentiate a cyst from an abscess? If not, what can?

Ultrasound

No, they look the same. Must do FNA to distinguish. 

29

What is the first line treatment for pancreatic pseudocysts? What is the treatment of choice if the patient is clinical? How are pancreatic abscesses best managed? 

Percutaneous aspiration 

Debride, drain and omentalize - both for abscesses and cysts

30

What is the approximate morality rate for dogs after pancreatic abscess removal? Cats? What about dogs post-pseudocyts removal?

Dogs- 40%

Cats- 25%

 

Dog-cyst: <25%