E2: Spleen, Pancreas and Peritonitis Flashcards
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.
What are these called? What are they made of?
Sidertoic plaques
Deposits of irona and calcium in the splenic surface
What is splenomegaly and what are some causes ?
Splenomegaly: symmetric enlagement of the spleen
Drugs: Thiopental, acepromazine
Congestion/Torsion
Infiltrative diseases
Immune-mediated diseases
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
How can you diagnose a splenic torsion?
Rads
US + doppler (Mottled/diffuse hypoechoic areas, no flow through vessels
CT (overkill)
What should you perform in conjunction with a splenectomy following a splenic torsion?
Gastropexy
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
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)
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)
What is the most common splenic neoplasia in dogs? Cats?
Dogs: HSA
Cats: MCT
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
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
What small breed dog is predisposed to splenic neoplasia?
Wheaten Terrier
What relationship does the size of a splenic mass have with malignancy?
Larger heavier masses are more likely to be benign
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
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)
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.
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
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)
What are indications for performong a partial splenectomy?
Trauma
Focal abscess
Partial infarction
(ONLY in dogs that are NOT at risk for splenic disease)
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
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
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
What are the peritoneal drainage options?
Primary closure (not for GI-based sepsis, best for parenchymal organ sources)
Open (most efficient but requires more care) - Gravity dependent or VAC
Closed (less risks) - Passive (less good) or Active (closed suction, Jackson Pratt)
