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Surgery 2 > Lecture 4: Surgery of the Spleen (Exam 1) > Flashcards

Lecture 4: Surgery of the Spleen (Exam 1) Flashcards

(40 cards)

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1
Q

Define splenomegaly

A

Enlargement of the spleen from any cause

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2
Q

Define splenectomy

A

Surgical removal of the speel

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3
Q

Define splenosis

A

Congenital or traumatic presence of multiple nodules of norm splenic tissue in the abdomen

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4
Q

Define siderotic plaques

A

Brown or rust colored deposits of iron & calcium on splenic surface

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5
Q

Define splenorrhaphy

A

Suturing of a ruptured spleen

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6
Q

What is this picture showing

A

Splenosis

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7
Q

What is this picture showing:

A

Siderotic plaques

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8
Q

Define hemangiosarcoma (HSA)

A

Malignant neoplasm arising from blood vessels

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9
Q

Define Hemangioma

A

Benign tumors of dilated BV

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10
Q

Define hematoma

A

Swelling or mass of blood (usually clotted) confined to an organ, tissue, or space caused by seepage of any reason

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11
Q

What are indications for splenic sx

A
  • Mass (Neoplasia & non-neoplastic)
  • Loss of vascularity secondary torsion (GDV & splenic torsion)
  • Trauma
  • Refractive immune-mediated hematologic disorders in some indiv cases
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12
Q

Incidentally found, non-ruptured splenic mass or nodules w/o associated hemoperitoneum are most commonly (malignant/benign)

A

Benign but surgery is warranted in these dogs as the prognosis is often fair or good

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13
Q

Describe a diffuse (symmetric) splenomegaly

A
  • Congestion (torsion, GDV, right sided HF, & drugs)
  • Infiltration due to infection
  • Splenic FB
  • Immune mediated disease
  • Neoplasia
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14
Q

Describe a focal (asymmetric splenomegaly

A
  • Benign processes
  • Neoplastic processes
  • Infiltrative splenomegaly from neoplasia is one of the most common causes of spontaneous splenomegaly in dogs & cats
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15
Q

Describe splenic torsion

A
  • Most often associated w/ GDV
  • Isolated splenic torsion in dogs is rare
  • Splenic vein becomes occluded
  • Splenic artery is partially blocked (infarction)
  • Splenomegaly
  • Acute or intermittent signs for weeks
  • Cause is unclear
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16
Q

Describe an acute splenic torsion

A
  • May be life threatening
  • Assoc w/ CV collapse & shock, increased likelihood of GDV, septicemia from massive bacterial overgrowth in the necrotic splenic tissue, & hemoabdomen
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17
Q

Describe a prophylactic gastropexy w/ splenectomy

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A
  • May be warranted after splenic torsion b/c of stretching of the gastric lig resulting in increased likelihood of GDV
  • Research has called this prac into question when splenectomy was not related to a GDV or splenic torsion
18
Q

What other diseases are associated w/ splenic infarction

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A
  • Liver disease
  • Renal disease
  • Hyperadrenocorticism
  • Neoplasia
  • Thrombus w/ CV disease
19
Q

Which Splenic enlargements, nodules, or masses are neoplastic disease benign

Study These Flashcards
A
  • Fibroma
  • Hemangioma
  • Lipoma
  • Myelolipoma
20
Q

Which Splenic enlargements, nodules, or masses are neoplastic disease

Study These Flashcards
A
  • Abscessation
  • Engorgement due to portal hypertension
  • Extramedullary hematopoiesis
  • Hematoma
  • Iatrogenic (drugs)
  • Thromobosis/infarction
  • Torsion
21
Q

Which Splenic enlargements, nodules, or masses are malignant

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A
  • Chondrosarcoma
  • Fibrosarcoma
  • Hemangiosarcoma
  • Histiocytosis
  • Liposarcoma
  • Lymphosarcoma
  • Mast cell tumor
  • Mesenchymoma
  • Metastatic neoplasia
  • Myoxsarcoma
  • Osteosarcoma
  • Rhabdomyosarcoma
  • Undifferentiated/anaplastic sarcoma
22
Q

Describe a splenic hemangiosarcoma (HSA)

Study These Flashcards
A
  • Most common splenic tumor in dogs
  • Most common malignant splenic tumor in cats
  • As many as 25% of dogs w/ splenic HSA may have concurrent right atrial HSA so an echocardiogram is non-emergent splenectomy to remove a splenic mass is warranted
  • More 1/3 of dogs present w/ acute nontraumatic hemoabdomen
23
Q

Where do HSAs freq metastasizes to

Study These Flashcards
A
  • Liver
  • Omentum
  • Mesentery
  • Brain
24
Q

T/F: Splenic hematomas/hemangiomas are often grossly indistinguishable from hemangiosarcomas

25
What is some pre op management that needs to be done before splenic sx
* Anemia (acute hemorrhage w/ trauma, rupture of hematoma, & underlying disease) * Coagulation of profiles should be performed if trauma is not suspected as cause of hemorrhage * Consider need for blood transfusion * Assess for hydration * Assess for DIC
26
Describe anesthesia during splenic sx
* Anemic px need O2 prior to induction & during recovery * Avoid barbiturates (cause splenic congestion) * Avoid acetylpromazine (RBC sequestration, hypotension, impact on platelet fxn) * Hypotension due to volume depletion
27
What is considered when discussing antibiotics for a splenic sx
* Age * Disease * Length of surgery * Immune status * State of debilitation
28
What is associated w/ a splenectomy performed in conjunction w/ dental cleaning & extraction in dogs
* Multi abscessation * Septicemia * Death
29
What instruments are used in a splenic sx
* Suction machine & sterile tubing * Pool suction tip * Laparotomy pads * Balfour retractor * "Spay pack" * LDS * TIA stapling device
30
What is this
LDS - ligating dividing stapler
31
What is this
TIA Stapling Device - Transverse Intestinal Stapler
32
Where can the spleen be found
Anywhere in the abdominal cavity
33
What branches off of the celiac artery and gives arterial blood supply to the spleen
The splenic artery (Has 3 to 5 branches)
34
what does the first branch of the splenic artery supply
* The pancreas * Must identify the pancreatic supply coming off of the splenic artery & ligate the splenic artery distal to it
35
Describe the beginning of a splenic sx
* Ventral midline approach from the xyphoid to a point caudal to the umbilicus * Perform a complete exploratory if neoplasia is suspected * Use balfour retractors if needed
36
What indicates for a partial splenectomy
Trauma or focal lesions to preserve splenic fxn
37
What is lost when a total splenectomy is done
* All splenic fxn * RBC reservoir * Hematopoiesis * Impt phagocytic fxn * Help w/ immunocompetence
38
What are some major tech needed for a total splenectomy
* Ligation @ splenic hilus * Splenic artery ligation * Bag of rochester carmalts * Laparoscopic
39
What should be done post op
* 24 H observation for hemorrhage * Hematocrit every few hours until stable * Nasal O2 for anemic px * Fluid therapy until self hydration * Electrolyte correction * Acid-base correction * Monitor for cardiac arrhythmias * Monitor for DIC * Antibiotics after 24 H * Pain management
40
What are some complications that can occur
* Hemorrhage * Traumatic pancreatitis * Gastric fistulation due to impairment of gastric blood flow * Previous infection w/ hemoparasites may become apparent after splenectomy

Surgery 2 (22 decks)

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