Procedures

Question 1

Splenectomy: which vessels should be ligated?

Answer 1

Short gastric arteries and veins (3 pairs)

Splenic artery and vein

Left gastroepiploic artery and vein

Small o mental arteries and veins

DONT locate pancreatic artery (branch of splenic artery) which supplies left lobe of pancreas

Question 2

Pringle manoeuvre indication and procedure

Answer 2

Indication: severe bleeding from liver e.g mass or trauma

•Occlude portal vein and hepatic artery (e.g blood flow to liver)
•limit to <20 mins occlusion
•Perform duodenal manoeuvre (mesoduodenum retracts intestines) to find epiploic foramen in right para lumbar fossa
• boundaries CVC dorsally, liver cranially, mesoduodenum caudally, hepatic artery and portal vein ventrally
•epiploic foramen is section of mesoduodenum not attached to body wall
•Place finger into epiploic foramen to occlude hepatic artery and portal vein (can place rumel tourniquet to address bleeding)