Spleen and Pancreas

Question 1

What supplies blood to the left limb of the pancreas?

Answer 1

Branch of the splenic a.

Question 2

What supplies blood to the body/right limb of the pancreas?

Answer 2

caudal pancreaticoduodenal a. —> branch of cranial mesenteric a.

Question 3

Which duct drains the right lobe of the pancreas and where does it enter the duodenum?

Answer 3

pancreatic duct; major duodenal papilla w/bile duct

*only duct in cats

Question 4

Which duct drains the left limb of the pancreas and where does it enter into the duodenum?

Answer 4

accessory pancreatic duct; minor duodenal papilla IN DOGS

Question 5

You’re performing a partial pancreatectomy on a dog with a pancreatic tumor. What technique should you use for your ligations?

Answer 5

hemoclips or bipolar cautery

Question 6

What is the rare but relevant surgical complication of a partial pancreatectomy?

Answer 6

devitalization of duodenum
caudal pancreaticoduodenal a.arises from the cranial mesenteric a…
vessel also supplies branches of duodenum…
BOTH are closely associated with proximal right lobe of pancreas
—> if damaged, duodenum can be compromised

Question 7

T or F:
Acute bouts of pancreatitis may lead to secondary pancreatic abscesses, but most of these are sterile.

Answer 7

TRUE:
enzymes escape into surrounding tissue
causing significant inflammation and fibrous tissue formation

Question 8

A dog presents for vomiting, diarrhea, and abdominal pain. ​A few weeks ago, he was seen and treated for gastroenteritis. On exam, you find he is also pyrexic, icteric, and you can palpate a mass in the abdomen. You take a radiograph and find an increased soft tissue density in the right cranial/central cranial abdomen and evidence of ascites/peritonitis. What is going on…?

Answer 8

signs can be highly variable, but these things are all in line with
pancreatic abscess

Question 9

Although laboratory data can be highly variable in cases of pancreatic abscesses, why would we see hyperbilirubinemia/elevated LEZ?

Answer 9

inflammation of the pancreas is causing the dudenal papilla of the common bile duct to swell shut

Question 10

What surgical management is indicated for pancreatic abscesses?

Answer 10

debridement and drain
(active drainage if generalized/septic peritonitis or high volume effusion suspected PO)
*omentalize - better outcomes than open drainage*

Question 11

What are the perioperative mortality rates for dogs and cats with regard to pancreatic abscess surgical treatment?

Answer 11

dogs: 40%
cats: 25%

Question 12

What’s the met rate (at the time of diagnosis) for exocrine pancreatic adenocarcinomas and survival times?

Answer 12

50-78% metastasis at time of Dx;

​3month survival in dogs;
<7days in the cat

Question 13

What is the tentative Dx for an insulinoma?

Answer 13

Whipple’s triad:
1. Clinical signs associated with hypoglycemia
​2. Fasting blood glucose concentration of 40mg/dL or LOWER
​3. Relief of neurological signs with feeding or glucose administration

Question 14

Normal fasting serum immunoreactive insulin concentrations range from 5-26 microIU/mL, but animals with insulinomas often exceed what value?

Answer 14

70 microIU/mL

Question 15

What type of diet might we use to medically manage a case of insulinoma?

Answer 15

High protein, complex carbohydrates
small, frequent meals (3-6/day)

Question 16

How can glucocorticoid therapy be helpful in medical management of insulinomas?

Answer 16

Increasing hepatic glucose production and
​decreasing cellular glucose uptake

Question 17

What oral hyperglycemia agent can be used to medically manage insulinomas and how does it exert its effect?

Answer 17

Diazoxide
​inhibits pancreatic insulin secretion and glucose uptake by tissue

Question 18

MST for insulinoma with no surgical treatment vs. surgical treatment?

Answer 18

196 days vs. 785 days!

​surgery + medical therapy (pred) on relapse= 1316days!

Question 19

Regional lymph node involvement would qualify an insulinoma as stage ___, with a MST of ____ days.

Answer 19

stage II; 547 days!

Question 20

If an insulinoma is confined to the pancreas, what stage is it and what is the MST?

Answer 20

Stage I; 785 days!

Question 21

How long would we expect a Stage III (systemic Mets) insulinoma patient to live?

Answer 21

217 days

Question 22

Generally, neoplasia in the spleen would be classified morphologically as “mass” (asymmetric enlargement), but in the case of infiltrative disease like LSA and MCT, it actually falls under?

Answer 22

Symmetric enlargement (splenomegaly)

Question 23

What ultrasonographic findings would be diagnostic for splenic torsion?

Answer 23

Mottled/diffuse hypoechoic areas,
intraluminal echogenic densities in veins,
no flow in splenic vessels

Question 24

Diffuse splenic hyperplasia is a result of _____ or ______,
but nodular hyperplasia is the manifestation of _____.

Answer 24

Immune stimulation or splenic hyperactivity (think IMHA);

sites of extramedullary hematopoiesis

Question 25

Older, larger (\>21kg) breed dogs such as GSD, labs, poodles, and goldens are at increased risk for HSA. What clinical finding makes the chance of malignancy in these dogs sky rocket (80%)?

Answer 25

**Presence of hemoperitoneum**

Question 26

_T or F_: Dogs with significantly higher mean mass-to-splenic volume ratio AND higher mean splenic weight as percentage of body weight are more likely to have HSA than a benign mass.

Answer 26

FALSE; other way around

Question 27

How does the turkey tail mushroom (*C.versicolor*, sold commercially under “I’m-Yunity”) provide alternative therapy for HSA?

Answer 27

``` Contains polysaccharopeptide (**PSP**) which causes cell-cycle arrest at the **G1/S** checkpoint w *alterations in _apoptogenic_ and _extracellular signaling_ proteins...* ``` _net result_: **reduction in proliferation** and **increase in apoptosis** in cancer cells

Question 28

What are the research study findings associated with the treatment of turkey tail mushroom and metastasis/MST in HSA dogs?

Answer 28

_15 splenectomized dogs w/HSA_ *median time to development or **progression of abdominal mets** **significantly delayed*** *in dogs receiving 100mg/kg/d I’m-Yunity*

Question 29

What are the **2 major techniques** to consider when performing a complete splenectomy?

Answer 29

**1. Ligation of individual hilar vessels** Preserves branches to pancreas/stomach, time consuming, less risk of PO hemorrhage **2. Ligation of the splenic and short gastric aa.** *doesn’t compromise blood flow to greater curvature, less surgical time, more challenging IF large mass/omental adhesions distort anatomy, increased risk of major hemorrhage w technique failure*

Question 30

In the approach to complete splenectomy, splenic artery ligation should consider the preservation of what?

Answer 30

**preserve the branch to the left limb of pancreas!** *(primary blood supply!)* {hilar (double) dissection preserves branches to pancreas and stomach}

Question 31

Similar to GDV, we can see ventricular arrhythmias after splenectomies. What’s the MOA behind this?

Answer 31

Compromised **venous return** to the heart caused by *intra-abdominal hemorrhage* and *compression of the caudal vena cava*