Surgery of the spleen and pancreas Flashcards Preview

Small animal surgery I > Surgery of the spleen and pancreas > Flashcards

Flashcards in Surgery of the spleen and pancreas Deck (32)
1

What are the canine surgical diseases of the spleen?

  • Hemangioma
  • Hemangiosarcoma
  • Lymphoma
  • Sarcomas
    • Fibro
    • Osteo
    • Malignant fibrous histocytoma
  • Mast cell tumors

2

What are the feline surgical diseses of the spleen?

Lymphosarcoma

Mast cell tumors

3

What are the clinical signs of splenic neoplasia?

  • Non-specific
    • General malaise
    • Inappetance
    • Abdominal distention
    • Weakness
    • Collapse
    • Pale MM

4

What are the diagnostics for splenic neoplasia?

  • Bloodwork
    • CBC
    • Chemistry
    • +/- coag times
  • Abdominal rads
  • Thoracic rads
  • Abdominal u/s
    • (Cannot differentiate benign from malignancy)

5

When is a partial splenectomy indicated?

  • Only indicated with a benign, focal disease process
    • Abscess
    • Laceration
    • Partial infection
    • Biopsy

6

T/F: A partial splenectomy is associated with significantly shortened surgery time compared to complete splenectomy

FALSE--significantly prolonged sx time

Increased risk of complications

7

When is a complete splenectomy indicated?

  • Severe trauma
  • Torsion
  • Infarction
  • Generalized infiltrative disease
  • Immune-mediated diseases (refractory cases)

8

When is a splenorrhaphy indicated? What is it?

Rarely indicated--lacerations, punctures

Closure of capsule

9

What are the causes of generalized splenomegaly?

  • Inflammation (uncommon)
  • Cellular hyperplasia
  • Congestion--torsion
  • Infiltration--lymphoma

10

What are the causes of focal splenomegaly?

  • Nodular hyperplasia
  • Neoplasia--HSA, histiocytic sarcoma, other sarcoma, mast cell tumor
  • Pseudotumor
  • Hemangioma 
  • Hematoma--benign, focal malformation
  • Abscess
  • Cysts
  • Segmental infarction

11

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

  • Splenic artery and vein
  • Left gastroepiploic artery and vein

12

Why is the histopathic diagnosis of hematoma or hemangioma still concerning for longterm prognosis?

Sometimes if hemangiosarcomas are present and the cells aren't well-differentiated yet they can be misdiagnosed as hemangiomas or hematomas

13

What are the general guidelines for predicting the malignancy of splenic tumors in dogs?

  • Given a population of dogs with splenic masses:
    • 50% of masses are malignant
    • 50% of malignant masses will be hemangiosarcomas
    • 60-75% of hemoabdomen cases will be hemangiosarcomas

14

What are the general guidelines for predicting the malignancy of splenic tumors in cats?

~75% of splenic diseases (splenomegaly or masses) are malignant

15

What is the prognosis for a hemangiosarcoma?

  • Varies with treatment
    • Sx alone
      • MST may be affected by tumor stage, # of lesions, and age at time of diagnosis
      • Stage I and II: MST = 86days
      • 1yr survival rate of 6%
    • Sx + chemo
      • MST range of 140-202days
    • Immunotherapy and intraperitoneal chemotherapy are other options

16

What are the possible complications following splenic surgery?

  • Hemorrhage
  • Vascular compromise of pancreas
  • Arrhythmias
    • VPCs
    • Ventricular tachycardia
  • DIC
    • Assoc. w/ ruptured neoplastic masses
  • GDV (?)
  • Infections not commonly seen in animals (common in people), unless possibly if highly endemic area

17

T/F: You should NEVER biopsy the pancreas unless indicated

TRUE

18

What are the various biopsy techniques for the pancreas?

  • Guillotine--use a loop of suture, free up a tag of pancreas and dissect a piece out leaving the suture in place
  • Lobar--remove a portion of the pancreas
  • Pinch (laparascopic)--insert probe and grab little bites and pull them off

19

How would you change your approach to obtaining biopsies change with focal vs. multifocal vs. generalized pancreatic lesions?

  • Right distal limb for diffuse disease
    • Decreased risk for damaging nearby structures
    • More mobile, farther from blood supply
  • Multifocal disease: multiple biopsies

20

What is the anatomy/blood supply to the pancreas?

  • Right lobe = cranial and caudal pancreaticoduodenal arteries
  • Left lobe = splenic artery
  • Body = hepatic artery
  • Pancreatic ducts
    • Dogs
      • Accessory duct (minor duodenal papilla)
      • Pancreatic duct (major duodenal papilla)
    • Cats
      • Single duct that fuses with bile duct--major duodenal papilla

21

What is the most common pancreatic tumor of dogs and cats?

Exocrine pancreatic adenocarcinoma

22

What is the treatment and prognosis of an exocrine pancreatic adenocarcinoma?

  • Might be resectable if small and no obvious metastases
  • Extremely poor prognosis
    • Highly malignant, locally invasive, early to metastasize

23

What is the treatment/prognosis for a gastrinoma?

  • Surgical resection of primary tumor may be warranted
    • Metastasis present at diagnosis in 70% of patients
  • Prognosis: unknown--low occurrence

24

What is the treatment for an insulinoma?

  • Surgical resection of all abnormal tissue
    • Includes primary tumor and all the resectable metastases
  • Must biopsy regional LN and liver for staging 

25

What is the prognosis for insulinomas?

  • Depends on clinical stage of disease at time of diagnosis
    • Sx w/o mets = normal glu for ~14mo
      • MST = 18mo
    • Sx w/ mets = normal glu for 2mo
      • MST 7-9mo
  • Newer studies support longer survival time with partial pancreatectomy

26

What are pancreatic pseudocysts? What is the signalment?

  • Collection of pancreatic secretions and debris in a non-epithelialized sac
  • Middle aged to older males
  • Dogs >> cats

27

How are pseudocysts diagnosed?

  • U/S 
    • Fluid-filled mass assoc. w/ pancreatitis
    • Debris may appear hyperechoic
    • Difficult to differentiate from abscess
  • Cytology
    • Best method of diagnosis
    • Conc. of pancreatic enzymes in fluid >> serum

28

How are pseudocysts treated?

  • 3 options:
    • U/S-guided percutaneous aspiration
      • Might need multiple treatments
    • Surgical resection
    • Debridement and drainage
      • Omentalization
  • Include supportive care for pancreatitis
  • 75% success rate regardless of treatment

29

How do pancreatic abscesses occur? What is the typical history?

  • Occur as sequela to pancreatitis
    • Release of digestive enzymes --> inflammation, fibrous tissue formation
    • Bacterial contamination less common
  • History consistent with diagnosis of acute abdomen
    • Lethargy, vomiting, abdominal pain

30

How are pancreatic abscesses diagnosed?

  • Rads
    • +/- gas in region of pancreas
    • Loss of abdominal detail (esp. in cranial abdomen)
  • U/S--mass lesions vs. hypoechoic structures
  • U/S-guided FNA and cytology
    • High cellularity
    • Degenerative neutraphils
  • Lab data may support dignosis of pancreatitis

31

How are pancreatic abscesses treated?

  • Emergency surgery
    • Debridement and omentalization vs. resection of affected tissue
      • Debridement carries significantly decreased morbidity compared to resection
    • +/- placement of active suction drain
    • Culture/histo must be obtained

32

What is the prognosis for pancreatic abscesses?

  • Guarded
    • 50-86% mortality rate
    • Risk of recurrence
    • No single clinical findings associated with poorer prognosis