SAOP3- Splenic Sx

  1. What diagnostics are often employed when working up a potential splenic mass?
    • abdominocentesis- possible to tap non-clotted blood, high hematocrit, malignant cells
    • abdominal radiography- ID mass effects, mass
    • ultrasound- measure spleen
    • chest rads- look for mets
    • echocardigraphy- look for right heart mass
    • advanced imaging
  2. What are differentials for a large splenic mass? (4)
    • hemangiosarcoma
    • hematoma
    • leiomyoma
    • leimyosarcoma
    • other sarcomas
  3. Can you differentiate a metastatic from a benign splenic mass on gross observation?
  4. What is the prognosis for hemangiosarcoma?
    mean survival time with surgery (2-4 months), with surgery and chemotherapy (6-8 months)
  5. What is the prognosis for splenic hematoma?
    prognosis good to excellent
  6. What are predictive factors for hemangiosarc? (5)
    • hemoabdomen
    • thrombocytopenia
    • DIC, schistocytes
    • ventricular arrhythmias (39% of dogs with HSA have one)
  7. Describe the approach to splenectomy for HSA. (3 principals)
    • incise xyphoid to prepuce (these masses are usually ginormous)
    • remove falciform ligament
    • use a balfour retractor to open the abdomen
  8. What are the techniques for splenectomy? (2)
    • hylus method
    • 3 pedicle ligation technique
  9. What vessels branch off the spleen and will be compromised during splenectomy?
    • short gastric arteries
    • branches to pancreas
    • greater omentum
  10. What are methods of ligation for the hylus method of splenctomy? (3) Briefly describe each.
    • LDS- ligate and divide stapler, small vessels only, dissect fat away from vessels first, expensive$$$
    • Ligasure- seals arteries up to 7mm, sutureless, electrosurgical device, expensive machine$$
    • Harmonic scalpel- cuts and seals vessels, sutureless, expensive device
  11. What are the important points of the 3 pedicle ligation method for splenectomy? (3)
    • performed with suture
    • technically simple and fast
    • MUST preserve pancreatic artery
  12. What are oncologic principals of splenectomy for HSA?
    • change gloves and instruments after removal of cancerous spleen (seeding possible)
    • lavage a lot
  13. How should you approach an incidental nodule on the spleen?
    • partial or complete splenectomy (complete is easier and less risky)
    • intraop cytology
    • send out biopsy
  14. You see brownish-gray plaque-like lesions all over the spleen of an old dog. What is it?
    siderotic plaques- benign in old dogs
  15. 70-80% of dogs with hemoabdomen are bleeding from...
    the spleen (20-30% are bleeding from the liver, kidney, adrenal)
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SAOP3- Splenic Sx
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