LBAH Informational Articles

Femoral Head Ostectomy (FHO)

When a hip gets dislocated it commonly will not go back into the socket. This is painful as it slides in and out of the hip joint. When that happens we need to do a surgery to remove the head of the femur and let it form a false joint. We also use this surgery for pets with hip dysplasia that will not be undergoing the more extensive hip replacement surgery called A Total Hip.

In this procedure the head (or ball) of the femur is removed. The remaining part of the femur forms a false joint with the muscles, ligaments, and tendons in the area. Even though this false joint is not as good as a real joint, there is a significant reduction in pain and over 90% return to normal function. Almost any sized dog can have this procedure even though it is much more effective in smaller dogs. Obese dogs and those with significant loss of muscle do not do as well. Compared to the other types of surgery this one is much more basic, and substantially less expensive.

This are the hips of Mickey, a very active Australian Shepherd. He has hip dysplasia on both sides. FHO surgery will be performed on his right hip.

 After the skin incision is made the muscles are separated to give visualization of the femoral head. It is gently rotated and brought up as far as possible.

A special air powered drill is used to cut the neck of the femur at just the right angle

The angle in the cut of the femoral neck is apparent. Also present on the head of this femur is a piece of the round ligament, one of the structures that anchors the head of the femur into the socket.

An opening remains where the head of the femur used to reside. The remaining bone will form a false joint, and allow this pet to move about pain free and well over 90% back to normal function.

 The muscles that were separated and cut are now carefully sutured. These muscles are necessary for normal movement of the false joint that will soon form.

 This is what remains after the surgery. Mickey healed rapidly after the surgery and is running around as fast as before, according to his worried mom.

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Retained Deciduous Teeth

It is not uncommon for us to encounter dogs with retained baby teeth. If they are still present at 6 months of age when your pet is spayed or neutered, we will remove them.

This dog is 8 months old and has a retained deciduous (D) tooth behind its erupting adult lower right canine (C) tooth. It is interfering with the eruption process of the normal canine tooth and will be removed

The instrument used to remove this tooth is called an elevator. The tooth is gently removed by rotating the elevator around the base of the tooth where it meets the gum line. This is to ensure complete removal of the tooth, including its root. Each tooth takes 5-10 minutes of gentle elevating to remove.

 

When the tooth is removed a small hole remains in the gum. The hole is usually so small that it heals rapidly and rarely requires suturing the gum. The healing time is the same whether the gum is sutured or not.

 

Here is the culprit after removal, notice how deep the root goes. The left 2/3 of this tooth (to the left of the arrow) is the root.

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Hip Dislocation

On occasion a dog or cat will dislocate its hip. This page shows the treatment of a poodle mix that fell while running, and is now completely lame on its rear leg.


Diagnosis

The diagnosis in this case is made with x-rays after an initial examination. The exam gave us clues that the pain was caused by a dislocation. When we gently extended the rear legs (depending on the type of dislocation) the dislocated leg appeared shorter than the normal leg.

This x-ray is of a dog with a dislocated hip. The ball of the left femur is completely out of the socket. Ligaments and the joint capsule have been torn for this to occur.

 


Medical Correction

Some pets with dislocated hips can be corrected without the need of surgery. Whether or not this occurs depends on the extent of the damage, especially to the ligaments, tendons, and joint capsule.

This pet was anesthetized and the head of the femur was gently placed back into the socket. It was securely taped so that the femur was held firmly in the socket. a special type of sling was applied to keep the head of the femur (the ball) pushed back into the socket. This method is not always successful, but it is worth trying to prevent surgery.

 


 

A radiograph is taken immediately after application of the splint to be certain the femoral head is still in the socket. One week later we repeated the x-ray to be certain it was still in place. This splint stayed on for 3 weeks, and this pet eventually healed completely.

Pain medication will be given to minimize discomfort. This dog will need to be confined and have minimal activity for several weeks.


Surgical Correction

In many cases we have to resort to surgery to correct the dislocation. When the hip is replaced in these dogs it does not stay in the socket. We have pictures of the surgery

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Forearm Fracture in a Dog

It is not uncommon for a dog or cat to fracture its forearm. The two bones that are usually involved are the radius and ulna. Depending on the severity of the fracture, it is either splinted or surgery is performed to stabilize the bones with plates or pins. In small breed dogs, due to their bone anatomy and blood supply, and splint will not suffice, and a plate is needed surgically for proper healing.

Radiograph

This pup had a mild fracture of the radius and ulna (forearm). Since young animals heal rapidly, and because the fracture was relatively stable, a special type of padded plastic splint was used to stabilize it. It will stay on for 4-6 weeks.

Splint

After the pup is sedated an anchoring tape is applied to prevent the splint from sliding off.

A heavy layer of cotton is wrapped around the leg, and the plastic splint is placed along the bottom of the leg outside this cotton layer.

Several layers of gauze are tightly wrapped over the cotton and plastic splint, and the initial anchoring tape is adhered on top of this gauze. This prevents the splint from sliding down.

A final layer of tape is wrapped over the gauze. This helps keep it dry, adds to the stability, and identifies this as a girl dog!

We can trace the progress of healing on a different dog (his name is Kaiser-he is a large Doberman puppy) with a radius and ulna fracture, by taking x-rays at 3 week intervals. This first x-ray shows Kaiser’s fracture, which he obtained by running into a table.

Here is Kaiser after his splint was applied. He is hiding his face because we used pink tape instead of blue (hey, that’s all we had at the time).

Three weeks after the splint was applied a routine x-ray was taken to assess healing. Both the dark areas and white areas at the fracture site are normal stages in the healing process.

Six weeks after the fracture (and not a day too soon for his dad), the bone has not only healed, but it has remodeled making it smoother and anatomically more correct. This bone will continue to remodel for many months.

Surgery

Surgical correction of a radius or ulna fracture frequently involves plates.  In toy and small breed dogs a splint will not suffice. Plates are mandatory to prevent a malunion or nonunion, which could lead to amputation. It is a specialized surgery requiring special equipment and expertise, along with meticulous placement of the fractured pieces.

If you look at this view of Pebbles’ fracture it looks like a splint could be utilized for stability.

On this view of the same bones the severity of the fracture is obvious. Surgery is needed due to the amount of displacement at the fractured edges and the fact it is a small breed dog.

Here is a view of the bones after a plate has been applied surgically. As you can see from the fractured ends, the alignment is perfect.

Another x-ray gives you an indication of the size of the plate from the top. The amount of cotton padding around the splint can be visualized also.

During and immediately after surgery we will give pain medication.

A splint is put on for additional support, comfort, and to prevent Pebbles from chewing at the surgical site. Pebbles will need to wear this splint as additional support until the fracture heals. This will take up to several months.

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Ear Cleaning

One of the most important things you can do to keep your pet’s ears clean and healthy is to clean them periodically, especially if they have been prone to infection. This page will show you the proper technique using a medium sized dog as an example. The technique for a cat is similar, the only major difference is in restraint. No matter which species you are restraining, pick a room that is quiet and free of small children. Please let one of our nurses give you an actual demonstration of this technique to develop your confidence.

Before we institute any cleaning of problem ears it is important to make a diagnosis. Not every case of ear infection is caused by ear mites, as many people are prone to think. Ear infections are commonly caused by bacterial infections, hypothyroidism (low thyroid), and allergies. We have found a consistent cause of chronic ear problems and infections is due to a food allergy, which is why we recommend Hill’s z/d, the gold standard for this type of food.

Canine Restraint

Depending on its size, put your dog on a table so that it is approximately chest high. Gently hug your pet under its neck with one of your arms, and put the other hand on the back of its head if necessary. Be patient, yet persistent. If your dog is small you can use the cat restraint technique.

Hugging your pet with your left hand under its chin gives you control and flexibility as to how much restraint is needed.

Feline Restraint

Wrapping your cat with a towel is a good way to restrain it for ear cleaning. In essence you will be wrapping it like a burrito. For cats in general the less restraint the better- let the towel do the work.

Put a large towel on a table and put your cat towards the front end of this towel.

Bring each side of the towel over the cat and leave only the head and tail to stick out

Bring the back, unfolded section of the towel over the front just up to the back of your cat’s head.

Finish the “burrito” by wrapping the towel under each side of your cat. The only thing sticking out of the towel at this point is the head.

Hug your cat gently to you with one hand and you will have your other hand free. Besides cleaning ears this restraint technique enables you to administer oral or topical medication.


Cleaning

Never put anything in your pet’s ear canal without proper restraint. As a general rule you should clean the ears by letting the cleaning solution bring the infection and discharge to the outside of the canal to be wiped away. You should not put Q-tips into your pets ears unless we tell you to and you have been shown the proper technique, and your pet is adequately restrained. Q-tips can damage the sensitive tissue that lines the ear canal. Also, an ear drum can easily be ruptured by placing objects in the ear canal, especially if the ear has an infection.

This is a typical picture of what might be encountered in an ear that needs cleaning.

The first thing to do is use a gauze to wipe away discharge that is on the surface.

Gently pull up on the ear and partially fill the ear with the cleaning solution. By straightening out the ear you allow the cleaning solution to flow down the ear canal to where the infection and debris are located.

After the canal had been partially filled massage the base of the ear canal very gently. Most pets find this part soothing.

Let your pet shake its head if it wants to. Then use a gauze to soak up the fluid that comes out of the ear.


Instill several drops of the actual medication we prescribe after the cleaning solution is out of the ear and the ear is relatively free of discharge. Most pets do fine with daily cleaning and medicating, your doctor will let you know if it should be done more or less frequently than daily.

Now is the time to reward the cleaner and cleanee for a job well done! If you think that was tough, how would you like to restrain this pet and clean its ears? The hugging under the chin technique doesn’t always work on a 300 pound tiger!

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Canine X-Rays

A few of the many radiographs we take each month. Click on some of them and they will enlarge. You can see the detail available with our Digital Radiography.  Click on them and most will enlarge.

All of these metallic objects (see arrows) are stainless steel sutures in Spunky. He is a Schnauzer that has gone through 3 abdominal surgeries. Two have been to remove bladder stones, one was to remove something he ate (you wouldn’t want to know what it was) that got lodged in his stomach.

 
The round white thing on the far right is a bladder stone in a different dog (urolithiasis). It is a Digital Radiograph, so click on it to enlarge. Do you see anything else in this radiograph?

The diffuse white area in the center of this dog’s abdomen is an abdominal tumor. Ultrasound will help pinpoint the exact location and will also enable us to perform a relatively simple biopsy.

 

That very large and rounded object in the chest of this dog is the heart. This is called cardiomegaly, and is due to heart failure.

This is what it is supposed to look like

Radiographs-VDChest1

Radiographs-VDChest

Severe Hip Dysplasia

Radiographs-HipDysplasia

Screw holes that remain after a plate to fix a fractured tibia (shin bone) is removed

OLYMPUS DIGITAL CAMERA

After surgery to lengthen the ulna. Damage to the radius has caused a deformity in this growing dog, and lengthening the ulna helps straighten it out.

OLYMPUS DIGITAL CAMERA

Normal knee joint

OLYMPUS DIGITAL CAMERA

This dog had chronic diarrhea that was finally diagnosed when an x-ray was taken. Those are 3 pennies in the rectum at the far right of the x-ray.

 

This Irish Setter has a condition know as bloat (GDV- Gastric Dilatation Volvulus). The large dark and circular area in the middle of the x-ray is a twisted and distended stomach. This is a very serious condition that requires immediate care.

Here is GDV one on a different dog. You can see the greatly distended stomach along with all the gas (dark areas) in the intestines on the right of the radiograph.

This is what a fractured femur (the one on the left) looks like months after it has healed

 

How many puppies can you count in this pregnant dog ? Do you want to see how a C-Section is performed?

With our Digital X-Ray you can see more detail on a different dog

The arrow points to arthritis in the spine, known as spondylosis. This is a common problem in many dogs as they age. We have numerous medications at our disposal that will help alleviate this painful affliction.

In this Digital Radiograph the spondylosis is so severe that nerves to the urinary bladder are not working well. The large round object on the right is the urinary bladder filled with urine because this pet cannot urinate properly. This is a painful condition that can lead to secondary infection and severe kidney problems.

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Cancer

The scientific word for cancer is neoplasia, meaning new growth. In reality, it is an abnormal growth of cells that interferes with an organ’s ability to function, resulting in a degree of failure in that organ. Some of these abnormal cells break off from the organ and spread to other organs in the body. This process is called metastasis, and is the hallmark of malignant cancer.

Cancer it is not one disease, has many different causes, and can affect every organ. This makes it quite a challenge to diagnose and treat. Even though the cause is not known in many cases, we do know of major factors that predispose pets to getting cancer. You will learn about this on this page regarding squamous cell carcinoma (SCC) in white cats that are exposed to the sun.

A major predisposing factor is dogs, cats and rabbits that are not neutered and spayed when they are young.  Their chances of getting breast, testicular, and prostate cancer increase significantly when they are not altered at an early age. The following pages have detailed information on this:

Dog Spay

Dog Neuter

Cat Spay

Cat Neuter

Rabbit Neuter

Rabbit Spay

We tend to see cancer more commonly in our geriatric patients.

This page has links to some of the more common cancer’s we see in animals. Click on any photo to enlarge it.


Dogs and Cats

Intestine

Kidney

Liver

Lymph node

Mammary (breast)

Mast cell

Spleen (hemangiosarcoma)

Squamous cell carcinoma (SCC)

Ferrets

Adrenal disease

Insulinoma

Liver

Rodents

Mammary (breast)

Ovarian

Reptiles

Tegu oral tumor

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Kidney (Renal) Cancer

Its not that often that we see a primary kidney cancer in a young pet. Unfortunately, it does occur. This page will show you how we diagnosed and treated it on a one year old Basenji.

This page emphasizes how fast things change, and a pet that is perfectly healthy on a physical exam and blood panel, can change for the worse.

Click on any photo to enlarge it. Graphic photo of a kidney with cancer on this page.

Normal Physical Exam

As part of our routine pre-operative spay exam a blood panel is run. It came back normal. Note the circle over BUN and Creatinine. They are tests of the kidneys, and they are normal.

Kidney-Tumor12 copy

Surgery and healing progresses as expected for a young dog. Over the next several months there was no indication of a problem.

Abnormal Physical Exam

History

Three months later this young dog was presented with signs of decreased appetite and not feeling herself.

Physical Exam

  • Body Temp- 101.6 degrees F
  • Mucous membranes- pink
  • Respiratory rate- 40 breaths per minute
  • Heart rate- 150 beats per minute
  • Haircoat- normal
  • Musculoskeletal system (bones and muscles)- normal
  • Mout- normal
  • Eyes- normal
  • Abdomen- normal
  • Lymph nodes- normal
  • Ears- normal
  • Heart- normal
  • Urogenital- normal
  • Weight- 22#, no change from 3 months prior

Interpretation- Even though this exam is essentially normal, a lack of appetite in a young dog is of concern. Also, no weight gain over the last 3 months is cause for concern in a young animal, and confirms the owners observation of lack of appetite.

Diagnostic Tests

  • Blood Panel

    It is obvious there is a serious problem with the kidney tests compared to 3 months prior. In addition, other tests are elevated, all leaning towards a serious kidney problem.

    Kidney-Tumor6

  • Ultrasound

    This is the abdominal ultrasound report. Read it carefully to see how detailed it is and note the abnormalities.

    The abnormalities are marked in the pictures to follow.

    Kidney-Tumor1

    Left kidney

    Kidney-Tumor2

    Right kidney

    Kidney-Tumor3

    Liver

    Kidney-Tumor4
    Kidney-Tumor5

    Small intestine

    Kidney-Tumor13

  • Cytology

    A fine need aspirate (FNA) was obtained during the ultrasound. This is a non-invasive way to obtain a sample as compared to a highly invasive (and more expensive) exploratory surgery. The skill of our ultrasound doctors gives us confidence in the accuracy of the FNA, although there is on guarantee it will give us an accurate cause to the enlarged kidneys.

    The sample is sent to a pathologist for microscopic analysis. It came back a malignant cancer called lymphosarcoma (LSA), also known as lymphoma.

    Kidney-Tumor9

  • Necropsy

Necropsy photo of a cat with kidney cancer. This is how lymphoma looks in a cat, not the dog above. The cancer is at the arrow, from the 7 PM to 2 AM position on the left.

cancerouskidney

Treatment

This is a serious problem that needs to be treated by a veterinary oncologist.

We send all of our cancer cases to the Veterinary Cancer Group

Kidney-Tumor14

This is the treatment protocol initiated 4 months ago

Kidney-Tumor11

Four months later this dog is doing well, with the kidney tests dramatically improved:

BUN- 35

Creatinine- 1.8

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Hemangiosarcoma

Spleen Disease (Hemangiosarcoma, Hematoma)

It is not uncommon for us to encounter problems with the spleen. Sometimes it just enlarges without any major problems, sometimes it twists on itself, sometimes it causes internal bleeding, and oftentimes it becomes cancerous. This page will emphasize cancer of the spleen, called hemangiosarcoma.

In breeds that have a high incidence of splenic tumor we recommend yearly exams starting at 5 years of age,  with radiographs and ultrasounds to catch this problem early before complications and spread, since the prognosis is poor in most cancerous spleens because they have already spread by the time of diagnosis.

Unfortunately, some pets, especially large breed dogs, will not show any symptoms until the spleen is huge. This occurred with a Labrador Retriever that was presented to us with the owner telling us “he just wasn’t doing right”.  He was eating good, was not vomiting, had no diarrhea, and was not coughing. This owner was astute and brought him in for an exam just in case.

A thorough exam and blood panel revealed no problems, so a radiograph was taken. This radiograph revealed a large abdominal mass. This could have been coming from the liver, spleen, intestines, kidneys, pancreas, or mesenteric lymph nodes. An ultrasound revealed it was from the spleen. The next day we removed an 8 pound rupturing spleen! You can see pictures of the surgery to remove this large mass in the surgery section later in this page.

Graphic surgical photos are on this page

Nomenclature

We will use some medical terms regarding the spleen:

  • Extra medullary hematopoeisis – The making of red blood cells outside of the bone marrow
  • Reticuloendothelial system – in regards to the spleen, it is the system that recycles red blood cells
  • Anemia – a low amount of red blood cells or hemoglobin
  • Thrombocytopenia – a decrease in thrombocytes, which are an important part of the clotting factors when there is bleeding.
  • Hemoabdomen – free blood in the abdomen
  • Splenomegaly – enlargement of the spleen as a result of any cause
  • Splenectomy – removal of the spleen
  • Hypersplenism- an enlarged spleen that is normal and not causing any problem

Spleen Anatomy

The spleen is an elongated and relatively flat organ that resides in the abdomen of mammals along the outer edge of the stomach. It has a tremendous blood supply that is closely attached to the blood supply supporting the stomach. It is the largest filter of blood in the body.

It has an outer capsule composed of smooth muscle and elastic fibers. The internal part of the spleen (called the parenchyma) has white pulp and red pulp. The white pulp is lymphatic tissue and the red pulp is part of the venous blood system. In between these pulps is elastic tissue that can fill up as needed.

A normal spleen in a cat

A normal spleen in a  small dog

A normal spleen in a medium sized dog

A swollen spleen in a medium sized dog

The blood supply to the spleen is closely adjoined to the stomach. You can see the dark vertical blood vessels in this photo as they enter fat between the stomach and a very enlarged and dark spleen in a semi-circle at the far right.

Physiology

The spleen has many functions. The four primary ones are:

  • Storage of cells
  • Production of red blood cells
  • Filtration of the bloodstream
  • Production of cells for the immune system

Iron that has been recycled from old red blood cells is stored in the spleen where it awaits transport to the bone marrow.

Fortunately, the body can get by without a spleen in most cases, so if there is a serious problem, and all other factors are equal, we will remove it. We tend to remove only spleens that are cancerous, rupturing, or have a torsion.

Diseases

Splenomegaly

Splenomegaly is a generalized term that simply means enlargement of the spleen. In some species, like ferrets, an enlarged spleen can be normal, and is called hypersplenism. A spleen can be enlarged diffusely or it might  have nodules in certain areas.

There are many causes for an enlarged spleen. The most common and important are listed in more detail below. Some of the more uncommon ones are due to infectious agents (erlichiosis, babesia, hemobartonella), FIP, medications, and immune mediated diseases.

This spleen has splenomegaly in addition to numerous nodules

Splenic Torsion

In this problem the spleen twists on itself, compromising the blood supply. When the spleen twists the blood keeps on pumping into it by the arterial system, but this same blood is not able to leave through the venous system, and the spleen becomes grossly engorged.

It can occur on its own, after excessive exercise, or due to trauma. It can occur in conjunction with Gastric Dilatation Volvulus (GDV), also known as bloat. We tend to see this torsion, along with GDV, in large and deep chested breeds.

If the torsion is chronic, there might be no symptoms at all, or there might be:

    • poor appetite (anorexia)
    • weight loss
    • discolored urine
    • vomiting- might be intermittent
    • weakness
    • weight loss.
    • collapse
    • death

Examination of a pet with splenic torsion might reveal:

    • pale mucous membranes (gums)
    • rapid heart rate (tachycardia)
    • painful abdomen
    • a large mass in the abdomen upon palpation
    • fever
    • dehydration
    • jaundice (icterus)

A blood panel might reveal:

    • anemia
    • low platelets (thrombocytopenia)
    • elevated white blood cells (leukocytosis),
    • elevated liver enzyme tests,
    • hemoglobin in the urine (hemoglobinuria)

This disease is diagnosed by imaging tests when the above symptoms are present. A radiograph might reveal a mass in the abdomen with the spleen abnormally located. Ultrasound can confirm the problem and give us an idea of its severity.

A splenic torsion is considered an emergency, so the treatment of choice is surgical removal after a pet has been stabilized by treating for shock. On the deep chested breeds we might even tack the stomach to the abdomen to help prevent potential GDV in the future.

Splenic Cancer

Some splenic masses that are cancerous are classified as benign, meaning they do not generally spread (metastasize), and only take up extra space within the abdomen. Even though they do not spread, sometimes this extra space they take up can interfere with other organs.

Some benign cancerous masses include lipoma (fatty tumors), hemagioma (associated with vasculature), and plasmacytosis (infiltration of plasma cells throughout the splenic nodule or tissue in general). Unfortunately, when a spleen has cancer it commonly is the malignant version and not this benign version.

The most common malignant tumor in the spleen is the hemangiosarcoma (HSA). It is also called malignant hemangioendothelioma). The cause is not known. It can spread to many different organs, making it highly malignant:

    • heart
    • lungs
    • muscle
    • skin
    • bones
    • abdomen
    • diaphragm
    • brain
    • kidney

HSA can also cause complications, such as disruption of the coagulation cascade which causes a mixture of abnormal clot formation as well as inability to control internal bleeding (known as disseminated intravascular coagulation, DIC).

Symptoms of HSA vary, and range from mild to severe. In extreme cases sudden blood loss can lead to sudden death.

These large nodules on this spleen are a malignant cancer called hemangiosarcoma

Another common type of malignant splenic cancer is lymphosarcoma, a type of cancer that can have a primary tumor in any other organ (i.e. lung, gastrointestinal tract, liver). Lymphosarcoma is one of the more common tumor types observed in the spleen of cats. Sometimes the tumor within the spleen is not even the primary tumor, but rather a single nodule or multiple nodules due to metastasis from a distant primary tumor.

Hematoma

Hematomas are one of the most common causes of an enlarged spleen in dogs, representing over 50% of splenomegaly cases. This type of splenic mass is basically an accumulation of pooled blood within the splenic tissue; many stop growing and are then resorbed after a period of time, but others grow exponentially and eventually rupture. A ruptured hematoma originating from the spleen is an emergency, and often the pet experiences an acute collapsing episode followed by a significant loss of blood into the abdomen (hemoabdomen). You can see the surgery of a dog with an 8 pound hematoma later in this page

Other causes

Congestions of the spleen can occur from iatrogenic causes, which are those associated with administration of certain drugs (i.e. anesthetic agents or tranquilizers). Congestion can also occur due to increased blood pressure within the vasculature of the liver (known as portal hypertension), which can occur secondary to congestive heat failure among others.  The spleen can over-react to particular conditions, resulting in a disease process known as hyperplastic, or reactive, splenomegaly. A spleen can become reactive when there is excessive stimulation of the immune system from conditions such as immune-mediated disease, bacterial infections, tick-borne diseases, and many more.

This spleen has a laceration

Diagnosis

Signalment

Dogs, cats, and ferrets can get splenic diseases, although it is much more of a problem in dogs. Splenomegaly itself can occur in most any age due to the numerous causes of the condition. For instance, if the cause of splenic enlargement is infectious, then the pet may be quite young. However, if the enlargement is cancerous, the pet tends to be middle aged (average 10 years in dogs). Due to the wide range of causes, there is no known gender predilection (males tend to be affected equally as often as females). Certain disease processes tend to be over-represented by specific breeds:

Splenic torsion tends to occur in large breed, deep-chested dogs:

Splenic tumors like HSA tend to occur in several breeds. It can be some common in some breeds that we  recommend physical exams, blood work, abdominal radiographs, and especially abdominal ultrasounds, yearly in these dogs as they reach 5 years of age:

    • German Shepherds
    • Golden Retrievers
    • Portugese Water Dogs
    • Boxers
    • English setters
    • English pointers
    • Great Danes
    • Skye Terriers
    • Bernese Mountain Dogs

History

In many cases, a patient with splenic disease has very little or no specific clinical signs. Observations made by owners at home might include non-specific indicators of illness:

    • lethargy
    • inappetence
    • weight loss
    • diarrhea
    • vomiting
    • collapse
    • discolored urine
    • abdominal distention

Physical Exam

Upon palpation of the abdomen, significant abnormalities of the spleen can usually be detected, especially when a large mass is present within the cranial aspect of the abdomen (toward the chest). However, a mass or enlarged organ in the cranial abdomen cannot always be differentiated from a mass or enlargement of the liver. In some cases, decreased pallor (pale gums) can be a sign of anemia or shock, which in combination with an abdominal mass can indicate a ruptured splenic mass or torsion. We confirm this with an ultrasound before surgery.

If the gums are pale, certain diseases of the spleen may lead to free blood in the abdomen, which can sometimes but not always be detected by palpation of a fluid wave. Other generalized signs might include weakness, fever, dehydration, poor pulses, increased heart rate (tachycardia), increased bleeding at site of blood draw (due to coagulopathy), and/or increased size of peripheral lymph nodes.

Diagnostic Tests

Some diagnostic tests which provide significant information include radiographs, blood work, ultrasonography, evaluation of the cells (cytology) through a fine-needle aspirate sample, and surgical exploration.

Radiography

The arrow points to what a spleen looks like on a radiograph. It is enlarged, although a lobe of the liver can easily overlap the spleen and make the spleen look enlarged. So in this case, technically its called hepatosplenomegaly.

Here is a dog with an enlarged spleen. Can you see it?

Splenectomy -SpleenRadSplenectomy -SpleenRadSplenectomy-LateralRad

The red circle delineates the enlarged spleen.

L.I. – Large Intestine

Pr- Prostate

Splenectomy -SpleenRadSplenectomy-SpleenRadCircle

Blood Panel

Blood work (clinical chemistry and complete blood counts) is a crucial component for detection of compromised organ function. Splenic involvement might reveal anemia (decreased red blood cells), thrombocytopenia (decreased platelets for clotting), leukopenia (decreased white blood cells) and reticulocytosis (increased immature red blood cells to indicate that the body is trying to compensate for the loss of mature red blood cells).

This is a blood panel that might be seen with splenic disease, although many other diseases can also cause this type of blood panel. The primary problem in this blood panel is anemia.

Fluid Analysis

If abdominal fluid is present we can remove it and analyze it. This is called abdominocentesis. There is no guarantee this will make a diagnosis since many cancers, including HSA, might not be found in this fluid.

Ultrasonography

Ultrasonography has revolutionized diagnosis in animals, and prevented many unnecessary exploratory surgeries (called celiotomies or laparotomies), while at the same time alerted us to the fact that we need to do immediate surgery. Keep in mind, our patients do not talk to us, and  an enlarging tumor in the abdomen in one of us humanoids would be uncomfortable, and cause us to seek medical care long before we see a dog or cat with a tumor growing in the abdomen.

Ultrasonography of the abdomen is an important modality for diagnosis of splenic disease because of its sensitivity to changes of organ size, shape, location, and even texture. An ultrasonographic examination in combination with radiographs provides a comprehensive understanding of which organs are involved and often helps to narrow the possibilities down to a select few differentials.

We use ultrasound to confirm our suspicions of a splenic tumor based on the breed, history, exam findings, and blood panels and radiographs. Ultrasound confirms the diagnosis, lets us know if the spleen is already rupturing, tells us the size of the spleen, and if there are any other internal organ problems. A critical component of the ultrasonographic exam in HSA is echocardiography (evaluation of the heart). A key site of metastasis associated with hemangiosarcoma is the right atrium. HSA that has spread to the right atrium of the heart is a serious sign, and the prognosis is not good. This is important information if we are thinking of surgical removal of the spleen.

The lines demarcate the margins of this spleen

Do you see the spleen in this picture without the demarcation?

A typical ultrasound report on a dog with a cancerous spleen

This ultrasound of the heart (echocardiogram) shows spread of the tumor to the right atrium, which is a poor prognosis

RV- Right ventricle

RA- Right atrium

Cytology

Aspiration of the cells in an organ for cytological exam by a pathologist is an important part of most abdominal ultrasounds. It helps prevent an exploratory surgery, and can lead to a diagnosis in many cases. Cytologic evaluation of splenic problems is not always indicated and can sometimes be contraindicated depending on certain disease processes. Certain cancers of the spleen as well as hematomas may result in significant blood loss if stuck with a needle due their fragile nature. Even though the ultrasound guides the biopsy location, if the disease process only involves a small portion of the splenic tissue, or is sporadically located throughout, then a small needle-sized sample may not obtain the affected tissue at all.

ECG (Electrocardiogram)

This tests the electrical activity of the heart. I some HSA’s there will be an arrhythmia

Definitive Diagnosis

Histopathology is the analysis of the spleen after it is removed. This gives us our final diagnosis.

Histopathology

Treatment

Surgery is a common treatment for splenic disease. This is called a splenectomy. If there is trauma or a problem in only a small part of the spleen, we might do a partial splenectomy since we always want to preserve as much function of the spleen as possible. This partial splenectomy is not common.

We do the surgery to remove the tumor, and if malignant add chemotherapy to help prevent spread after we do the surgery. Prior to surgery we do an ultrasound of the heart as already mentioned, and also take chest radiographs to check for spread of a tumor. We also perform a clotting panel since blood loss is common in this surgery and we do not want post operative bleeding.

Unfortunately, survival time for dogs and cats with surgery alonge HSA is only 1-3 months, with most dogs dying due to spread of the HSA to other organs, causing these organs to malfunction. This emphasizes the need for an early diagnosis in the breeds prone to this cancer.

Dogs that have surgery to remove the spleen, and that are also treated with chemotherapy, might survive up to 9 months. This depends on whether the tumor has spread, and again emphasizes the need for an early diagnosis. Dogs and cats have less side effects than people on chemotherapy, and their quality of life is high if this therapy is instituted immediately after surgery.

Dogs that are diagnosed at a young age, have had the HSA rupture prior to surgery, have evidence of spread to other organs when the splenectomy is performed, or have a more aggressive grade of tumor, do not tend to live 9 months after surgery.

The primary chemotherapy drug for HSA is Adriamycin (doxorubicin). It will slow the disease process, but it will not cure your pet of this disease. The doctors at the Veterinary Cancer Group in Tustin institute this therapy.

If a pet is anemic, or we anticipate significant blood loss during surgery, we will give a blood transfusion prior to surgery or during the procedure. Post operatively if a pet is not doing well we will give a blood transfusion also.

After doing a cross match to ensure compatibility we obtain whole blood for the transfusion

Splenectomy

A splenectomy is performed to treat and sometimes cure this problem. It is sometimes done as an emergency procedure if the spleen has ruptured and there is significant internal bleeding.

Pre-anesthetic preparation is important in every surgery we perform, no matter how routine, because surgery is not an area to cut corners.  Once a pet is anesthetized, prepared for surgery, and had its monitoring equipment hooked up and reading accurately, the surgery can begin.

This is a sterile abdominal surgery, and our surgeons scrubs with a special antiseptic soap prior to gowning and gloving

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While our patient is being anesthetized our surgeon is already in our surgical suite setting up instruments. Our surgeon is ready to start before our patient is at a proper plane of anesthesia. Once the anesthetist gives the green light the surgery starts immediately. We want our surgeon waiting for his patient, not the other way around.  All of this is to minimize anesthetic time.

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We keep a close tab on important physiologic parameters for all of our surgeries. Monitors like this give us an early warning of an impending problem.

This machine monitors:

Temperature

Heart Rate

Heart rhythm

Oxygen saturation

Carbon dioxide level

Respiratory rate

Surgery-Monitor

In addition to our monitoring equipment our anesthetist stays “hands on” in monitoring important physiologic parameters. Our anesthetist is using a special stethoscope (esophageal), that is passed down the esophagus and lays right over the heart. This gives us a clear sound of the heart and how it is beating.

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To minimize anesthetic time we routinely have 2 doctors working as a team performing the splenectomy.  They work together as a well orchestrated team.Our patient is under anesthesia and our surgeons are completing the draping process while our anesthetist is adjusting the surgical lights.

By working together early in the surgery we minimize anesthetic time.

For a pet that might already be anemic it is important to minimize blood loss during surgery. Special care is taken on entering the abdomen to minimize loss. There is minimal bleeding at this point as our surgeon gently dissects the sub Q (subcutaneous) tissue just under the skin.

As the surgery progresses we sometimes encounter significant bleeding from blood vessels in the sub Q fat and from muscles that are cut. All of them are clamped or cauterized before proceeding further. For a pet that might already be anemic this added blood loss is important to control, and it is stopped immediately.

When all bleeders are under control (called hemostasis) we enter the abdomen. We make our incision at a specific spot in the abdominal muscles called the linea alba. It is at this spot that there are minimal blood vessels. The linea also has strong tendinous attachments to the muscle, so when we sew it back together these tendons attachments have more holding ability than the abdominal muscles alone. This will prevent a hernia.

Our first view of the spleen once we have entered the abdomen. It is the round and reddish structure at the top of the abdominal opening and just to the left of our surgeon’s finger.

A spleen that is not healthy is friable and can easily rupture when handled. Our surgeon has to gently coax it out to prevent  this from happening.

Once it is finally exteriorized the problem is obvious. At this point we do not know if it is cancerous or not. We do know it is in the process of rupturing and glad we are getting it out now.

Now that we have it ready for removal we have to ligate its blood supply. As you remember from your surgical anatomy above the blood vessels to the spleen are closely related stomach. It is important to ligate the blood supply very close to the spleen so as not to compromise the blood supply to the stomach, leading to serious consequences.

This blood supply can be surrounded by fat. We have to isolate segments before we ligate.

In the center of this picture you can see one blood vessel that is already ligated. On the right our surgeon is in the process of ligating another blood vessel.

We have completed 3 ligations at this point, with many more to go.

Our surgeons work simultaneously, each starting at a different end of the spleen, so they can complete this tedious part of the surgery sooner. Its all about secure ligation of these blood vessels and minimal anesthetic time.

As part of the natural healing process there is a tissue in the abdomen called omentum. It is like a net, and surrounds an organ that might be diseased. For example, a ruptured intestine that is leaking intestinal fluid (extremely irritating to the abdomen and will cause a peritonitis), will have this net surround the intestine to wall off the leak.

In the case of this rupturing spleen the omentum covered the spleen to help prevent further blood loss. These are clots on the omentum from that. At this point in time during the surgery we cannot determine for sure if these are clots or spread of tumor. The report from the pathologist will tell us for sure. It turns out that this time they are clots.

When the spleen is completely removed we complete our exploratory surgery by checking the other internal organs, especially the liver. Once this check is complete we suture the muscle layer (the linea alba) closed. Again, we work as a team, with each surgeon (they are both lefties) suturing the linea until they meet in the center.

Once we have finished suturing our patient, who is already on a pain patch (Duragesic or Fentanyl patch- which is removed in 3 days), is given an additional pain injection and carefully monitored post-operatively. As part of the monitoring we perform a simple blood panel to make sure there was no problem with blood loss during surgery. If the blood loss is significant we will give a blood transfusion with the blood we have already set aside specifically for this patient.

Post operatively we take radiographs of the chest and perform and ultrasound every 2 months for cases of HSA looking for distant and local metastasis.

Occasionally we come across a spleen that is so large it is hard to believe it can get this big. The following spleen was over 8 pounds, removed for a 65 pound labrador named Jake.  Dr. P and Dr. R had to do this one together. Removing it was like delivering a baby!

The size was obvious as soon as we entered the abdomen. At this point in time we were not sure if it was a boy or a girl! Dr. P is coaxing it out of the abdomen at the beginning of the surgery, being very careful not to rupture it.

We had to be very gentle  because it was quite delicate(friable) and already rupturing

Ligating the blood vessels to the spleen was more difficult than usual because of the size, scar tissue, and omental tissue that covered the rupturing spleen

It turns out that this was a hematoma and the dog did fine for several more years. Lucky this spleen did not rupture before the surgery.  Most likely, with a hematoma this large, death would have ensued rapidly.

Ancillary Treatment

After surgery we will consult with the oncologists at the Veterinary Cancer Group for further treatment

Post Surgical Treatment

Prognosis

A successful outcome from surgery depends on what disease process is present and how long it has been present.

Splenic Hematoma – good

Splenic Torsion – good

Hemangiosarcoma – guarded to poor.

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Lymph Node Diseases

The lymph nodes are part of the lymphatic system. They have several important functions and are good indicators of disease. During a physical exam the external ones can be palpated to determine if they are enlarged. The medical term for this is lymphadenopathy.

Causes

Lymph nodes can enlarge due to several reasons:

  • Inflammation

    A reaction to a foreign body might cause this.

  • Infection

    Bacterial, viral, or fungal infections can cause them to enlarge. This enlargement might be a sign that they are performing their job as expected. When the infection subsides the lymph node should return to normal size.

  • Cancer

    The most common cancer that causes this problem is called lymphoma (also know as lymphosarcoma)

Examination

Internal Lymph Nodes

Numerous lymph nodes exist within the thoracic and abdominal cavities. They can not be palpated easily, and their enlargement does not show up on routine blood samples. They might be seen on radiographs or ultrasound if they are significantly enlarged. They can be found when performing an exploratory surgery.

This radiograph of the chest shows the heart and lungs clearly. The lower arrow points to the location of the sternal lymph node. It is not visible in this dog because it is normal. The top arrow points to a round, white structure. It is a tumor nodule that has spread from cancer elsewhere in body.

This radiograph of the abdomen shows the liver and stomach clearly. The lower arrow points to the general location of the mesenteric lymph node. The top arrow points to the location of the sublumbar lymph node. Neither one is visible.

The scalpel blade is pointing to the mesenteric lymph node. This node is found at the center of the small intestine loops. This one is enlarged because this cat has kidney cancer, which has spread to the mesenteric node.

Here is another enlarged mesenteric lymph node from a cat with intestinal cancer called lymphosarcoma.

External Lymph Nodes

Mammals have numerous external lymph nodes (also called peripheral lymph nodes) that can be palpated during a physical examination. This is of great advantage because we can easily feel if they are enlarged without having to rely on diagnostic tests. Reptiles and birds do not have external lymph nodes.

Five external lymph nodes are routinely palpated during a physical exam. All of them are paired, which is another advantage because we can compare one to another and notice subtle changes in size:

  1. Submandibular

    They are located in the neck area near the angle of the jaw. They lay right next to the salivary glands, so it is important to palpate the correct structure.

  2. Prescapular

    Located just in front of the shoulders. Follow the arm up to the point of the shoulder to find them.

  3. Axillary

    Found on each side of the chest in the armpit area. They tend to be small, and are more forward then most people realize.

  4. Inguinal

    Found on the abdomen towards the inside of each rear leg. There is significant fat in this area, so they might be difficult to find, even if enlarged. Also, there is mammary tissue in the area that can easily feel like an enlarged lymph node if the mammary tissue has an infection or cancer.

  5. Popliteal

    Found on each rear leg on the opposite side of the knee. They are relatively superficial and easy to feel.

We will gladly teach you how to palpate these lymph nodes whenever you bring your pet in for a physical  exam. These are internal organs so they are always palpated in a gentle manner. You might want to palpate them on a weekly basis at home. If you think they are enlarged bring your pet in for an exam so we can determine if there is a problem.

Diagnosis

Fine Needle aspiration

This test is a relatively simple way to obtain a significant amount of information from an enlarged lymph node. In this test we use a small needle (similar to the one we use to give vaccines) and gently insert it into the enlarged lymph node. We aspirate some of the lymph node material and put it on a microscope slide.

This ferret has a very large right submandibular lymph node. Do you see the needle on the left side of the picture that we are using to obtain the aspirate sample?

The aspirated material is put on a microscope slide for analysis by a pathologist. They will put special stains on the material and carefully scrutinize it under the microscope.

This is a typical report obtained when the pathologist reads the sample on the microscope slide. It is from a labrador with 2 enlarged lymph nodes.

The fine needle aspirate test is not infallible at finding a problem. When the needle is inserted it is put in only by feel. It is possible for the lymph node to have a problem area that the needle missed. Also, we are giving the pathologist only a very small sample to read. It can be difficult to determine the health of the whole lymph node when only a small sample is taken.

Due to these limitations the pathologist sometimes can not say for certain what caused the lymph node to enlarge. If it comes back inconclusive then we might keep the lymph node under close observation. If there are other changes in the rest of the physical exam, or laboratory data indicates there might be a significant problem, we will remove the whole lymph node and submit it for analysis.

If the fine needle aspirate report comes back that cancer is suspected we will remove the lymph node, no matter what the other laboratory tests indicate.

Biopsy

The most accurate way to determine if a lymph node is seriously diseased is to remove the whole node and submit it for analysis. It gives us significantly more information than the fine needle aspirate. It requires anesthesia and an small incision in the skin. We routinely use our laser for skin incisions for its great ability to minimize bleeding, swelling, and post-operative pain.

This picture shows a popliteal lymph node in Dr. P’s hands. He is getting ready to make an incision in the skin over the lymph node with the laser.

This is the inflamed popliteal lymph node as it appears under the skin. It will be completely removed.

Here it is after complete removal. It is the size of a large pea.

The report on this dog gave us a diagnosis of valley fever, which is a fungal infection. You don’t have to read through all of the medical mumbo jumbo to get to the valley fever diagnosis at the end. In the last paragraph you can see that special stains were needed to make the final diagnosis. These special stains are not easily performed on a fine needle aspirate.

This report of cancer came back on a Labrador Retriever. This is the same dog that had the fine needle aspirate report above.

This cat has an enlarged popliteal lymph node. We used the laser in this case also.

We use the laser to make an incision in the skin because of the lasers ability to minimize bleeding.

The inflamed lymph node is easily visualized. Note the lack of blood in the surgery site.

The anatomy of this lymph node is not normal, an indication that it is diseased.

Because of the unique qualities of the laser we are able to perform this surgery with a very small incision.

Treatment

Inflamed lymph nodes are treated with an anti-inflammatory like cortisone. Pets with bacterial or fungal infections are treated with antibiotics or anti-fungal medications. There is no specific treatment for a lymph node that is enlarged due to a viral infection. If cancer is the cause of the enlargement it will be treated with surgery, chemotherapy, radiation, or a combination of all of these.

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