Spleen Tumor Emergencies
Feb 11, 2015 09:10PM
By Dr. Tanya Tag, DVM, DACVECC
One of the hardest parts of my job is telling owners that their best friend and family member needs emergency surgery. There are many reasons why pets can end up in this predicament but the hardest for clients to except and a doctor to explain is when the cause remained silent and hidden until the problem suddenly appeared. These owners thought their pet was normal or just showed minor changes they felt were explained by older age. Sometimes the pet was recently seen by their veterinarian and given a clean bill of health, leading to even more shock. Sadly, this scenario often accompanies dogs that present as an emergency with bleeding splenic tumors.
The spleen is an organ located inside the dog’s abdomen closer to the dog’s liver and chest and on the left side. It is responsible for storing and filtering red blood cells and helps the immune system. There are a variety of things that can happen to the spleen that result in an ER visit for your pet. One of the most common is a bleeding splenic tumor. Trauma to the spleen, such as being hit by a car or falling, can also rupture the spleen and cause it to bleed into the abdomen. Because the spleen stores blood, animals can lose a large blood volume very quickly and go into shock.
When a pet is ill the clinical signs they exhibit are often related to the function of the organ that is affected. Because the spleen stores blood, if it is damaged it often bleeds causing anemia. If it only bleeds a little before the body is able to clot the bleeding, an owner may not notice much change in their pet, or may see subtle changes like abdominal discomfort, panting, increased thirst and urination. If the spleen begins bleeding again or the body is unable to stop the bleeding the symptoms in your pet are more pronounced; pale gums, collapse, severe pain, restlessness, panting, abdominal distension, weakness, staggering, and dazed appearance.
When a case presents to the Pet+ER it is immediately triaged to help us determine if the patient is stable. Since these cases can present with a variety of clinical signs our initial response and work up will be driven by your pet’s immediate needs. Unstable pets may receive an IV catheter and fluid support while tests to determine the underlying problem are started. Typically a patient’s blood pressure, blood glucose, red blood cell count, EKG, radiographs, and a brief abdominal ultrasound (termed FAST for focused assessment sonography for trauma) are needed as supplemental information to the physical exam to start honing in on the problem. If the ultrasound shows fluid in the abdomen, collection of this fluid (abdominocentesis) will be done to determine if there is abdominal bleeding or other fluid present. Evaluation of this fluid for the red blood cell count, type of cells present, glucose level, total protein, and ability to form a blood clot, all may be necessary to give you an accurate idea of what is going on with your pet. If bleeding is found, a more detailed ultrasound may be done after the patient is stabilized to help locate where the bleeding is coming from and if there appears to be one problem or multiple abnormalities present. One of the limitations of radiographs or ultrasound is that we cannot use it to look at mass or organ and determine if a cancer is benign or malignant. Certain things may suggest a malignant tumor, such as the presence of other masses in multiple organs, or certain patterns in the chest on x-rays, but it cannot eliminate the concern for spread cancer if these changes are not seen. This is where this type of case gets really difficult. As a veterinarian we often come back to the owner with the knowledge that we found a splenic mass and blood in the abdomen but what to do from there is not an easy decision. We can often stabilize (sometimes with the help of a blood transfusion) a bleeding mass so that the patient is able to undergo surgery, but there is no way for us to know what type of mass is present without a biopsy. The common causes of splenic masses are: cancer- such as hemangiosarcoma, nodular hyperplasia (a benign splenic enlargement), hematoma and splenic cyst. The scary thing about this is that you cannot tell by looking at these masses which is occurring, so even at surgery we are faced with the reality of removing the spleen to stop the bleeding and sending a sample of the mass to a pathologist for microscopic evaluation of the tissue to help determine what type of problem caused the mass. If hemangiosarcoma is diagnosed prognosis is 2-3 months with surgery alone and 4-6 months with surgery and chemotherapy. There are no great recent research papers that tell us exactly how prevalent this aggressive cancer is, however older studies suggest 50- 66% of splenic tumors are malignant hemangiosarcoma. As a veterinary criticalist, and in surveying other veterinary specialists, our experience is that 80-90% of dogs that present for bleeding splenic tumors have hemangiosarcoma.
Unfortunately, problems that arise with the spleen often do not show up until they are well established. Routine wellness exams and routine bloodwork are important to detect subtle changes in your pet’s condition, such as abdominal or splenic enlargement, changes in the size of lymph nodes, or anemia. Bear in mind, that even on thorough physical exams, splenic mass are often unable to be palpated, and blood work is usually normal until a mass has bled or the spleen has ruptured some of the red blood cells. Subtle signs that your dog is having a problem may include weight loss, a pot belly appearance, intermittent collapse, or dementia.
The Pet+ER has a free iPhone app that can help you store information about your pet so that it is readily accessible should an emergency arise and can help you connect with us. If you are ever concerned about your pet’s health, see your primary care veterinarian or emergency veterinarian right away.
Dr. Tanya Tag, DVM, DACVECC, received her Doctor of Veterinary Medicine degree from Maryland Regional College of Veterinary Medicine, in Blacksburg, VA. She completed her internship at Animal Emergency and Referral Center in Fort Peirce, FL and her Emergency and Critical Care residency at Louisville Veterinary Specialists and Emergency Services in Louisville, KY. Dr. Tag is the Chief of Staff at the Pet+ER in Towson, MD where she leads a team of eight emergency and critical care doctors at the 24/7 Emergency and Trauma center. She is also the only board-certified criticalist in the Baltimore Metropolitan Area.
- See more at: http://www.marylanddogmag.com/_articles/2014/fall/spleen_tumor_emergencies.html#sthash.4IW55LRO.dpuf