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spring 24: surgery > 5+ 6. shunts > Flashcards

5+ 6. shunts Flashcards

1
Q

left divisional shunt

A

left:
left medial lobe
left lateral lobe

central:
right medial and quadrate

right:
right lateral lobe and caudate process of caudate lobe

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2
Q

right divisional shunt

A

left:
left medial lobe
left lateral lobe

central:
right medial and quadrate

right:
right lateral lobe and caudate process of caudate lobe

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3
Q

central divisional shunt

A

left:
left medial lobe
left lateral lobe

central:
right medial and quadrate

right:
right lateral lobe and caudate process of caudate lobe

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4
Q

— ligament connect liver to diaphragm

A

right and Left triangular ligament

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5
Q

— ligament connect liver to foramen vena cava

A

coronary ligament

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6
Q

— ligament attaches to liver to the diaphragm and body wall

A

falciform

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7
Q

— attaches caudate lobe of liver to cranial pole of — kidney

A

hepatorenal ligament
Right

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8
Q

blood supply for hepatic artery is from

A

aorta - celiac - hepatic- hepatic branches

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9
Q

hepatic artery brings — % of blood flow to liver

A

20-25
* at low BP can increase to 60% to supply O2 to liver

aorta-celiac-hepatic-branches of hepatic

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10
Q

blood supply to portal vein in dogs vs cats

A

both:

  • cranial and caudal mesenteric veins
  • gastrosplenic veins

Dogs only: gastroduodenal vein!

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11
Q

portal vein supply —% of blood flow to liver

A

75-80

dogs have gastroduodenal vein

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12
Q

what does liver do

A
  • Metabolism of lipids, carbs, proteins, vitamins
  • hemostasis- coag factor
  • protein production
  • immunologic functions
  • detox
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13
Q

PT and PTT for shunt pts

A

may be longer, but clinical bleeding not normal

  • may resolve 6 weeks post sx
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14
Q

what bloodwork for shunts in dogs

A
  • low albumin, globulin, cholestrol, glucose
  • normal or elevated liver enzymes
  • low BUN/creat
  • low coags= high PT, PTT
  • high ammonia (liver incharge of ammonia to urea)= low urea

(ABC glucose)

cats: low Creat, BUN
slight increase ALT,ALP

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15
Q

most common cause of intrahepatic shunt

A

patent ductus venosus (between aorta and liver)

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16
Q

most single extrahepatic shunts are

A
  • congenital
  • young small/toy breeds
  • DSH, persians, himalayans
  • from gastric or splenic veins
17
Q

most single extrahepatic shunts are from the

A

from gastric or splenic veins

18
Q

what happens to portal vein with single extrahepatic shunt

A

becomes smaller

usually form gastric or splenic veins in small toy breed dogs

19
Q

intraheptic shunts usually occur in

A

large breed
congenital- most common patent ductus venosus

20
Q

what happens to portal vein with intrahepatic shunt

A

dilated/ turbulent

21
Q

multiple extrahepatic shunts occur 2nd to

A

portal hypertension

  • older dogs- end stage liver disease
  • young animals- congenital hepatopathy or arteriovenous fistula

poor prognosis

22
Q

what does portal vein look like in multiple extrahepatic shunts

A

older dogs- end stage liver disease → portal HTN
young dogs- congenital heptaopathy or AV fistula

23
Q

what causes ascites with extrahepatic shunts

A

low albumin

( made in liver- decreased blood flow to liver= less albumin= less oncontic pressure = fluid leave vessels into tissues)

24
Q

shunts in cats might have — eyes

A

copper colored iris

25
Q

what are some clinical signs of pt with shunt

A
  • Central nervous signs: drooling, aggression, head pressing, seizures, ataxia
  • GI signs- GI bleed (dogs), vomiting, diarrhea
  • Urinary signs- hematuria, dysuria, stones (ammonium biurate)
  • cats- copper colored iris
  • small stature
  • Cryptorchid/ retained baby teeth
  • large kidneys
26
Q

what type of urinary stones with hepatic shunts

A

ammonium biurate

27
Q

good bloodwork test for hepatic shunt in cats

A

biles acids

  • both pre and post bile acids will be ↑
28
Q

medical treatment for shunts

A

low protein diet
lactulose
antibiotics
seizure control- benzo, pheno, keppra
GI ulcer treatment: antiacids
hepatoprotective: Vit E, milk thistle

29
Q

why give lactulose to shunt pts

A
  • can be given by enema
  • ammonia- ammonium
  • increase fecal transit times so bacteria move through faster= less time for toxins to effect pt
30
Q

why give antibiotics to shunt pt

A

trying to kill off bacteria that create urea

  • ampicillin, amoxicillin, neomysin, metro
31
Q

how to measure portal pressure during shunt repair

A

water manometer
pressure transducer

32
Q

what happens to BP when you tie off shunt

A

it will drop- blood will backflow into GI tract

33
Q

post op care for shunt repair

A
  • IV fluids
  • Prevent hypothermia, hypoglycemia
  • Monitor blood pressure
  • Monitor for portal hypertension
  • Development of ascites
  • Monitor for seizures
  • Abdominal discomfort
34
Q

how to treat post op seizures from shunt repair

A
  • mannitol
  • IV midazolam, diazepam or propofol
  • pheno
  • fix electrolyte, acid/base, ammonia, BG
  • postassium bromide

spring 24: surgery (22 decks)

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