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Small Animal Surgery > 8 - Liver, Biliary, Pancreas, Spleen > Flashcards

8 - Liver, Biliary, Pancreas, Spleen Flashcards

1
Q

What 3 things does the liver synthesize?

A
  1. Plasma proteins (albumin)
  2. Coag factors
  3. Bile acids
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2
Q

What 4 things does the liver metabolize?

A
  1. Nutrients (CHO, lipids, proteins)
  2. Drugs
  3. Toxins
  4. Vitamins and minerals
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3
Q

What are the 2 main surfaces of the liver?

A

Diaphragmatic and visceral

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4
Q

What are the 6 lobes of the liver?

A
  1. R lateral
  2. R medial
  3. Quadrate
  4. L medial
  5. L lateral
  6. Caudate (caudate and papillary processes)
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5
Q

What is the afferent blood supply to the liver?

A

Portal system = portal vein

Arterial system = aorta

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6
Q

What provides the liver with most of the hepatic blood supply?

A

portal vein

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7
Q

What supplies most liver tumors with their blood supply?

A

aorta

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8
Q

What is the efferent blood supply from the liver and where does it drain?

A

hepatic veins –> caudal vena cava

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9
Q

What are the 2 main arterial branches that supply the liver and what is the major artery they come off of?

A

Celiac artery –> Hepatic a. –> R and L lateral branches

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10
Q

1

A

hepatic artery

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11
Q

2

A

gastroduodenal artery

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12
Q

3

A

L branch of the hepatic artery

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13
Q

4

A

branches to the left lobes

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14
Q

5

A

right branch of the hepatic artery

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15
Q

6

A

R gastroepiploic artery

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16
Q

7

A

L gastric artery

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17
Q

8

A

splenic artery

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18
Q

9

A

angiographic catheter

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19
Q

What does the R portal branch supply?

A

R lateral lobe

Caudate process

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20
Q

What does the L portal branch supply?

A

R medial, Quadrate, L medial, L lateral, papillary process

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21
Q

What is the normal portal pressure?

A

8-12 mmHg

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22
Q

What are the 3 main hepatic veins? Which one is largest and what does it drain?

A
  1. Right
  2. Middle/central
  3. Left = largest –> drains L lateral, L medial, quadrate, part of R medial
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23
Q

1

A

caudal vena cava

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24
Q

2

A

R hepatic vein

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25
Q

3

A

L hepatic vein

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26
Q

4

A

Branches to L lobes

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27
Q

5

A

middle hepatic vein

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28
Q

6

A

branch to papillary process

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29
Q

7

A

R renal vein

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30
Q

8

A

angiographic catheter

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31
Q

9

A

occlusion balloon

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32
Q

Why would liver dysfunction lead to coagulopathy?

A

Clotting factors are not sufficient in #

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33
Q

What would hypoproteinemia due to liver dysfunction lead to?

A

Delayed wound healing (albumin <2g/dL)

Ascites

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34
Q

When does hypoalbuminemia occur?

A

When there is ~70% loss of helpatic functional capacity

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35
Q

What can impaired immune function due to liver dysfunction lead to?

A

Increased risk for sepsis

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36
Q

What is the function of the gall bladder?

A

Bile storage

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37
Q

Where is the gall bladder?

A

Between R medial and quadrate lobes

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38
Q

What forms the common bile duct?

A

Cystic duct + hepatic ducts

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39
Q

In dogs, where do the CBD and pancreatic duct join?

A

At the major duodenal papilla

40
Q

In cats, where do the CBD and the pancreatic duct join?

A

Prior to entering the major duodenal papilla

41
Q

What is different about the duodenal papilla of dogs compared to cats?

A

Dogs have a minor duodenal papilla in addition to a major one

42
Q

The GB contracts when stimulated by _____.

A

cholecystokinin

43
Q

What is the route of bile?

A

R/L hepatic ducts –> cystic duct –> common bile duct –> major duodenal papilla

44
Q

What are 3 ways by which we can get a liver biopsy?

A
  1. Percutaneous
  2. Laparoscopic cup biopsy
  3. Open
45
Q

What are 3 types of percutaneous biopsies?

A
  1. FNA
  2. Core biopsy
  3. Ultrasound guided
46
Q

What are 3 types of open liver biopsies?

A
  1. Wedge
  2. Punch
  3. Guillotine
47
Q

What is not an absolute contraindication for surgical biopsies? What method may be preferred for this?

A

Coagulopathy;

Laparoscopic may be preferred

48
Q

What are advantages to laparascopic liver biopsies?

A
  1. Minimally invasive
  2. illumination, magnification
  3. Larger samples obtained
49
Q

What are the disadvantages to laparascopic liver biopsies?

A
  1. Have to wait until it clots
  2. Specialized/expensive equipment needed
50
Q

What are punch biopsies good for?

A

Parenchymal lesions not at the margins

51
Q

In a punch biopsy of the liver, penetration of _____ thickness should be avoided.

A

>1/2

52
Q

What can be used to facilitate coagulation after taking a liver punch biopsy?

A

Absorbable gelatin sponge

53
Q

Punch biopsies of the liver are good for lesions in the _____.

A

middle of a lobe

54
Q

What is a guillotine technique for taking a liver biopsy?

A

Loop of suture is placed around protruding margin, is pulled tight crushing though parenchyma, and the hepatic tissue is amputated ~5 mm distal to ligature

55
Q

Guillotine liver biopsies are meant for lesions at the ____ of the lobe.

A

edge

56
Q

What is a wedge liver biopsy?

A

Several overlapping mattress sutures are placed, crushing through tissues but not cutting through –> wedge excised

57
Q

What can be a problem with a partial liver lobectomy?

A

hemorrhage

58
Q

What is the ideal closure device for a partial liver lobectomy?

A

Thoracoabdominal stapler

59
Q

What are 3 things that can be done with a liver biopsy?

A
  1. Histopath
  2. Copper analysis
  3. Culture
60
Q

What would be considered a “bad” biopsy sample?

A

Too small, crushed, not representative of disease

61
Q

What is the most common problem that can arise from a liver biopsy?

A

hemorrhage

62
Q

What is a portosystemic shunt?

A

Anomalous vessels allowing blood to bypass the liver parenchyma and enter systemic circulation directly;

Abnormal communication bt the portal venous system and the systemic venous system

63
Q

What are the 2 common types of PSSs?

A

extrahepatic vs. intrahepatic

64
Q

What are the 3 types of portal vein hypoplasia?

A
  1. Portal vein hypolasia - microvascular dysplasia
  2. Portal vein hypoplasia with portal hypertension
  3. Idiopathic non-cirrhotic portal hypertension
65
Q

What are 3 possible hepatic vascular anomalies?

A
  1. PSS
  2. Portal vein hypoplasia
  3. Hepatic arteriovenous fistulas
66
Q

What can the hepatic vascular anomalies lead to?

A

Hepatic encephalopathy

67
Q

Small and toy dog breeds tend to have _____ shunts.

A

extrahepatic

68
Q

Large breed dogs tend to have _____ shunts.

A

intrahepatic

69
Q

What type of PSS do cats usually have and what is a clinical sign to look for?

A

Extrahepatic; look for copper-colored eyes

70
Q

What are the 2 types of extrahepatic shunts and how many of them are there usually?

A

Congenital (usually single)

Acquired (usually multiple)

71
Q

_____ _____ shunts are usually a result of portal hypertension.

A

Acquired extrahepatic

72
Q

Intrahepatic shunts are usually _____ and _____.

A

congenital, single

73
Q

What tests should be run when a PSS is suspected?

A

Chem, CBC, UA, serum bile acids, ammonia levels

74
Q

What findings could be seen on abdominal rads when there is a PSS?

A

Microhepatica +/- cystic calculi

75
Q

What imaging is essential for definitive diagnosis of a PSS shunt?

A
  1. Abdominal ultrasound
  2. CT angiogram
  3. Positive contrast portography
  4. Nuclear scintigraphy (Technesium 99 pertechnetate)
76
Q

What finding on a CBC is consistent with a PSS?

A

Microcytosis (60-72%) because there is not appropriate iron transport

77
Q

What findings on a chem are consistent with a PSS?

A
  1. +/- elevated liver enzymes
  2. Decreased albumin, glucose, urea, cholesterol
78
Q

What finding on a bile acids test is consistent with a PSS?

A

Very elevated

79
Q

What findings on an ammonia test is consistent with a PSS?

A

usually is elevated

80
Q

Why is a CT angiogram the preferred imaging for a PSS Dx?

A

It is the most sensitive and plausible to do (91%)

81
Q

How long is medical treatment required for PVH-MVD?

A

lifelong

82
Q

What is the goal of medical treatment for hepatic vascular anomalies?

A

Minimize signs of and risk for hepatic encephalopathy;

Decrease protein = decrease ammonia

83
Q

What are the 6 main things that should be done in medical treatment for hepatic vascular anomalies?

A
  1. Low protein diet
  2. Oral antibiotic (amoxi/ampicillin)
  3. Lactulose
  4. Anti-seizure
  5. Hepatoprotective
  6. GI protectants (esp. intrahepatic shunts)
84
Q

What is the treatment of choice for definitive treatment of a PSS?

A

GRADUAL attenuation of the shunting vessel with an ameroid ring constrictor, cellophane banding, or hydraulic occluder.

85
Q

What is a method that can be used to intervene when it is not possible to close an intrahepatic shunt surgically?

A

Interventional radiology: Percutaneous transjugular caval stent and coil embolization

86
Q

What is the prognosis for animals that survive perioperative period for PSS repair?

A

good to excellent

87
Q

What are 2 common indications for extrahepatic biliary surgery?

A
  1. Extrahepatic biliary obstruction
  2. Biliary mucocele
88
Q

What is a gallbladder mucocele?

A

Distention of GB by inappropriate accumulation of mucus

89
Q

What does a gallbladder mucocele cause?

A

Decreased bile flow, decreased GB motility, altered water absorption;

Can lead to GB rupture - bile peritonitis

90
Q

What breed is predisposed to gallbladder mucoceles?

A

Shetland sheepdogs

91
Q

What other diseases are GB mucoceles associated with?

A

Hyperadrenocorticism, hypothyroidism, IBD

92
Q

What are clinical signs associated with a GB mucocele?

A

Vomiting, inappetance, jaundice, lethargy

93
Q

What are chem findings consistent with a GB mucocele?

A

Increased ALT, ALP, bilirubin

94
Q

What is a finding on abdominal US that is consistent with a GB mucocele?

A

“Stellate” or “kiwi fruit” appearance

95
Q

What is the preferred treatment for a GB mucocele?

A

Cholecystectomy

96
Q

What are contraindications for a cholecystectomy?

A
  1. CBD not patent
  2. Hepatic ducts compromised

Small Animal Surgery (17 decks)

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