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ECVS Tobias > 95. Liver and Biliary System questions > Flashcards

95. Liver and Biliary System questions Flashcards

1
Q

What makes surgery of the liver and extrahepatic biliary tract technically challenging in small animals?

A

Limited mobility, high vascularity, friable hepatic tissue, and physiologically compromised patients.

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2
Q

What is the approximate right-to-left mass proportion of the liver in dogs?

A

Approximately 3:2.

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3
Q

Name the four main lobes of the liver in dogs and cats.

A

Left, right, quadrate, and caudate lobes.

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4
Q

Which lobe is the largest in the liver of dogs and cats?

A

The left lobe.

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5
Q

What separates the left lateral and medial lobes of the liver in dogs?

A

A substantial cleft.

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6
Q

Which lobe of the liver forms part of the gallbladder fossa?

A

The quadrate lobe.

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7
Q

Where is the caudate process of the caudate lobe usually located?

A

Near the level of the twelfth intercostal space.

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8
Q

What ligament attaches the liver to the diaphragm?

A

The coronary ligament.

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9
Q

Which ligament attaches the caudate lobe of the liver to the right kidney?

A

The hepatorenal ligament.

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10
Q

What are the primary blood supplies to the liver?

A

The hepatic artery and portal vein.

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11
Q

What percentage of blood volume and oxygen does the hepatic artery supply to the liver?

A

20% of blood volume and 50% of oxygen.

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12
Q

What percentage of blood flow and oxygen does the portal vein supply to the liver?

A

80% of blood flow and 50% of oxygen.

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13
Q

What does the cystic artery supply?

A

The gallbladder.

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14
Q

What veins form the portal vein in dogs?

A

The cranial and caudal mesenteric veins.

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15
Q

What are the main divisions of the portal vein as it enters the liver in dogs?

A

Right and left main branches.

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16
Q

What is the role of Kupffer cells in the liver?

A

Phagocytosis of harmful endogenous and foreign substances.

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17
Q

Which cells are responsible for bile production in the liver?

A

Hepatocytes.

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18
Q

Where does the common bile duct enter the duodenum in dogs?

A

At the major duodenal papilla.

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19
Q

Which vitamin is essential for coagulation factor activation in the liver?

A

Vitamin K.

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20
Q

What is the hepatic arterial buffer response?

A

A compensatory mechanism where decreased portal flow increases hepatic arterial perfusion.

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21
Q

Which substance’s washout is believed to influence the hepatic arterial buffer response?

A

Adenosine.

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22
Q

What complication can result from bile spillage in the peritoneal cavity?

A

Bile peritonitis.

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23
Q

What is the main imaging modality for evaluating the liver and biliary tract in small animals?

A

Ultrasonography.

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24
Q

What is a typical sign of extrahepatic biliary obstruction on ultrasound?

A

Distention of the common bile duct.

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25
Q

What are common causes of extrahepatic biliary obstruction in dogs?

A

Pancreatitis, neoplasia, gallbladder mucoceles, cholangitis, and cholelithiasis.

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26
Q

What is the Pringle maneuver?

A

A technique involving temporary compression of the hepatic artery and portal vein to control hemorrhage.

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27
Q

What is the composition of bile?

A

Bile acids, bilirubin, cholesterol, phospholipids, water, bicarbonate, and other ions.

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28
Q

What pigment gives feces its brown color and results from bile breakdown?

A

Stercobilin.

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29
Q

What is the main function of bile salts in the intestine?

A

Emulsification of fats for digestion and absorption.

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30
Q

Which species has a conjoined bile and pancreatic duct just before entering the duodenum?

A

Cats.

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31
Q

What is the role of the sphincter of Oddi?

A

Regulates the flow of bile and pancreatic secretions into the duodenum.

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32
Q

Which imaging modality is commonly used for assessing hepatic blood flow and vascular anomalies?

A

Color-flow Doppler ultrasonography.

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33
Q

What are the three hepatic divisions in cats based on portal vein supply?

A

Right, central, and left divisions.

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34
Q

What role does the liver play in glucose metabolism?

A

Maintains plasma glucose through gluconeogenesis and glycogenolysis.

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35
Q

What occurs in cases of severe hepatic disease concerning plasma proteins?

A

Hypoalbuminemia due to loss of hepatic functional capacity.

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36
Q

Which liver function test is crucial before invasive procedures in animals with liver disease?

A

Coagulation screening.

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37
Q

What is the most common cause of extrahepatic biliary tract trauma in dogs?

A

Blunt abdominal trauma, often from motor vehicle accidents.

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38
Q

What imaging technique provides functional evaluation of the extrahepatic biliary tract in humans but is less common in veterinary use?

A

Magnetic resonance cholangiopancreatography.

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39
Q

What is a common complication in cats with extrahepatic biliary obstruction during anesthesia?

A

Hypotension and poor response to vasopressor agents.

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40
Q

What causes “kiwi fruit” gallbladder appearance on ultrasound?

A

Gallbladder mucocele.

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41
Q

How is bile peritonitis confirmed in an animal?

A

By comparing bilirubin concentration in abdominal fluid to peripheral blood.

42
Q

What is a transjugular liver biopsy?

A

A biopsy technique performed through the jugular vein to avoid penetrating the liver capsule.

43
Q

Which coagulation factors are synthesized in the liver but are vitamin K-dependent?

A

Factors II, VII, IX, and X.

44
Q

Which liver biopsy technique is considered the least invasive?

A

Fine needle aspiration.

45
Q

What is the most common complication of liver surgery?

A

Hemorrhage.

46
Q

What is the purpose of bile salt supplementation in patients with biliary obstruction?

A

To prevent endotoxemia and improve fat emulsification in the intestine.

47
Q

How soon after extrahepatic biliary obstruction does bile duct dilation occur in dogs?

A

Within 24 to 48 hours.

48
Q

What is the main surgical approach to hepatic masses requiring complete lobectomy?

A

Blunt dissection with ligation, surgical stapling, or vessel sealing devices.

49
Q

What is the likely outcome if an animal undergoes 80% hepatectomy?

A

Increased risk of death due to portal hypertension rather than liver failure.

50
Q

What imaging feature distinguishes malignant from benign focal hepatic lesions in MRI?

A

High sensitivity (100%) and specificity (86%) in one study.

51
Q

Which liver lobe is most commonly divided into two sublobes? Options: A) Right medial | B) Left lateral | C) Left medial | D) Quadrate

A

B) Left lateral

52
Q

What is the primary attachment of the liver to the diaphragm? Options: A) Hepatorenal ligament | B) Hepatoduodenal ligament | C) Coronary ligament | D) Gastrohepatic ligament

A

C) Coronary ligament

53
Q

What is the usual location of the right lateral lobe of the liver in relation to the median plane in dogs? Options: A) To the right of the median plane | B) To the left of the median plane | C) Directly on the median plane | D) Near the caudate process

A

A) To the right of the median plane

54
Q

The caudate process of the caudate lobe extends to which intercostal space? Options: A) 8th | B) 10th | C) 12th | D) 14th

55
Q

Which blood vessel supplies the most oxygen to the liver? Options: A) Portal vein | B) Hepatic artery | C) Vena cava | D) Mesenteric artery

A

B) Hepatic artery

56
Q

The right middle branch of the hepatic artery supplies which liver lobe? Options: A) Left medial lobe | B) Caudate lobe | C) Right medial lobe | D) Left lateral lobe

A

C) Right medial lobe

57
Q

Which ligament loosely surrounds the papillary process of the liver? Options: A) Hepatoduodenal ligament | B) Lesser omentum | C) Coronary ligament | D) Hepatorenal ligament

A

B) Lesser omentum

58
Q

What percentage of blood flow to the liver is provided by the portal vein? Options: A) 10% | B) 20% | C) 50% | D) 80%

59
Q

In dogs, how many branches does the portal vein usually divide into upon entering the liver? Options: A) One | B) Two | C) Three | D) Four

60
Q

What is the primary function of bile salts? Options: A) Emulsify fats | B) Maintain blood pressure | C) Regulate blood sugar | D) Provide immune defense

A

A) Emulsify fats

61
Q

In cats, which duct merges with the bile duct just before entering the duodenum? Options: A) Accessory pancreatic duct | B) Primary pancreatic duct | C) Hepatic duct | D) Mesenteric duct

A

B) Primary pancreatic duct

62
Q

Which structure regulates the flow of bile and pancreatic secretions into the duodenum? Options: A) Portal vein | B) Sphincter of Oddi | C) Hepatogastric ligament | D) Hepatic duct

A

B) Sphincter of Oddi

63
Q

Kupffer cells in the liver are primarily responsible for which function? Options: A) Producing bile | B) Storing glycogen | C) Phagocytosis | D) Blood pressure regulation

A

C) Phagocytosis

64
Q

Which coagulation factors are dependent on vitamin K for activation? Options: A) I, II, III, IV | B) II, VII, IX, X | C) III, V, VIII, IX | D) VI, VIII, XI, XII

A

B) II, VII, IX, X

65
Q

A significant liver injury due to blunt trauma in dogs often results in damage to which area? Options: A) Left medial lobe | B) Right medial lobe | C) Common bile duct | D) Quadrate lobe

A

C) Common bile duct

66
Q

Which imaging modality is most effective for detecting focal liver lesions? Options: A) CT scan | B) Radiography | C) Ultrasonography | D) MRI

A

C) Ultrasonography

67
Q

The Pringle maneuver temporarily compresses which two structures? Options: A) Hepatic artery and portal vein | B) Vena cava and hepatic artery | C) Common bile duct and portal vein | D) Coronary ligament and vena cava

A

A) Hepatic artery and portal vein

68
Q

Which imaging technique is least useful for assessing liver size in dogs? Options: A) Radiography | B) Ultrasonography | C) MRI | D) Scintigraphy

A

A) Radiography

69
Q

What is the primary cause of extrahepatic biliary obstruction in dogs? Options: A) Tumors | B) Pancreatitis | C) Trauma | D) Gallbladder mucoceles

A

B) Pancreatitis

70
Q

What is a major indicator of bile peritonitis in abdominal fluid? Options: A) High glucose level | B) Low bilirubin concentration | C) Elevated bilirubin concentration | D) High albumin level

A

C) Elevated bilirubin concentration

71
Q

What is the function of bile pigments in the intestines? Options: A) Digestion of proteins | B) Converting fats to amino acids | C) Forming urobilinogen | D) Stimulating acid secretion

A

C) Forming urobilinogen

72
Q

Which artery branches to form the hepatic artery? Options: A) Mesenteric artery | B) Aorta | C) Renal artery | D) Celiac artery

A

D) Celiac artery

73
Q

Which imaging technique is used to visualize hepatic blood flow? Options: A) Doppler ultrasonography | B) Plain radiography | C) MRI | D) CT scan

A

A) Doppler ultrasonography

74
Q

The majority of bile is reabsorbed and returned to the liver through which vein? Options: A) Splenic vein | B) Hepatic vein | C) Portal vein | D) Mesenteric vein

A

C) Portal vein

75
Q

What commonly causes ‘kiwi fruit’ gallbladder appearance on ultrasound? Options: A) Cholecystitis | B) Gallbladder mucocele | C) Bile duct stricture | D) Liver tumor

A

B) Gallbladder mucocele

76
Q

What liver function is associated with the production of bile acids? Options: A) Gluconeogenesis | B) Cholesterol metabolism | C) Lipogenesis | D) Protein synthesis

A

B) Cholesterol metabolism

77
Q

Which technique is used to sample liver tissue through a jugular approach? Options: A) Fine needle aspiration | B) Wedge biopsy | C) Transjugular biopsy | D) Punch biopsy

A

C) Transjugular biopsy

78
Q

Which type of liver biopsy is least invasive? Options: A) Transjugular biopsy | B) Wedge biopsy | C) Tru-Cut needle biopsy | D) Punch biopsy

A

C) Tru-Cut needle biopsy

79
Q

Which of the following is NOT typically stored in the liver? Options: A) Glycogen | B) Vitamins | C) Glucose | D) Fat

A

C) Glucose

80
Q

The accessory pancreatic duct is usually larger in which species? Options: A) Cats | B) Dogs | C) Rabbits | D) Horses

81
Q

Bile duct obstructions are most commonly seen in cats due to: Options: A) Pancreatitis and cholangiohepatitis | B) Trauma and tumors | C) Gallstones and mucoceles | D) Foreign body ingestion

A

A) Pancreatitis and cholangiohepatitis

82
Q

Hypoalbuminemia in liver disease is due to: Options: A) Reduced bile flow | B) Reduced protein synthesis | C) Increased blood flow | D) Hepatic artery occlusion

A

B) Reduced protein synthesis

83
Q

Which ligament attaches the liver to the lesser curvature of the stomach? Options: A) Hepatorenal ligament | B) Gastroduodenal ligament | C) Hepatogastric ligament | D) Hepatoduodenal ligament

A

C) Hepatogastric ligament

84
Q

What is the role of albumin in the blood? Options: A) Store iron | B) Bind and transport molecules | C) Produce bile | D) Coagulate blood

A

B) Bind and transport molecules

85
Q

What does the hepatic arterial buffer response do? Options: A) Regulates bile secretion | B) Increases arterial perfusion in response to decreased portal flow | C) Stores glucose | D) Increases portal flow to manage systemic blood pressure

A

B) Increases arterial perfusion in response to decreased portal flow

86
Q

Which vitamin deficiency is most likely to affect coagulation factors due to liver dysfunction? Options: A) Vitamin A | B) Vitamin D | C) Vitamin E | D) Vitamin K

A

D) Vitamin K

87
Q

What structure does the hepatic artery pass through before reaching the liver? Options: A) Epiploic foramen | B) Coronary ligament | C) Hepatogastric ligament | D) Hepatorenal ligament

A

A) Epiploic foramen

88
Q

Which hepatic ligament is most commonly involved in attaching the liver to the diaphragm? Options: A) Left triangular ligament | B) Hepatoduodenal ligament | C) Coronary ligament | D) Hepatorenal ligament

A

C) Coronary ligament

89
Q

Which liver lobe is most commonly associated with gallbladder attachment? Options: A) Right lateral lobe | B) Quadrate lobe | C) Caudate lobe | D) Left medial lobe

A

B) Quadrate lobe

90
Q

Which enzyme level is typically elevated in dogs with bile duct obstruction? Options: A) Amylase | B) Creatinine | C) Alkaline phosphatase | D) Lipase

A

C) Alkaline phosphatase

91
Q

What is the purpose of the Pringle maneuver during liver surgery? Options: A) Control hemorrhage | B) Increase liver blood flow | C) Stimulate bile secretion | D) Decompress the portal vein

A

A) Control hemorrhage

92
Q

In cats, which pancreatic duct is usually absent? Options: A) Accessory pancreatic duct | B) Primary pancreatic duct | C) Cystic duct | D) Hepatic duct

A

A) Accessory pancreatic duct

93
Q

How does obstructive jaundice affect liver function? Options: A) Increases glycogen storage | B) Impairs Kupffer cell activity | C) Enhances bile production | D) Reduces cholesterol synthesis

A

B) Impairs Kupffer cell activity

94
Q

What is the most common cause of bile peritonitis in dogs? Options: A) Trauma | B) Liver tumor | C) Pancreatitis | D) Hepatic cysts

95
Q

Which vessel provides 95% of blood supply to liver tumors? Options: A) Hepatic artery | B) Portal vein | C) Vena cava | D) Splenic artery

A

A) Hepatic artery

96
Q

Which technique is used to control capsular hemorrhage during liver surgery? Options: A) Hemostatic sponges | B) Portal vein ligation | C) Blunt dissection | D) Pringle maneuver

A

A) Hemostatic sponges

97
Q

What is a common side effect of extensive liver resection in dogs? Options: A) Hypercalcemia | B) Hypoglycemia | C) Cardiac arrhythmia | D) Renal failure

A

B) Hypoglycemia

98
Q

What substance is produced by hepatocytes to aid in fat digestion? Options: A) Bilirubin | B) Gastrin | C) Bile acids | D) Glucagon

A

C) Bile acids

99
Q

Which diagnostic test is most sensitive for assessing liver function in dogs? Options: A) CT scan | B) MRI | C) Scintigraphy | D) Blood glucose level

A

C) Scintigraphy

100
Q

What is a common finding in abdominal ultrasound of a dog with extrahepatic biliary obstruction? Options: A) Enlarged spleen | B) Distended common bile duct | C) Dilated renal pelvis | D) Shrunken liver lobes

A

B) Distended common bile duct

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