Digestion & Metabolism 2: Feline Biliary Sx Flashcards
3 BILIARY surgical syndromes?
- EXTRA-HEPATIC BILIARY TRACT OBSTRUCTION
- GALLBLADDER MUCOCELE
- BILE PERITONITIS
EXTRA-HEPATIC BILIARY TRACT OBSTRUCTION…
3 forms?
1. = 2 common examples?
2. = 4 common examples?
3. = 1 common example?
- EXTRALUMINAL = OUTSIDE biliary system, usually from PANCREAS
–> PANCREATITIS
–> PANCREATIC NEOPLASIA - INTRALUMINAL
–> CHOLELITHIASIS = stones in GALLBLADDER
–> GALLBLADDER MUCOCELE = from bile CONGEALING
–> FB
–> NEOPLASIA - INTRAMURAL
–> NEOPLASIA usually of GALLBLADDER or BILE DUCT
why can the bile duct get so easily OBSTRUCTED?
has SMALL LUMEN
what PART of bile makes bile flow obstruction so bad?
what CAN happen if BILE OBSTRUCTED? (2)
the BILE SALTS make obstruction bad
what CAN happen?
1. BACTERIAL OVERGROWTH from SALT, usually GRAM NEGATIVE that can MAKE ENDOTOXINS that get absorbed
2. LIVER has DECREASED CLEARANCE due to obstructed bile ducts
SECONDARY diseases that occur due to BILE DUCT OBSTRUCTIONS (6)
these are ALL due to ____ as a result of bile obstruction
SECONDARY diseases…
1. DECREASED MYOCARDIAL CONTRACTILITY
2. HYPOTENSION
3. ACUTE RENAL FAILURE
4. COAGULOPATHIES (DIC)
5. GI HEMORRHAGE
6. DELAYED WOUND HEALING
ALL due to ENDOTOXEMIA
5 _____-_____clinical signs of BILE DUCT OBSTRUCTION?
what is this SECONDARY to?
if ____ is ABOVE ____-____ mg/dL, then EASIER TO DIAGNOSE
5 NON-SPECIFIC signs?
1. LETHARGY
2. ANOREXIA
3. VOMITING
4. DIARRHEA
5. ICTERUS
+/- ABDOMINAL PAIN
secondary all to ENDOTOXEMIA
BILIRUBIN above 1.5-2 mg/dL –> GOOD FOR BILE DUCT OBSTRUCTION
CLIN PATH findings for BILE DUCT OBSTRUCTION (6)
- HYPERBILIRUBINEMIA
- INCREASED ALP
- INCREASED ALT/GGT (liver enzymes)
- LEUKOCYTOSIS
- HYPOALBUMINEMIA
- PROLONGED COAGULATION
what is the BEST imaging technique for BILE DUCT OBSTRUCTION?
what 4 things could we possibly see?
what OTHER imaging could we possibly use & what specific reason would it be best for?
ABDOMINAL ULTRASOUND IS BEST
4 things to see on ABDOMINAL US…
1. CHOLELITHS
2. BILIARY or PANCREATIC NEOPLASIA
3. GALLBLADDER MUCOCELES
4. ENLARGED BILE DUCT/GALLBLADDER
can also do RADS, but really only best for CHOLELITHS (stones)
SCINTIGRAPHY…
= what is it showing in BILE DUCT OBSTRUCTION?
how can we ID dz & what IS the dz?
= shows HOW FAST CONTRAST passes through GALLBLADDER –> INTESTINES
ID BILIARY TRACT OBSTRUCTION because NEEDS TO GET TO INTESTINES WITHIN A CERTAIN AMOUNT OF TIME
BILIARY MUCOCELE…
commonality?
underlying disease is called….
what do we see grossly?
the GALLBLADDER can look… (2)
this is often an ____ finding
COMMON
underlying disease = CYSTIC MUCINOUS HYPERPLASIA of the GALLBLADDER
grossly? = BILE becomes THICK, SHINY & CONGEALED and CANNOT GO THROUGH BILIARY TRACT
GALLBLADDER can look…
1. GREEN
2. THIN-WALLED
often INCIDENTAL FINDING
ID DZ (overall dz & underlying)
BILIARY MUCOCELE
from CYSTIC MUCINOUS HYPERPLASIA
in SEVERE cases of BILIARY MUCOCELE…
now becomes…
PRESSURE NECROSIS of GALLBLADDER WALL can lead to RUPTURE & BILE PERITONITIS
becomes AN EMERGENCY
BILIARY MUCOCELE gets DEFINITIVE diagnosis via….
gallbladder has a ____ ____ appearance or resembles a ____
via ULTRASOUND (more useful & sensitive diagnostic tests)
gallbladder has CLASSICAL STELLATE APPEARANCE or resembles a “KIWI”
BILE PERITONITIS…
is often a RESULT of…
3 causes? which is the most common?
is often a RESULT of EXTRA-HEPATIC BILIARY TRACT OBSTRUCTION causing BILE LEAKAGE into abdomen
3 causes?
1. TRAUMA like a PENETRATING WOUND
2. COMPLICATION after a SURGERY for BILIARY TRACT OBSTRUCTION
3. RUPTURED GALLBLADDER MUCOCELE from PRESSURE NECROSIS
BILE PERITONITIS…
what CBC finding do we have?
2 BEST diagnostics?
WHAT parameter is considered DIAGNOSTIC for BILE PERITONITIS?
this disease is ALWAYS considered a….
on CBC = HYPERBILIRUBINEMIA
2 BEST diagnostics?
1. ABDOMINAL US
2. ABDOMINOCENTESIS & ANALYSIS
DIAGNOSTIC = If BILIRUBIN IN EFFUSION is ≥ 2X BILIRUBIN in SERUM
ALWAYS considered a SURGICAL EMERGENCY!
BILE in peritoneum is ____-____ & makes ____ EVEN ____ when it’s there
if VERY SEVERE, might have to…
PRO-INFLAMMATORY, PERITONITIS, WORSE
if VERY SEVERE, might have to OPEN ABDOMEN & DRAIN
how do we ACCESS biliary structures via INCISION?
need ability to have good ____
lighting?
pack LAP sponges….
ACCESS biliary structures = LAPAROTOMY from XIPHOID to PUBIS –> HUGE INCISION
need ability to have good RETRACTION
LIGHTING should be EXCELLENT because BILIARY SYSTEM SITS UNDER DIAPHRAGM
pack lap sponges BETWEEN DIAPHRAGM & LIVER
BILE DUCT sits ___-___ cm ____ from ____
3-6 cm, CAUDAL, PYLORUS
CHOLECYSTOTOMY
= definition
can be used in WHAT dz?
commonality? why?
= ENTERING the GALLBLADDER & CLOSING IT BACK UP
can be used to REMOVE CHOLELITHS
RARELY performed! because if it DOESN’T HEAL FROM SX, LEAKAGE IS LIKELY
CHOLEDOCHOTOMY
= definition
what DZ can we do this for?
= making incision INTO COMMON BILE DUCT
if STONES in COMMON BILE DUCT
CHOLECYSTECTOMY
commonality?
= definition?
usually done after ___
procedure? (three, start with WHERE gallbladder is & end with where we ligate)
COMMON procedure
= REMOVAL of GALLBLADDER
usually done after RUPTURE
procedure?
1. GALLBLADDER sits in FOSSA OF LIVER, so DISSECT LIVER OUT
2. DISSECT liver out to CYSTIC DUCT
3. and LIGATE JUST BELOW GALLBLADDER before the HEPATIC DUCTS empty into COMMON BILE DUCT
CHOLECYSTOENTEROSTOMY
= definition
example of DZ?
procedure? (2)
requires a HEALTHY…
= trying to DIVERT bile AROUND and BYPASS COMMON BILE DUCT
EXAMPLE dz?
–> LARGE, NON-RESECTABLE PANCREATIC MASS that causes COMPRESSION/OBSTRUCTION of common bile duct?
procedure?
1. make a HOLE in GALLBLADDER
2. connect to OPENING in JEJUNUM or DUODENUM
requires a HEALTHY GALLBLADDER
CHOLEDOCHAL TUBE STENTING
= definition/used for…
can also be used for ____ to prevent FORMATION of ____ or ____ tissue
EVENTUALLY, the body will ____ ____ sutures
= used for TEMPORARY OCCLUSION of BILE and PUT SOMETHING IN BILE DUCT TO KEEP IT OPEN/DRAIN until we RESOLVE UNDERLYING CAUSE OF OBSTRUCTION
can also be used for REPAIR of bile duct to prevent FORMATION of STRICTURE or SCAR TISSUE
EVENTUALLY, the body will BREAK DOWN SUTURES
CHOLECYSTOSTOMY TUBE
can be placed WHAT 2 ways?
can be used as… (2)
what does this help relieve?
commonality? why? (2 reasons)
can be placed…
1. SURGICALLY
2. PERCUTANEOUSLY –> from BODY WALL into GALLBLADDER
can be used as…
1. PRIMARY treatment
2. or ADJUNCT TO SURGERY
can help relieve BILIARY TRACT OBSTRUCTION
RARE because we can cause…
1. BILE LEAKAGE
2. BILE PERITONITIS
why should we do CULTURE & SENSITIVITY for ABDOMINAL EFFUSION?
can often have concurrent BACTERIAL infection
when doing BILIARY surgery, should also consider adding a ____ TUBE because…
FEEDING TUBE because patient OFTEN VERY SICK
POST-OP MANAGEMENT of BILIARY Sx..
sometimes patients spend time in ____ after
5 managements we can do?
ICU
5 managements?
1. continued FLUID therapy
2. MONITOR electrolytes/acid-base
3. NUTRITION via FEEDING TUBE
4. ANTIBIOTIC therapy if C&S results require
5. +/- OPEN ABDOMINAL DRAINAGE if CHRONIC BILE PERITONITIS
7 POST-OP COMPLICATIONS of BILIARY sx?
what is the MOST COMMON complication?
- LEAKAGE of bile –> MOST COMMON, THIN wall of gallbladder/common bile duct
- PERITONITIS
- HEMORRHAGE
- PANCREATITIS from manipulation
- RE-OBSTRUCTION of biliary tree from underlying PATHOLOGY
- ASCENDING CHOLANGIOHEPATITIS from BACTERIA in DUODENUM
- SEPSIS
LEAKAGE of bile is most common in WHAT dz?
BILE PERITONITIS
what PROCEDURE is likely to cause ASCENDING CHOLANGIOHEPATITIS?
why?
CHOLECYSTOENTEROSTOMY
because it CONNECTS GALLBLADDER to DUODENUM or JEJUNUM, so ENTERIC BACTERIA CAN CAUSE INFECTION
PROGNOSIS for BILIARY Sx is ___ IF…
BUT…
GOOD if SURVIVE THE PERIOPERATIVE PERIOD
but DURING PERIOPERATIVE PERIOD, MORTALITY & COMPLICATIONS HIGH RATE
