Digestion & Metabolism 2: Liver & Pancreas Sx Flashcards
LEFT vision of the liver makes up ____% of hepatic volume
CENTRAL DIVISION…
1. what 2 lobes?
2. surrounds WHAT?
RIGHT division 2 lobes?
50%
CENTRAL VISION…
1. RIGHT MEDIAL & QUADRATE lobe
2. surrounds GALLBLADDER
RIGHT division…
1. RIGHT LATERAL LOBE
2. CAUDATE PROCESS of CAUDATE LOBE
HEPATORENAL LIGAMENT attaches…
we need to remove this WHEN
attaches CAUDATE PROCESS of LIVER LOBE to RIGHT KIDNEY
we need to remove this WHEN REMOVING THE KIDNEY
LEFT TRIANGULAR LIGAMENT LOCATION & WHAT IT ATTACHES
found on the LEFT AND RIGHT side of liver and ATTACH LIVER LOBES TO DIAPHRAGM
the HEPATIC artery is derived from the ____ ____, which comes off of the ____
supplies WHICH divisions of the liver?
CELIAC ARTERY, AORTA
supplies RIGHT, CENTRAL & LEFT portions
PORTAL VEIN is high in ____ factors, called ___ & ____ which are IMPORTANT for _____ _____
PORTAL VEIN made up of WHAT 4 other vessels? what do they drain?
–> which vessel is ONLY IN DOGS & NOT CAT
HEPATOTROPHIC, GLUCAGON & INSULIN, LIVER DEVELOPMENT
4 vessels that make up portal vein?
1. CRANIAL MESENTERIC VEINS
2. CAUDAL MESENTERIC VEINS
3. GASTROSPLENIC VEINS
4. GASTRODUODENAL VEIN (DOGS ONLY)
liver starts REGENERATION within ____ following RESECTION
with STAGED hepatectomies, can allow for up to ____% of hepatic volume
HOURS, 95%
4 indications for LIVER SURGICAL INTERVENTION?
which one is COMMONLY DONE?
- DIAGNOSTIC BIOPSY (COMMONLY DONE)
- LOBAR DZ
–> NEOPLASIA
–> ABSCESS
–> TORSION of LIVER LOBE - TRAUMA
- CONGENITAL ABNORMALITY such as PORTOSYSTEMIC SHUNT
SCREENING B/W FINDINGS for PRIOR to LIVER SURGERY? (4)
- ELEVATION in HEPATOCELLULAR ENZYMES ALT, AST
- HYPERBILIRUBINEMIA
- HYPOGLYCEMIA
- DECREASED BUN
if liver LOBE TORSION or ABSCESSATION, what CBC finding can we expect?
LEUKOCYTOSIS
if LARGE LIVER TUMOR, can cause _____ syndrome & WHAT CBC finding?
PARANEOPLASTIC, THROMBOCYTOSIS
what 3 PREOP diagnostics should we do for the LIVER?
- SCREENING B/W
- COAGULATION PROFILES
- URINALYSIS
on _____ RADS for LIVER DISEASE, what 3 things should we look for?
THORACIC rads
3 things?
1. SPACE OCCUPYING MASS
2. EFFUSION/loss of abdominal detail
3. evidence of METASTASIS
CONTRAST ENHANCED HARMONIC US…
what 2 things are administered?
why is the second thing given?
what is overall shown?
2 things?
1. CONTRAST MEDIA
2. GAS-FILLED MICROBUBBLES
micro bubbles given because they HAVE A HIGH DEGREE OF ECHOGENICITY
can help IMAGE BLOOD FLOW & TUMORS that TAKE UP A LOT OF BLOOD
on US, ____ DISEASED liver should be ____echoic CENTER with ____RIM
MALIGNANT
HYPERECHOIC center with HYPOECHOIC RIM
when are CTs performed for liver patients?
usually for LARGE LIVER TUMORS to ensure NO METASTASIS
how is a LIVER BIOPSY PERFORMED on SUPERFICIAL PERIPHERAL LIVER TUMOR? (2 easy steps)
- take HEMOSTAT & CRUSH TISSUE around TUMOR
- then, CUT IT OFF
liver biopsy steps for DEEPER lesion? (3 steps, last is what occurs at the site)
- DERMAL PUNCH
- fill hole with HEMOSTATIC AGENT
- promotes HEMOSTASIS at site
what is the MOST COMMON PROCEDURE for SA LIVER?
4 indications?
WHAT dictates the TECHNIQUE? (2)
what DIVISION of the liver is BEST SUITED FOR THIS?
MOST COMMON = LIVER LOBECTOMIES
4 indications?
1. NEOPLASIA
2. ABSCESSES
3. LIVER LOBE TORSION
4. METASTASIS
TECHNIQUE dictated by…
1. LOCATION of tumor
2. SIZE of tumor
the LEFT division of the liver BEST FOR COMPLETE LOBECTOMY
most RIGHT and CENTRAL division of liver get THIS kind of surgery….
if CENTRAL, usually ALSO REQUIRES…
RIGHT & CENTRAL = make PARTIAL LOBECTOMIES
if CENTRAL, usually ALSO REQUIRE GALLBLADDER REMOVAL
if there’s a HEPATIC NEOPLASIA, tends to be ___
most common PRIMARY hepatic neoplasia in…
DOGS = ???
CATS = ???
what 3 OTHER primary neoplasias are possible?
METASTATIC
PRIMARY hepatic neoplasia in…
DOGS = HEPATOCELLULAR ADENOCARCINOMA
CATS = BILIARY ADENOCARCINOMA
other 3 primary?
1. HEPATOCELLULAR ADENOMA
2. NEUROENDOCRINE CARCINOMA
3. MESENCHYMAL TUMORS
HEPATIC NEOPLASIA…
common age?
4 ___-___ clinical signs…
possibly can PALPATE….
HEMOABDOMEN common in ____ > ____
3 clinical signs secondary to LIVER FAILURE?
age = 9-12 YEARS
4 NON-SPECIFIC signs…
1. LETHARGY
2. ANOREXIA
3. WEIGHT LOSS
4. VOMITING
possibly can PALPATE abdominal mass
HEMOABDOMEN common in CATS > DOGS
3 clinical signs secondary to LIVER FAILURE…
1. ICTERUS
2. POOR BODY CONDITION
3. ASCITES
HEPATOCELLULAR CARCINOMA…
most common PRIMARY liver tumor in ___
tends to show ___ necrosis, but can also have these other 2 types
most commonly affects the ___ LOBE
most common site of metastasis?
PROGNOSIS?
DOGS
tends to show MASSIVE necrosis, but also…
1. MULTIFOCAL
2. DIFFUSE
most commonly affects the LEFT lobe
LNs most common site of METASTASIS
PROGNOSIS for MASSIVE GENERALLY GOOD if SURGICAL INTERVENTION
NEUROENDOCRINE CARCINOMA…
AKA?
categorize this!
involved with ______ SYNTHESIS
___ involvement of the liver
commonality?
metastasis?
prognosis?
AKA CARCINOID
involved with HORMONE SYNTHESIS
PRIMARY liver neoplasia
DIFFUSE involvement of the liver
RARE in DOGS/CATS
HIGH rate of metastasis
POOR prognosis
MESENCHYMAL TUMORS…
can RARELY be ___, mostly ____
tends to be ____ & involve MULTIPLE ____
treatment?
prognosis?
can RARELY be PRIMARY, mostly SECONDARY/COMMON SITE OF METASTASIS
tends to be NODULAR & involve MULTIPLE LOBES
treatment = SURGERY
prognosis = GUARDED
HEPATIC ABSCESS…
commonality?
risk factor?
1 clinical sign in DOGS & 1 in CATS?
what is a common cause?
in DOGS, presents as ___ lesions but ___ lesions in cats
higher MORTALITY ___ > ___
RARE in dogs & cats
DIABETES is risk factor
clinical signs?
DOGS = PYREXIA
CATS = HYPOTHERMIC
a common cause is E. COLI
in DOGS, presents as SOLITARY, while in CATS it’s MULTIFOCAL
higher MORTALITY CATS > DOGS
LIVER LOBE TORSION…
commonality?
more common in ___ ____ liver lobe
see what 2 CBC findings?
on PE, can see what 2 signs?
treatment & response?
RARE
more common in LEFT LATERAL liver lobe
CBC…
1. LEUKOCYTOSIS
2. INCREASED ALT
on PE…
1. CRANIAL ABDOMINAL MASS
2. ABDOMINAL PAIN
respond VERY WELL To RESECTION
what is the MOST COMMON COMPLICATION for LIVER PROCEDURES?
what 2 INCISION locations would be adequate for a LARGE RIGHT-SIDED TUMOR?
what 4 things should we keep nearby during liver sx?
what CBC complication can we see with liver sx?
MOST COMMON COMPLICATION = HEMORRHAGE
2 INCISION locations for LARGE R-SIDED TUMOR..
1. STERNOTOMY
2. PARACOSTAL INCISION
4 things NEARBY…
1. BLOOD PRODUCTS
2. VITAMIN K
3. VENTILATOR SUPPORT
4. ANTIBIOTICS
CBC…
–> HYPOGLYCEMIA
why does HEPATIC disease cause an INCREASED RISK for HEMORRHAGE and THROMBOSIS?
liver helps produce PROCOAGULANT (vitamin K) and ANTICOAGULANT SUBSTANCES, so either CLOTS or BLEEDS TOO MUCH
what 3 blood products should we PRETREAT patients with PRIOR to liver surgery?
- FRESH WHOLE BLOOD
- FRESH FROZEN PLASMA
- VITAMIN K
HYPOGLYCEMIA & HEPATIC dz…
commonality?
likely in WHAT AGE patients? also more likely in 2 other patient scenarios?
UNCOMMON
more likely in…
1. YOUNG animals
2. SMALL DEBILITATED patients
3. patients undergoing EXTENSIVE HEPATECTOMY
what kinds of drugs should we AVOID giving to an animal with hepatic disease?
what’s a SPECIFIC example?
avoid drugs that undergo EXTENSIVE HEPATIC METABOLISM
SPECIFIC example = DIAZEPAM
what is the MOST COMMON bacteria found in liver?
what other bacteria can be present?
MOST COMMON BACTERIA = CLOSTRIDIUM PERFRINGENS
can also see STAPH
in HEPATOBILIARY disease, cats tended to have HIGHER LIKELIHOOD of ____ ____, with most of the ____ originating from the _____
requires WHAT treatment?
BACTERIAL INFECTION, BACTERIA, GI
requires BROAD-SPECTRUM COVERAGE DURING LIVER SX
WHERE should we place LAPAROTOMY sponges for LIVER SURGERY?
if a patient has NEGATIVE PRESSURE in THORACIC CAVITY, can do WHAT?
___ ___ sutures can help IMPROVE LIVER ACCESS
place LAP sponges between DIAPHRAGM & LIVER
if a patient has NEGATIVE PRESSURE in THORACIC CAVITY, can MAKE AN INCISION to relieve
use GASTRIC STAY SUTURES can help IMPROVE LIVER ACCESS
3 examples of HEMOSTATIC agents?
what do they aim to do?
3 examples?
1. GELATIN SPONGE
2. OXIDIZED REGENERATED CELLULOSE (promotes platelet aggregation
3. FIBRIN GLUE
aim to promote HEMOSTASIS & STOP BLEEDING
PRINGLE MANEUVER…
when is it used?
2 steps?
how long should we hold it?
used for EXTENSIVE HEMORRHAGE?
2 steps…
1. place finger through EPIPLOIC FORAMEN
2. put GENTLE PRESSURE to SIMULTANEOUSLY COMPRESS PORTAL VEIN & HEPATIC ARTERY
hold for <20 MINUTES
TOTAL HEPATIC VASCULAR OCCLUSION should be done if…
if there’s EXTENSIVE HEMORRHAGE
if there’s an INTRACTABLE hemorrhage, what should we do? (2)
- HEPATIC ARTERY LIGATION
- +/- REMOVE GALLBLADDER
PARTIAL hepatic LOBECTOMY…
tends to be for WHAT kinds of lesions?
can use WHAT kind of device?
perform ____ ____ of vessels
WHAT part of the liver is NOT EASILY ACCESSIBLE for this?
tends to be for SMALL, PERIPHERAL lesions
can use SURGICAL STAPLING device
perform BLUNT DISSECTION of vessels
HILUM is NOT EASILY ACCESSIBLE
ID LESION
LARGE LIVER TUMOR
COMPLETE hepatic LOBECTOMY…
usually performed at WHAT part of the liver?
make sure to take off the ____ LIGAMENTS
usually performed on the HILUS
make sure to take off the TRIANGULAR ligaments
COMPLICATION rate of LIVER Sx is ____
what 3 structures can ACCIDENTALLY be LIGATED when performing liver sx?
HIGH
3 structures?
1. PORTAL VEIN
2. COMMON BILE DUCT
3. VESSELS in ADJACENT LIVER LOBE
what should we monitor POST OP & WHY?
what should we look for on ECG?
monitor HEMORRHAGE post-op because MIGHT NOT BE SEEN UNDER GA
on ECG, should look for VENTRICULAR ARRHYTHMIAS/VTAC
if a cat has PANCREATITIS, likely also has a ____ ____ ____ because most of pancreatic excretions occur through the ____ ____
BILE DUCT OBSTRUCTION, PANCREATIC DUCT
3 surgical diseases of the PANCREAS?
what disease DOES NOT require sx?
- PANCREATIC ABSCESS
- PANCREATIC PSEUDOCYST
- NEOPLASIA
PANCREATITIS DOESN’T REQUIRE SX
EXOCRINE PANCREATIC NEOPLASIA…
what is the MOST COMMON exocrine pancreatic neoplasia in dogs?
2 structures in the pancreas that are AFFECTED?
SEX, AGE & BREED likely in dogs?
age likely in CATS?
4 clinical signs?
prognosis?
what is the MOST COMMON exocrine pancreatic neoplasia in dogs? = ADENOCARCINOMA
2 structures in the pancreas that are AFFECTED?
1. ACINAR CELLS
2. DUCTAL EPITHELIUM
SEX, AGE & BREED likely in dogs?
1. FEMALE
2. OLDER
3. AIRDALES
age likely in CATS? = OLDER
4 clinical signs?
1. VOMITING
2. ANOREXIA
3. WEIGHT LOSS
4. ICTERUS
prognosis? = EXTREMELY POOR
for PANCREATIC SURGERY….
should use ____ surgical technique because…
it has a ____ blood supply with the ____
need to preserve AT LEAST ONE ____ ___ in ____
METICULOUS surgical technique because CAN CAUSE PANCREATITIS
it has a SHARED blood supply with DUODENUM
need to preserve AT LEAST ONE EXCRETORY DUCT in DOGS
2 SURGICAL techniques & descriptions for PANCREATIC SURGERY?
- DISSECTION & LIGATION
–> go into LOBULES and with HEMOSTAT, ligate VESSELS/DUCTS when RESECTING - SUTURE FRACTURE TECHNIQUE
–> CRUSH through PARENCHYMA and TIE IT OFF
