Digestion & Metabolism 2: Liver & Pancreas Sx Flashcards by Nellie O'Leary

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

LEFT TRIANGULAR LIGAMENT LOCATION & WHAT IT ATTACHES

found on the LEFT AND RIGHT side of liver and ATTACH LIVER LOBES TO DIAPHRAGM

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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)

How well did you know this?

Not at all

Perfectly

liver starts REGENERATION within ____ following RESECTION

with STAGED hepatectomies, can allow for up to ____% of hepatic volume

HOURS, 95%

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

SCREENING B/W FINDINGS for PRIOR to LIVER SURGERY? (4)

ELEVATION in HEPATOCELLULAR ENZYMES ALT, AST
HYPERBILIRUBINEMIA
HYPOGLYCEMIA
DECREASED BUN

How well did you know this?

Not at all

Perfectly

if liver LOBE TORSION or ABSCESSATION, what CBC finding can we expect?

LEUKOCYTOSIS

How well did you know this?

Not at all

Perfectly

if LARGE LIVER TUMOR, can cause _____ syndrome & WHAT CBC finding?

PARANEOPLASTIC, THROMBOCYTOSIS

How well did you know this?

Not at all

Perfectly

what 3 PREOP diagnostics should we do for the LIVER?

SCREENING B/W
COAGULATION PROFILES
URINALYSIS

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

on US, ____ DISEASED liver should be ____echoic CENTER with ____RIM

MALIGNANT

HYPERECHOIC center with HYPOECHOIC RIM

How well did you know this?

Not at all

Perfectly

when are CTs performed for liver patients?

usually for LARGE LIVER TUMORS to ensure NO METASTASIS

How well did you know this?

Not at all

Perfectly

how is a LIVER BIOPSY PERFORMED on SUPERFICIAL PERIPHERAL LIVER TUMOR? (2 easy steps)

take HEMOSTAT & CRUSH TISSUE around TUMOR
then, CUT IT OFF

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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?

1. FRESH WHOLE BLOOD 2. FRESH FROZEN PLASMA 3. 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)

1. HEPATIC ARTERY LIGATION 2. +/- 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?

1. PANCREATIC ABSCESS 2. PANCREATIC PSEUDOCYST 3. 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?

1. DISSECTION & LIGATION --> go into LOBULES and with HEMOSTAT, ligate VESSELS/DUCTS when RESECTING 2. SUTURE FRACTURE TECHNIQUE --> CRUSH through PARENCHYMA and TIE IT OFF