E2- Hepatobiliary sx

Question 1

Label the divisions of the liver

how many lobes?

Answer 1

6 lobes

(right is main blood supply)

Question 2

T/F: Blunt trauma to abdomen can lead to liver fracture

Answer 2

True

Question 3

Examples of penetrating wounds to the liver

Answer 3

gunshot, arrows, bite wounds

Question 4

Clinical signs related to blood loss are _____

Answer 4

acute

Question 5

The closer the injury is to the _____, the greater the likelihood surgery will be necessary to the liver

Answer 5

hilus (large vessels located here)

Question 6

What is the pringle maneuver?

Answer 6

interrupting the flow of blood through the hepatic artery and the portal vein and thus helping to controlbleeding from the liver

can occlude w/ fingers for about 15 minns

helps control intra-op bleeding

Question 7

Liver biopsy techniques

Answer 7

fine needle aspirate

tru-cut needles- image guided, open

laparoscopic

skin biopsy punch

guillotine technique

Question 8

Tru-Cut needle

Answer 8

ultrasound guided

laparoscopy

exploratory celiotomy

Question 9

When we use a skin biopsy punch to take a liver sample, what can we put into hole?

Answer 9

surgicel- gel foam helps hemostasis

Question 10

name the bx method

Answer 10

guillotine technique

Question 11

Indications for a parital lobectomy

Answer 11

biopsy

neoplasia

trauma

abscess

cysts

-will regenerate. can remove 85% of liver

Question 12

Which bx technique of the liver usually results in the most blood loss?

Answer 12

parenchymal fracture and ligation

Question 13

name the method

Answer 13

overlapping sutures

Question 14

T/F: we cannot staple the liver

Answer 14

FALSE: there is a stapling technique

use 2-3 lines of staples

Question 15

Surgities

Answer 15

used for small/large lobectomies

loop and tighten

can use 2 of them to cut distal to ligatures

Question 16

Cholecystitis/Cholangiohepatitis

Answer 16

inflam of gall bladder/ inflam of gall bladder and liver

necrotizing cholecystitis

rupture may result in septic peritonitis

Question 17

Cholecystitis/Cholangiohepatitis treatment

Answer 17

can treat medically if not ruptured -enteric organisms, E. coli, klebsiella, enterobacter, anaerobes

surgery: assess extrahepatic biliary tree, cholecystectomy

Question 18

Biliary mucoceles

Answer 18

mucus accumulation w/in gall bladder

-dont know the cause

thick mucus forms blockage so bile backs up in liver so we see icterus

Question 19

Signalment for Biliary mucoceles

Answer 19

older (9yrs)

small and medium size dogs

shelties, cocker spaniel

Question 20

Clinical signs for Biliary mucoceles

Answer 20

Question 21

Physical exam for biliary mucoceles

Answer 21

abdominal pain

icterus

fever

Question 22

Biochem abnormalities for biliary mucoceles

Answer 22

Question 23

Diagnostic imaging for biliary mucoceles

Answer 23

survey rads

ultrasonography: enlarged gallbladder w/ immobile echogenic bile, striated or stellate pattern = “kiwi sign”

Question 24

Treatment of biliary mucoceles

Answer 24

medical management? cholerectics (could lead to rupture)

Cholecystectomy

confirm patency of bile duct

culture bile- if not on antibiotics

antibiotics

Question 25

Indications for a Cholecystectomy

Answer 25

removal of the gallbladder

• necrotizing cholecysititis
• chronic cholectcystitis
• biliary mucocele
• cholelithiasis
• neoplasia
• trauma

Question 26

Duodenotomy with catheterization of bile duct so bile contents empty into _____

Answer 26

duedenum

Question 27

Complications of a Cholecystectomy

Answer 27

Bile peritonitis

• failure to adequately ligate bile duct
• failure to recognize and ligate small ducts entering cystic duct

Bleeding

• failure to ligate cystic artery

Question 28

Examples of biliary obstruction

Answer 28

inflammatory dz

choleliths and choledocholiths

neoplasia

inspissated bile- sludge/mucus

parastites- liver flukes

Question 29

Examples of Extraluminal biliary obstructions

Answer 29

pancreatic dz- severe pancreatitis puts pressure on duct, source of inflam

duodenal dz-inflam/tumor obstructing duct

Question 30

Choledochotomy: what is it? indications?

Answer 30

incision into dilated common bile duct

indications: choledocholithiasis, biliary sludge

Question 31

Bile duct stenting is most commonl done to relieve ____

Answer 31

obstruction due to extraluminal compression

Question 32

Bile duct stenting- temporarily ___ bile after suturing bile duct

Answer 32

divert

Question 33

Bile duct stenting- suture catheter to _____ with absorbable suture

Answer 33

intestinal wall

Question 34

Bile duct stenting- when suture breaks down bile duct contraction will dislodge catheter into ____

Answer 34

intestine

Question 35

Why would we do a biliary diversion?

Answer 35

irreparable obstructionor trauma of common bile duct (need to divert the bile)

Question 36

Cholecystoduodenostomy:

describe it

why must the initial size of the stoma needs to be 2.5-3cm ling?

Answer 36

mobilizing gallbladder out of fossa, move towards duodenum, make stoma, will empty directly to duodenum -no sphincter so it just flows

2.5-3cm long to reduce the risk of the gallbladder becoming impacted with ingesta causing cholecystitis and/or cholangiohepatitis

Question 37

List some complicatins of biliary diversion

Answer 37

leakage

cats- high morbidity and mortality (often related to underlying dz), chronic vomiting

dogs- ascending infections, bleeding at stoma site

Question 38

Causes of bile peritonitis

Answer 38

trauma- bile duct more common

spontaneous rupture- gallbladder

iatrogenic- trying to express gall bladder

Question 39

Describe the appearance of bile peritonitis

Answer 39

green, greenish-brown to brown discoloration

stains serosal surfaces

Question 40

Bile peritonitis abdominal effusion: compare what fluids?

what makes it positive?

Answer 40

compare fluid and serum bilirubin

positice if fluid is >/= 2x serum

Question 41

Abdominocentesis methods

Answer 41

four quadrant tap

ultrasound guided aspirate

DPL

Question 42

Bile Peritonitis: sterile bile= chemical peritonitis

Answer 42

overall well - tolerated

prognosis good if underlying cause eliminated

Question 43

Bile Peritonitis: infected bile = septic peritonitis

Answer 43

prognosis guarded to poor

morbidity and mortality are high