E2- Hepatobiliary sx Flashcards
Label the divisions of the liver
how many lobes?
6 lobes
(right is main blood supply)
T/F: Blunt trauma to abdomen can lead to liver fracture
True
Examples of penetrating wounds to the liver
gunshot, arrows, bite wounds
Clinical signs related to blood loss are _____
acute
The closer the injury is to the _____, the greater the likelihood surgery will be necessary to the liver
hilus (large vessels located here)
What is the pringle maneuver?
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
Liver biopsy techniques
fine needle aspirate
tru-cut needles- image guided, open
laparoscopic
skin biopsy punch
guillotine technique
Tru-Cut needle
ultrasound guided
laparoscopy
exploratory celiotomy
When we use a skin biopsy punch to take a liver sample, what can we put into hole?
surgicel- gel foam helps hemostasis
name the bx method
guillotine technique
Indications for a parital lobectomy
biopsy
neoplasia
trauma
abscess
cysts
-will regenerate. can remove 85% of liver
Which bx technique of the liver usually results in the most blood loss?
parenchymal fracture and ligation
name the method
overlapping sutures
T/F: we cannot staple the liver
FALSE: there is a stapling technique
use 2-3 lines of staples
Surgities
used for small/large lobectomies
loop and tighten
can use 2 of them to cut distal to ligatures
Cholecystitis/Cholangiohepatitis
inflam of gall bladder/ inflam of gall bladder and liver
necrotizing cholecystitis
rupture may result in septic peritonitis
Cholecystitis/Cholangiohepatitis treatment
can treat medically if not ruptured -enteric organisms, E. coli, klebsiella, enterobacter, anaerobes
surgery: assess extrahepatic biliary tree, cholecystectomy
Biliary mucoceles
mucus accumulation w/in gall bladder
-dont know the cause
thick mucus forms blockage so bile backs up in liver so we see icterus
Signalment for Biliary mucoceles
older (9yrs)
small and medium size dogs
shelties, cocker spaniel
Clinical signs for Biliary mucoceles
Physical exam for biliary mucoceles
abdominal pain
icterus
fever
Biochem abnormalities for biliary mucoceles
Diagnostic imaging for biliary mucoceles
survey rads
ultrasonography: enlarged gallbladder w/ immobile echogenic bile, striated or stellate pattern = “kiwi sign”
Treatment of biliary mucoceles
medical management? cholerectics (could lead to rupture)
Cholecystectomy
confirm patency of bile duct
culture bile- if not on antibiotics
antibiotics
Indications for a Cholecystectomy
removal of the gallbladder
- necrotizing cholecysititis
- chronic cholectcystitis
- biliary mucocele
- cholelithiasis
- neoplasia
- trauma
Duodenotomy with catheterization of bile duct so bile contents empty into _____
duedenum
Complications of a Cholecystectomy
Bile peritonitis
- failure to adequately ligate bile duct
- failure to recognize and ligate small ducts entering cystic duct
Bleeding
- failure to ligate cystic artery
Examples of biliary obstruction
inflammatory dz
choleliths and choledocholiths
neoplasia
inspissated bile- sludge/mucus
parastites- liver flukes
Examples of Extraluminal biliary obstructions
pancreatic dz- severe pancreatitis puts pressure on duct, source of inflam
duodenal dz-inflam/tumor obstructing duct
Choledochotomy: what is it? indications?
incision into dilated common bile duct
indications: choledocholithiasis, biliary sludge
Bile duct stenting is most commonl done to relieve ____
obstruction due to extraluminal compression
Bile duct stenting- temporarily ___ bile after suturing bile duct
divert
Bile duct stenting- suture catheter to _____ with absorbable suture
intestinal wall
Bile duct stenting- when suture breaks down bile duct contraction will dislodge catheter into ____
intestine
Why would we do a biliary diversion?
irreparable obstructionor trauma of common bile duct (need to divert the bile)
Cholecystoduodenostomy:
describe it
why must the initial size of the stoma needs to be 2.5-3cm ling?
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
List some complicatins of biliary diversion
leakage
cats- high morbidity and mortality (often related to underlying dz), chronic vomiting
dogs- ascending infections, bleeding at stoma site
Causes of bile peritonitis
trauma- bile duct more common
spontaneous rupture- gallbladder
iatrogenic- trying to express gall bladder
Describe the appearance of bile peritonitis
green, greenish-brown to brown discoloration
stains serosal surfaces
Bile peritonitis abdominal effusion: compare what fluids?
what makes it positive?
compare fluid and serum bilirubin
positice if fluid is >/= 2x serum
Abdominocentesis methods
four quadrant tap
ultrasound guided aspirate
DPL
Bile Peritonitis: sterile bile= chemical peritonitis
overall well - tolerated
prognosis good if underlying cause eliminated
Bile Peritonitis: infected bile = septic peritonitis
prognosis guarded to poor
morbidity and mortality are high
