Exam 3 - Approach To Liver Masses Flashcards
what are the 6 lobes of the liver in the dog/cat?
- left lateral lobe
- left medial lobe
- right medial lobe
- right lateral lobe
- quadrate lobe
- caudate lobe - caudate process of caudate lobe & papillary process of the caudate lobe
label numbers 1-7
- right medial lobe
- right lateral lobe
- caudate process of the caudate lobe
- papillary process of the caudate lobe
- left lateral lobe
- left medial lobe
- quadrate lobe
what is included in the left division of the liver?
left lateral lobe, left medial lobe, & papillary process of the caudate lobe
what is included in the right division of the liver?
right lateral lobe & caudate process of the caudate lobe
what is included in the central division of the liver?
quadrate lobe & right medial lobe
in dogs, ________ liver lesions are more common than _____ tumors (2.5X)
metastatic
primary
in cats, _________ __________ tumors are more common than ________ tumors
primary hepatobiliary
metastatic
what is the signalment of animals affected with liver masses?
usually older animals - no breed or sex predilection
when may an animal with a liver mass have more severe clinical signs?
hemoperitoneum
caval occlusion
biliary obstruction
what are the non-specific signs associated with animals with a liver mass?
inappetence, weight loss, etc
what is the common history seen in dogs & cats with a liver mass upon presentation?
symptomatic in 50% of cats & 75% of dogs - particularly when malignant
T/F: in 75% of cases, there is a palpable mass upon physical exam of an animal with a liver mass
true
what else, other than a palpable mass, may you see on physical exam on a patient with a liver mass?
pale mucus membranes, jaundice, & fluid wave/abdominal distension
what clin path abnormalities may be seen on a patient with a liver mass?
non-specific changes reflecting hepatobiliary damage/stasis
elevated AlkP/ALT very common - especially with primary tumors
with metastatic disease - elevated AST/Tbili may be more common
paraneoplastic hypoglycemia possible with hepatic adenomas
what is the gold standard in humans for diagnosing a liver mass?
MRI
what is the preferred imaging used for diagnosing a liver mass in dogs/cats?
ultrasound is most common with CT used for surgical planning
CT is better at localized mass origin & provides more information on the relationship of the mass with the caudal vena cava
why are rads minimally useful in diagnosing a liver mass in dogs/cats?
need to look at the entire abdomen & get information on where the mass is arising from
before doing an ultrasound guided liver FNA, what should you do?
check for bleeding disorders!!! CBC & coagulation panel
what are some risk factors for hemorrhage for patients with a liver mass done prior to an FNA?
thrombocytopenia
prolonged PT in dogs
prolonged APTT in cats
what are some contraindications for doing an ultrasound guided liver FNA on a patient with a liver mass?
ascites
hepatic cysts
vascular tumor
lesions close to large bile ducts or vessels
if you have a patient with a defined liver tumor, do you do a liver biopsy? why?
no!! risk of hemorrhage is too high
what are the 3 types of primary liver tumors?
- massive - single large mass within 1 lobe of the liver
- nodular - multifocal & in more than 1 lobe of the liver
- diffuse - global effacement or nodules in all liver lobes
T/F: benign, hyperplastic nodules are very common in older dogs, 70% in dogs > 6 years of age & 100% in dogs > 14 years
true
T/F: typically surgery is only indicated for tumors with massive morphologic distribution
true