Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

SA DX & TX II > Exam 3 - Approach To Liver Masses > Flashcards

Exam 3 - Approach To Liver Masses Flashcards

1
Q

what are the 6 lobes of the liver in the dog/cat?

A
  1. left lateral lobe
  2. left medial lobe
  3. right medial lobe
  4. right lateral lobe
  5. quadrate lobe
  6. caudate lobe - caudate process of caudate lobe & papillary process of the caudate lobe
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

label numbers 1-7

A
  1. right medial lobe
  2. right lateral lobe
  3. caudate process of the caudate lobe
  4. papillary process of the caudate lobe
  5. left lateral lobe
  6. left medial lobe
  7. quadrate lobe
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what is included in the left division of the liver?

A

left lateral lobe, left medial lobe, & papillary process of the caudate lobe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what is included in the right division of the liver?

A

right lateral lobe & caudate process of the caudate lobe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what is included in the central division of the liver?

A

quadrate lobe & right medial lobe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

in dogs, ________ liver lesions are more common than _____ tumors (2.5X)

A

metastatic

primary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

in cats, _________ __________ tumors are more common than ________ tumors

A

primary hepatobiliary

metastatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is the signalment of animals affected with liver masses?

A

usually older animals - no breed or sex predilection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

when may an animal with a liver mass have more severe clinical signs?

A

hemoperitoneum

caval occlusion

biliary obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what are the non-specific signs associated with animals with a liver mass?

A

inappetence, weight loss, etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is the common history seen in dogs & cats with a liver mass upon presentation?

A

symptomatic in 50% of cats & 75% of dogs - particularly when malignant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

T/F: in 75% of cases, there is a palpable mass upon physical exam of an animal with a liver mass

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what else, other than a palpable mass, may you see on physical exam on a patient with a liver mass?

A

pale mucus membranes, jaundice, & fluid wave/abdominal distension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what clin path abnormalities may be seen on a patient with a liver mass?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what is the gold standard in humans for diagnosing a liver mass?

A

MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what is the preferred imaging used for diagnosing a liver mass in dogs/cats?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

why are rads minimally useful in diagnosing a liver mass in dogs/cats?

A

need to look at the entire abdomen & get information on where the mass is arising from

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

before doing an ultrasound guided liver FNA, what should you do?

A

check for bleeding disorders!!! CBC & coagulation panel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what are some risk factors for hemorrhage for patients with a liver mass done prior to an FNA?

A

thrombocytopenia

prolonged PT in dogs

prolonged APTT in cats

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what are some contraindications for doing an ultrasound guided liver FNA on a patient with a liver mass?

A

ascites

hepatic cysts

vascular tumor

lesions close to large bile ducts or vessels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

if you have a patient with a defined liver tumor, do you do a liver biopsy? why?

A

no!! risk of hemorrhage is too high

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what are the 3 types of primary liver tumors?

A
  1. massive - single large mass within 1 lobe of the liver
  2. nodular - multifocal & in more than 1 lobe of the liver
  3. diffuse - global effacement or nodules in all liver lobes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

T/F: benign, hyperplastic nodules are very common in older dogs, 70% in dogs > 6 years of age & 100% in dogs > 14 years

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

T/F: typically surgery is only indicated for tumors with massive morphologic distribution

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what is the number one malignant liver tumor in dogs? what is the second?

A
  1. hepatocellular carcinoma
  2. bile duct carcinoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

in dogs, are benign or malignant liver tumors more common?

A

malignant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

in cats, are benign or malignant liver tumors more common?

A

benign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

what is the number one benign liver tumor in cats? what is the second?

A
  1. bile duct adenoma
  2. hepatocellular adenoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

what is the prognosis of a dog with a malignant bleeding liver mass?

A

poor, <100 days

30
Q

what is the prognosis of a dog with a benign bleeding liver mass?

A

~900 days

31
Q

what are the likely tumor types present if a dog presents with hemoabdomen due to a ruptured liver mass?

A

63.5% of hepatocellular carcinoma or other benign mass

36.5% hemangiosarcoma or other malignant mass

32
Q

__________ ___________ represents up to 77% of all non-hematopoietic tumors in the dog with up to 30% being benign _________ __________

A

hepatocellular carcinoma

hepatocellular adenoma

33
Q

of the occurrence of hepatocellular carcinomas in dogs, what is the most common morphological type?

A
  1. massive - 60%

nodular is 30% & diffuse is 10%

34
Q

of the morphological types, which ones have the highest potential for metastasis? what sites is metastasis seen?

A

nodular or diffuse - 93%!!!!

regional lymph nodes & peritoneum

35
Q

T/F: metastatic potential of hepatocellular carcinomas varies based on distribution type (morphological types)

A

true

36
Q

what is the most effective treatment for massive hepatocellular carcinoma? what is the median survival time? what is the prognosis?

A

surgery - >1500 days & without surgery, <300 days

prognosis is good even with incomplete resection

37
Q

what tumor type makes up 50% of biliary tumors in cats?

A

bile duct adenoma aka biliary cystadenoma

38
Q

when do cats develop clinical signs from biliary cystadenomas?

A

only when the tumor starts to press on organs

39
Q

what is the preferred treatment of biliary cystadenomas? what is the prognosis?

A

surgical removal - good prognosis

40
Q

what is the most common malignant tumor in cats which is also the second most common in dogs?

A

bile duct carcinoma aka cholangiocarcinoma

41
Q

what is the morphological presentation of cholangiocarcinomas?

A

can be any of the 3 - massive, diffuse, & nodular

42
Q

what is the metastatic rate of bile duct carcinomas in dogs & cats? what is the prognosis?

A

dogs - 88%
cats - 67-80%

carcinomatosis

generally poor prognosis

43
Q

what is a carcinoid? what is its morphology?

A

neuroendocrine tumor - always diffuse or nodular

44
Q

what is the prognosis of carcinoids?

A

poor - metastasis >90%, die in weeks

45
Q

T/F: carcinoids are rarely a primary tumor

A

true - more common to develop primary in gi tract or pancreas with metastasis to the liver

46
Q

this histopathology shows what type of tumor?

A

carcinoid - neuroendocrine

47
Q

what is the prognosis for sarcomas in the liver?

A

prognosis is poor unless it is massive (amenable to surgery) with no metastatic disease

48
Q

what are the morphological types of sarcomas seen in the liver?

A

nodular - 64%

massive - 36%

49
Q

what is the metastatic rate of sarcomas of the liver?

A

85-100%

50
Q

although rare, what are the most commonly reported primary hepatic sarcomas in dogs & cats?

A

dogs - leiomyosarcomas

cats - hemangiosarcomas

51
Q

is surgery indicated for metastatic liver disease?

A

nope - only for biopsy & staging

52
Q

the liver is a common site for metastasis in dogs from what primary tumor types?

A

splenic tumors, pancreatic tumors, & gi tract tumors

lymphoma, malignant histiocytosis, & systemic mastocytosis also possible

53
Q

why is chemo not used commonly for treating primary liver tumors? what are some other treatment options apart from surgery?

A

limited utility

microwave ablation, radiation therapy

54
Q

how much of the liver can you remove with out complication? how much would cause death?

A

~70% - can be acutely removed without complications

removal of 84% will cause death

55
Q

what things may slow liver regeneration?

A

comorbidities such as biliary obstruction & diabetes

56
Q

after acute surgical removal of part of the liver, when does regeneration begin? when does it finish?

A

begins almost immediately

near complete by 1 week

57
Q

when may you use the guillotine technique for an open liver biopsy? how is it performed?

A

better for diffuse disease or lesions at the margins of the liver

isolate a corner/margin of the liver & place a circumferential suture around the region with a surgeon’s knot using 3-0 PDS

use metzenbaums to remove the sample a few mm from the suture

58
Q

when may you use the punch biopsy for an open liver biopsy? how is it performed?

A

better for centrally located/focal lesions

use a 4-6mm punch & absorbable gelatin sponge - insert instrument & rotate

use metzenbaums to amputate the deep margin of the sample & carefully remove

pack site with gel foam

59
Q

what are some pre-op considerations before doing a liver lobectomy?

A

must blood type the patient & have blood available

need coagulation panel

60
Q

what are the complication rates associated with liver lobectomies?

A

26% overall complication rate & 40% for right divisional tumors - massive hemorrhage is very real, so you need close post-op monitoring

61
Q

what is the peri-operative mortality associated with liver lobectomies?

A

5-11%

62
Q

when doing a liver lobectomy, what equipment might you have on hand?

A

surgical stapler

ligasure

vascular clamps

hemoclips

poole suction tip

63
Q

what is the hilar lobectomy technique? when is it used?

A

ligation of the vasculature & bile ducts at the hilus of the liver lobe/division in question - many liver tumors when doing a lobectomy

64
Q

T/F: when doing a liver lobectomy, you ideally need a margin of normal liver between the resection site & the mass

A

true

65
Q

what is the most common liver tumor in the dog? what is the prognosis?

A

massive hepatocellular carcinoma - good prognosis with surgery

66
Q

what is the most common liver tumor in the cat? what is the prognosis?

A

biliary cystadenomas - good prognosis with surgery

67
Q

what is the best imaging modality for planning liver tumors? does it determine if it can be resected or not?

A

CT is best for planning

DOES NOT DETERMINE IF IT CAN BE RESECTED

68
Q

should you refer a liver lobectomy surgery to a referral center?

A

A&M wants you to

69
Q

should you refer a liver lobectomy surgery to a referral center?

A

A&M wants you to

70
Q

label numbers 1-7

A
  1. right lateral lobe
  2. caudate process of caudate lobe
  3. right lateral lobe
  4. right medial lobe
  5. quadrate lobe
  6. left lateral lobe
  7. papillary process of caudate lobe

SA DX & TX II (62 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions