Hepatic Surgery Flashcards
where does the liver sit within the abdomen?
cranially, with 2/3rds of it mass to the RHS
how is the liver divided?
4 lobes - left, right, caudate and quadrate
what is the liver attached to?
diaphragm, right kidney, lesser curvature of the stomach and proximal duodenum
which major vessel runs through the liver?
caudal vena cava - firmly attached to liver
where does the liver receive blood from?
hepatic portal vein (from digestive tract and spleen) - 70-80%
hepatic artery - oxygenated blood - 20%
where does the oxygen supply to the liver come from?
50% hepatic portal vein and 50% hepatic artery
how does blood leave the liver?
drains into hepatic veins which exit at the dorsal border of the liver into the caudal vena cava
what is one of the main challenges of hepatic surgery?
high vascularity of the liver
when do we start to see clinical signs of hepatic impairment?
not until 70-80% of functional hepatic tissue is lost - large functional reserve
what might we see if synthesis and clearance of proteins (albumin) is impaired?
albumin-bound drugs and anaesthetic agents, ascites
what are the main functions of the liver?
synthesis and clearance of proteins (albumin)
metabolism of nutrients
production/activation of clotting factors
clearance of toxins (ammonia, drugs)
immunoregulation
GI function
storage - vitamins, fats, glycogen, copper
what might occur as a result of impaired metabolism of nutrients?
hypoglycaemia, lethargy, weight loss
what might occur as a result of impaired clearance of toxins?
excessive sensitivity to drugs, neurological signs, PUPD, anorexia, vomiting
what might occur as a result of impaired production/activation of clotting factors?
clotting problems, haemorrhage
what might occur as a result of impaired immunoregulation?
endotoxaemia, sepsis
what might occur as a result of impaired GI function?
weight loss, diarrhoea
what are some of the non-specific signs you might see with impaired liver function?
PUPD, lethargy, weight loss
where are bile acids synthesised?
in the liver
how are bile acids excreted?
into hepatic ducts - converge to form common bile duct
what happens to bile when the body is not digesting?
bile drains from the liver and passes via the cystic duct to the gall bladder
what happens to bile in the gallbladder?
storage and concentration
how does bile exit the gallbladder?
flows out via the cystic duct to the common bile duct and into the duodenum