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ACVN - SURGICAL NURSING > Hepatic Surgery > Flashcards

Hepatic Surgery Flashcards

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1
Q

How many lobes are there in the liver and what are they?

A

4
- left which is the largest
- right
- caudate
- quadrate

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2
Q

Where does the liver sit in the abdomen?

A

within the cranial abdomen, 2/3 of its mass on the right hand side of midline

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3
Q

What is the liver attached to?

A

the diaphragm, right kidney, lesser curvature of the stomach and the proximal duodenum

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4
Q

What is attached to and runs through the liver?

A

vena cava

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5
Q

Where does the liver recieve its blood from?

A

hepatic portal vein from the digestive tract and spleen

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6
Q

Wahat percentage blood volume is supplied by the portal vein?

A

70-80%

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7
Q

How is the liver supplied with blood?

A

the hepatic artery and portal vein

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8
Q

What percentage volume of blood does the hepatic artery provide?

A

20%

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9
Q

Where does portal blood and arterial blood mix?

A

the sinusoids in the liver

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10
Q

Where does the portal blood drain into?

A

hepatic veins which exit the dorsal border of the liver into the caudal vena cava

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11
Q

What is the functionof the liver?

A

synthesis and clearance of proteins
- metabolism of nutrients (carbohydrates, lipids, amino acids)
= production/activation of clotting factors
- clearance of toxins (amonia, drugs etc)
- immunoregulation
- gastrointestinal function
- storage - vitamins, fats, glycogen, copper

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12
Q

What cells are involved in immunoregulation in the liver?

A

Kupffer cells

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13
Q

When will you see clinical signs of impairment if liver function is lost?

A

70-80%

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14
Q

What is synthesised in the liver?

A

bile acids

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15
Q

Where are bile acids excreted?

A

into hepatic ducts which drains the bile acid out of the liver

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16
Q

What do the multiple hepatic ducts converge to form?

A

common bile duct

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17
Q

What happens when the body is not digesting?

A

bile drains from the liver and passes via the cystic duct to the gall bladder where it is stored and concentrated

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18
Q

What happens to bile during digestion?

A

it flows out from the gall bladder via the cystic duct to the common bile duct and into the duodenum

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19
Q

What is the main functions of bile acids?

A
  • help with digestion and absorption of fat
  • neutralises gastric acid and inhbitis gastric acid secretion to prevent intestinal ulceration
20
Q

What diagnostic testing can be done to test liver function?

A
  • haematology, biochemistry, blood gas/electrolytes, urinalysis, dynamic bile acid testing
21
Q

What abdominal diagnostic testing can be done to test liver function?

A

radiography (plain and contrast), ultrasound, CT, MRI, scintigraphy

22
Q

What medical management can you doto stabilise the patient prior to liver surgery?

A
  • prescription diet
  • oral antibiotics
  • oral lactulose
23
Q

What drugs should you avoid if a patientis undergoing hepatic surgery?

A

those that undergo hepatic metabolism

24
Q

What are some examples of drugs that should be avoided in hepatic surgery?

A

aspirin chloramphenicol, diazepam, fluorouracil, clindamycin,azathioprine , oxytetracycline

25
Q

What could you consider giving as a pre-treatment if they have co-agulation abnormalities?

A

vitamin K or fresh frozen plasma

26
Q

What should you do as soon as the patient has been admitted for hepatic surgery?

A
  • complete coagulation profile
  • minimum platelet count
  • activated thromboplastin time
  • prothrombin time
27
Q

Why would you give antibiotics to these patients?

A

bacteria in the liver and risk of endotoxaemia/sepsis

28
Q

What condition might occur due to significant liver resecton?

A

hypoglycaemia

29
Q

Why might you blood type for a liver lobectomy?

A

risk of haemorrhage

30
Q

What general nursing care should you provide to hepatic surgery patients?

A
  • water replenishment and regular toilet trips due to PUPD
  • tempting to eat if anorexic
31
Q

Why might you peform a liver biopsy?

A

establish diagnosis/prognosis where hepatic disease is suspected

32
Q

What might indcate a partial or complete hepatic lobectomy?

A

benign or malignant mass, abscess or liver lobe torsion

33
Q

What might indicate surgical correction of portosystemic shunt?

A

portosystemic shunt

34
Q

What might inidcate a cholecystectomy or cholecysoenterostomy?

A
  • extrahepatic biliary tract obstruction
  • cholelithiasis
  • gall bladder mucocele
  • pancreatitis
  • neoplasia
  • biliary tract rutpure and bile peritonitis
35
Q

What is a cholecystectomy?

A

removal of the gall bladder

36
Q

What is a cholecystoenterostomy?

A

rorouting the gall bladder to the duodenum

37
Q

What are the peri-operative considerations?

A
  • hypotension
  • hypothermia
  • haemorrhage and coagulation abnormalities
  • IV fluid therapy
  • pre-medication and induction agents - avoid drugs that undergo hepatic metabolism
  • ventilation
  • antibiotics
38
Q

What post-operative care should be provided?

A
  • intensive nursing for critical animals
  • analgesia
  • minimum database/haematology and biochemistry
  • antibiotics if infection present
  • nutrition
  • monitor for sepsis or systemic inflammatory response syndrome (SIRS)
39
Q

What post-op monitoring should you do?

A
  • physical parameters
  • bood pressure, ideally through arterial line
  • signs of haemorrhage
  • leakage of bile
40
Q

What surgical complications can occur?

A

hypotension, hypothermia, hypoglycaemia, haemorrhage, leakage of bile, sepsis

41
Q

What perentage of portosystemic shunts are congenital?

A

80%

42
Q

What percentage of portosystemic shunts are acquired?

A

20%

43
Q

What percentage of congenital portosystemic shunts are extrahepatic?

A

65-75%

44
Q

What percentage of congenital portosystemic shunts are intrahepatic?

A

25-35%

45
Q

What breeds are affected by extrahepatic portosystemic shunts?

A

small breeds, torkshire terriers, cairn terriers, west highland white terriers

46
Q

What breeds are affected by intrahepatic portosystemic shunts?

A

large dog breeds, irish wolfhounds, australian cattle dogs, labradors

47
Q

What is a portosystemic shunt?

A

anamolous blood vessel which connects the hepatic portal vein within the stsemic venous circulation e.g caudal vena cava, thereby bypassing the liver and diverting some of the portal blood supply away from the liver

ACVN - SURGICAL NURSING (17 decks)

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