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Surgical Nursing > Hepatic surgery > Flashcards

Hepatic surgery Flashcards

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1
Q

How does the liver get its blood supply?

A

Hepatic artery, hepatic portal vein, hepatic vein

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2
Q

What is the function of the liver?

A 
Synthesis proteins (albumin) 
Synthesis and activation of clotting factors
Storage of fats, viatmins, glycogen, copper
Degradation of toxins, ammonia, drugs
Lipid metabolism 
Gastrointestinal function  
Carbohydrate metabolism (glucose) 
Reticuloendothelial function
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3
Q

What conditions take place if a patient has hepatic insufficiency?

A

Hypoproteinaemia
Hypoglycemia
Coagulopathy
Hepatic encephalopathy

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4
Q

How should you assess the haemotological system in liver disease and how do you treat before surgery?

A

Assess clotting times APTT PT

Consider pre-treatment with vitamin K or fresh frozen plasma

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5
Q

Are antibiotics indicated for liver surgery?

A

Yes
Anaerobic bacteria within the liver, give peri-operative intra-venous antibiotics
Sample areas of the liver for culture

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6
Q

How do you take samples of the liver?

A 
Ultrasound guided FNA, tru-cut biopsy 
Surgical biopsy (more accurate, potentially safer, laproscopic)
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7
Q

What are the indications for a liver lobectomy?

A

Neoplasm- benign, malignant
Biopsy/removal of lesion
Liver lobe torsion
abscess

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8
Q

What are the risks of a liver lobectomy and how much of the liver can you remove?

A

Haemorrhage blood type!

70% of the liver

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9
Q

What are the indications for biliary tract surgery?

A 
Extrahepatic biliary obstruction
-choleithiasis (gall stones)
-gall bladder mucocele
-pancreatits 
-neoplasia 
Biliary tract rupture and bile peritonits 
-trauma 
-disease process (cholecystitis, inflammation of the gall bladder)
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10
Q

What are the clinical signs of liver disease?

A 
Non-specific
Vomiting 
Icterus 
annorexia
Abdominal pain
Hypovolaemia shock (severe EHBO or bile peritonitis)
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11
Q

What parameters show up on haemotology and biochemistry as abnormal in liver disease?

A 
ALT and ALP raised 
Decreased albumin 
Increased cholesterol and bilirubin 
Bile facilitates the absorption of vitamin k
Coagulation abnormalities (DIC)
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12
Q

A patient has severe liver dysfunction leading to coagulation abnormalities what can you give to treat this?

A

Vitamin k-three doses at 0.5-1.5mg/kg s/c or im

Frozen plasma in emergencies 10ml/kg

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13
Q

What can cause bile peritonitis and how is it treated?

A

Trauma vs biliary tract disease
sterile vs septic
manage peritonitis
treat underlying cause

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14
Q

What are the two types of biliary surgery and what is important to consider?

A

Cholecystectomy-Surgical removal of the gall bladder
Cholecystoeneterostomy- Gall bladder is joined to the small intestine
Better to preserve the common bile duct rather than the gall bladder

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15
Q

What is the outcome for patients undergoing biliary surgery?

A

Systemically unwell
intensive post-op care monitor bile leakage, sepsis, SIRS
Significant mortality
cats poor prognosis for neoplasia

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16
Q

What should you include in the post-operative care of a patient undergoing biliary surgery?

A 
Analgesia 
Keep close eye on clotting times 
Temperature 
Blood pressure 
signs of haemorrhage (PCV, TS, MM, CRT)
Signs of bile leakage (peritonitis) 
Sepsis 
SIRS
17
Q

What is a congenital portosystemic shunt?

A

Persistence of a vein travelling between the hepatic portal vein before it has reached the liver to the vena cava

18
Q

What are the affected breeds of a porto-systemic shunt

A 
Extrahepatic 
-westies
-cairns
-yorkshire
Intraheptaic
-labs
-irish wolfhounds
-Australian cattle dogs
19
Q

What are the clinical signs of a portosystemic shunt?

A 
Shunted growth 
Obtunded 
Seizures 
Hepatic encephalopathy
high ammonia 
Urinary tract signs 
Gastrointestinal signs 
Drug intolerance
20
Q

What investigations should be completed to look for a portosystemic shunt?

A

Signalment and history
Blood tests
imaging

21
Q

What haemotology parameters may be abnormal for a portosystemic shunt?

A

non-specific
anaemia
microsytosis

22
Q

What biochemistry parameters may be abnormal in a portosystemic shunt case?

A 
Decreased urea
Decreased albumin 
Decreased cholesterol 
Hypoglycemia 
increased ALT and ALP
23
Q

What urinalysis parameters may be abnormal for a portosystemic shunt?

A

USG decreased

ammonium biurate crystalluria

24
Q

What liver specific tests can you carry out to assess for a portosystemic shunt?

A

Ammonia-converted to urea in the liver, abnormal 80% portosystemic shunt cases
Bile acids
most useful test 100% sensitive

25
Q

What imaging is useful to observe for a portosystemic shunt?

A

Ultrasound
Portovenography
-intraoperative under fluroscope guidance
-provides information on shunt configuration
-information of intra-hepatic vascularture
-confirms diagnosis

26
Q

What is the medical management of a portosystemic shunt?

A

Retaining lactulose enema (removes ammonia)
Restricted protein diet
antibiotics
seizure medication

27
Q

Is surgery recommended vs medical management in the portosystemic shunt?

A

Yes
Much better survival rates
medically manage 2-3 weeks before surgery

28
Q

What are the goals of portosystemic shunt surgery?

A

To ligate the shunt
Restore normal portal blood flow
resolve hepatic insufficiency and clinical signs

29
Q

What is the concern with complete ligation of the portosystemic shunt and how may it be avoided?

A

Liver hypertension
Partial ligation is an option
Gradual attenuation devices available
-ameroid constrictor, cellophane band, intravascular coil

30
Q

How is portovenography carried out?

A

Contrast is injected into the jejunal vessel during surgery under fluoroscopic guidance

31
Q

What are the complications with portosystemic shunt surgery?

A 
portal hypertension 
haemorrhage 
GI bleeding 
neurological complications (don't arise straight away take a few days) 
Hypoglycemia 
mortality
32
Q

What are the outcomes for portosystemic shunt surgery?

A

Better prognosis for extrahepatic
84-94% good
Intrahepatic 50-100%
Complete attenuation better clinical outcome

Surgical Nursing (24 decks)

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