Hepatobiliary Flashcards
OBJ: Given a patient with a specific hx and/or PE indicative of hepatobiliary disease, be able to determine ddx and create a rational diagnostic plan
OBJ: Be able to create a rational pre-operative and post-operative plan for animals ndergoing hepatobiliary surgery
OBJ: Be able to discuss indications for specific surgical techniques for hepatobiliary disease
PBJ: Be able to discuss complications and prognosis of common surgical hepatobiliary diseases
What are the clinical sing of hepatic parenchymal disease
- Lethargy, anorexia, weight-losss
- Vomiting/Diarrhea
- Ascites, abdominal distension - only if severe
- Collapse/weakness/shock
- PU/PD
- Hepatic encephalopathy - only if severe
- Icterus - only if severe
- Asymptomatic
What are the clinical signs associated with severe hepatic parenchymal disease
- Ascites, abdominal distension
- Hepatic encephalopathy
- Icterus
What findings are seen on CBC/Chemistry with hepatic parenchymal disease?
- Signs of ongoing injury
- Cholestasis
- Decreased functional liver capacity (end-stage liver)
What are the ddx for hepatocellular injury?
- Benign (vacuolar hepatopathy, extramedullary hematopoiesis)
- Secondary effect (trauma, shock)
- Toxic/infectious
- chronic active hepatitis
- Immune-mediated, copper-associated
- Hepatic lipidosis (cat)
- Hepatic parenchymal mass/disease
What diagnostic tests can be used to narrow down the cause of hepatocellular injury?
- Abdominal radiographs
- Abdominal US
- CT Scan (Sx planning)
- FNA, Biopsy, Fluid analysis
- Staging
What are the ddx for a liver mass?
- Abscess
- Neoplasia
- Cyst
- Liver lobe torsion
What are the signs of a hepatic abscess?
How are they diagnosed?
Treatment?
- Vague clinical signs to sepsis
- Elevated ALP and left shift neutrophilia
- Dx: Abdominal US and cytology/culture
- mixed echogenicity +/- gas
- Tx:
- Medical (antibiotics)
- Surgical (lobectomy)
What is the most common neoplasia of the liver?
What is the common primary neoplasia of the liver in dogs? cats?
how are they diagnosed?
- Most common: metastatic
- Dogs: Hepatocellular carcinoma
- MST > 1400 days for massive form
- US and Cytology useful
- Cats: Biliary Cystadenoma
- ‘cysts’ with anechoic fluid on ultrasound
- Cytology less useful unless solid mass
What are the clinical signs of hepatocellular injury?
- Asymptomatic
- Nonspecific signs
- Similar signs as hepatic disease
- Icterus
- Signs of shock
What diagnostic tests can be done to differentiate the causes of hepatocellular injuries?
- Blood work (increased Bilirubin/ALP)
- Coagulation disturbances more common
- Abdominal radiographs
- Abdominal US
- Fluid analysis (bilirubin 2x higher than in serum)
What are the differentials for elevated cholestatic enzymes?
- Pre-hepatic: hemolysis
- Hepatic: severe parenchymal disease
- Post-hepatic: Gall bladder mucocele, Extrahepatic biliary tract obstruction, Biliary tract rupture
What causes Gallbladder mucocele?
- Cystic mucosal hyperplasia
- Increased mucus can lead to duct obstruction or gallbladder rupture
- Hyperadrenocorticism, Hypothyroidism
How is a gallbladder mucocele diagnosed?
- US - ‘classic’ stellate/kiwi appearance
What breeds are predisposed to gallbladder mucoceles?
- Shelties
- cocker spaniels
What is the treatment for a Gallbladder mucocele
- Cholecystectomy > medical management
- Emergent/urgent for symptomatic/icteric dogs, bile peritonitis/ruptured gallbladder, distended bile ducts
What is the prognosis for treatment of gallbladder mucoceles?
- Post-operative mortality ~20-30%
- 5% complication rate for asymptomatic dogs
How is a Cholecystectomy completed?
- Bile duct catheterized and flushed
- Gallbladder dissected free of liver
- Cystic duct ligated
- Can be done laparoscopically
What are extrahepatic causes of biliary tract obstruction?
- Pancreatitis/Cholangiohepatitis (cats)
- neoplasia
- choleliths
How is biliary tract obstruction diagnosed
Abdominal US
What is the treatment for biliary tract obstructions?
- Surgery
- remove obstruction if possible
- +/- place a choledocal stent
