Hepatobiliary Flashcards
Cheney, JSAP, 2019:
Ultrasound vs CT for solitary hepatic masses
What % of solitary hepatic masses were correctly localized by ultrasound?
What % of solitary hepatic masses were correctly localized by CT?
Sensitivity was highest for both ultrasound and CT for masses of which division?
Cheney, JSAP, 2019:
74% of solitary hepatic masses were correctly localized by ultrasound
84% of solitary hepatic masses were correctly localized by CT
Sensitivity was highest for left division masses
Goode, JVIM, 2019:
Blood flow in hepatic tumors
What vessel does the majority of the tumor blood supply arise from?
Goode, JVIM, 2019:
The majority of the tumor blood supply arises from the hepatic artery and not the portal vein - there were significant decreases in portal blood flow in areas of tumor growth compared to normal hepatic parenchyma
Hanson, JAVMA, 2017:
Liver lobectomy and blood transfusions
What % of dogs vs cats required a blood transfusion?
Blood transfusion requirements based on lobe removed or number of lobes removed?
Mortality rate for dogs that received blood transfusions vs dogs that did not receive blood transfusions?
Mortality rate for cats that received blood transfusions vs cats that did not receive blood transfusions?
Hanson, JAVMA, 2017:
17% of dogs vs 44% of cats required a blood transfusion
Neither the lobe removed nor the number of lobes removed affected the requirement for a blood transfusion
Mortality rate in dogs: 2% that received a blood transfusion vs 4% that did not receive a blood transfusion
Mortality rate in cats: 22% of cats overall, no difference in survival between those that did or did not receive a blood transfusion
Linden, Vet Surg, 2019:
Central division hepatic lobectomies
Intra-op complication rate?
Immediate post-op complication rate?
Peri-op mortality rate?
2-week mortality rate?
Linden, Vet Surg, 2019:
Intra-op complication rate: 48%
Immediate post-op complication rate: 33%
Peri-op mortality rate: 11%
2-week mortality rate: 15%
Parkanzy, JVIM, 2019:
Gallbladder mucoceles
2-week mortality rate?
MST for surgically treated vs medically treated vs medically then surgically treated dogs?
What factor(s) were associated with decreased survival regardless of treatment?
Parkanzy, JVIM, 2019:
2-week mortality rate: 20%
MST: 1802 days for surgically treated dogs vs 1340 days for medically treated dogs vs 203 days for medically then surgically treated dogs
Increased serum creatinine concentration, hyperphosphatemia, increased ALP activity and increasing severity of gallbladder mucocele type were associated with decreased survival regardless of treatment type
Youn, JAVMA, 2018:
Cholecystectomy for gallbladder disease
What % of dogs had positive bacterial cultures from bile samples?
Overall mortality rate?
Mortality rate in the non-elective cholecystectomy group vs the elective cholecystectomy group?
What factor(s) were associated with mortality?
What factor(s) were not associated with mortality?
Youn, JAVMA, 2018:
22% had positive bacterial cultures from bile samples
Overall mortality rate: 9%
Mortality rate was 20% in the non-elective cholecystectomy group vs 2% in the elective cholecystectomy group
Azotemia was associated with mortality
Gallbladder rupture was not associated with mortality
Cheney
Ultrasound and CT for localizing hepatic masses
JSAP 2019
Correct predictions
~US 74%
~CT 84%
Sensitivity highest on LEFT
Linden
Central division Hepatic Lobectomies
VetSurg 2019
Hilar resection
~increased intra-op complications
~increaed PO complications
Hemorrhage in 33%
most required transfusion
Mortality
~Peri-op 11%
~2 weeks 15%
HCC MST not reached
~ 1 year & 3 year 82%
margins did not affect survival time
Youn
Elective cholecystectomy
JAVMA 2018
Mortality 9%
2 vs 20%
Survival associated with
~decreased Alb
~increased ALT
~increased T. Bili
Hattersley
Intra-op hypotension and cholecystectomy
JSAP 2020
Mortaility 17%
~b/f d/c 13%
Mortality associated with
~ileus
~hypoproteinemia
*ASA grade (on univarient)
Parkanzley
Cholecystectomy vs. medical management
JVIM 2019
Survival times
~1802 d w/ Sx
~1340 d with medical management
~203 days with medical management followed by surgery
Decreased survival ~GB mucocele type ~ALKP ~Creat ~Phosph
Wilson
Biliary Rupture on AUS
VetRadUS 2021
40% had normal T. bili
Rupture associated with
~Leukocytosis
~Neutrophilia
Piegols
Cholecystectomy for GB mucocele
VetSurg 2021
Catheterization ~PO pancreatitis ~higher ASA ~elevated T. bili ~Dilated CBD ~longer Sx Time
Putterman
Normograde vs. Retrograded CBD catheterization
VetSurg 2021
Retrograde catheterization
~any PO complication
~persistent GI signs
No difference in survival
Tbili drop
~NG 71%
~RG 39%
Tbili increased
~NG 15%
~RG 38%
Diplomate decreased risk of complications
Parkanzky et al JVIM 2019
What were the differences in long term survival for surgical vs medical vs Med+surg management of gall bladder mucoceles?
Shortest survival with med+surg, longest survival time with surgical treatment
Med+ surgical treatment = 14x increased risk of death