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
~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
Overall mortality?
Mortality associated with?
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
Main finding?
Biliary rupture blood work changes?
40% had normal T. bili
Rupture associated with
~Leukocytosis
~Neutrophilia
Piegols
Cholecystectomy for GB mucocele
VetSurg 2020
Catheterization (vs. not)
~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
Youn et al JAVMA 2018
What is the mortality rate for elective vs nonelective cholecystectomy?
Overall 9%
Elective 2%
Nonelective 20%
Cheney et al JSAP 2019 What was the accuracy of localization for U/S vs CT for liver masses?
74% accurate for ultrasound 84% accurate for CT
What did Hanson et al JAVMA 2017 conclude about blood transfusion requirements for dogs and cats following liver lobectomy?
Overall mortality rate
17% of dogs and 44% of cats required transfusion
8% over all mortality rate - higher in dogs receiving transfusion
Lamb et al JSAP 2018 What is the most accurate CT finding to determine the origin of a hepatic mass?
Identification of hepatic lobar veins or portal branches - can be used to distinguish right, central or left divisional masses with 93% accuracy
Lamb et a JSAP 2018 recommended what CT finding guidelines for determining the origin of hepatic masses?
- entirely to the left of midline = left divisional mass
- medial, lateral or dorsal to portal vein = right division
- dorsal displacement of stomach ~ usually left divisional
- left displacement of stomach ~ usually right divisional
- Hepatic lobar veins or portal branches can be used to distinguish right, central or left divisional masses **most accurate
Linden et al VetSurg 2019 How did surgical methods influence outcome for dogs with central division hepatic lobectomies?
- Hilar resection - increased risks of intra-op and short term PO complications.
- TA stapler = decreased risks of long term PO complications
- Right medial lobe removal = increased risk of intra-op complications vs quadrate lobe
Wilson, VRU 2021
What % ruptured GB had normal TBili?
What was statistically different between rupture and non-rupture?
40%
Leukocytosis & Neutrophilia
Bini VRU 2022
GB wall thickness affected by which pre-meds
Dexmedetomidine & Morphine
Kakar FJMS 2021
What was associated with hypocoagulable and hyperfibrinolytic TEG in cats with cholestatic liver disease?
What was associated with hypocoagulable state in cats with cholestatic liver disease?
What was associated with hypocoagulable and hyperfibrinolytic TEG in cats with cholestatic liver disease?
~synthetic failure (prolonged PT and aPTT)
What was associated with hypocoagulable state in cats with cholestatic liver disease?
~high disease activity (ALP)
Pavlick JVIM 2021
What % of GBM patients were in a hypercoaguable state on TEG?
83%
Griffin JVIM 2021
In cats with EHBO that underwent stenting, how many had an improvement of clinical signs?
How many had decreased T. bili conc?
Survival to discharge?
What was associated with recurrence?
MST of cats that survived to discharge?
What was associated with survival to discharge?
In cats with EHBO that underwent stenting, how many had an improvement of clinical signs?
75%
How many had decreased T. bili conc?
68%
Survival to discharge?
78%
What was associated with recurrence?
Cholelithiasis
MST of cats that survived to discharge?
931 d
What was associated with survival to discharge?
Absence of peritoneal effusion
Gori JVIM 2021
In dogs with elevated Pb levels on liver biopsy, what were 2 other findings?
Pb was higher in dogs with HiCu levels
Microcytosis
Allan JVIM 2021
In dogs with cholelithiasis what biochemical abnormalities were associated with being symptomatic?
What location of stone was associated with being symptomatic?
Was MST different between treatment modality?
In dogs with cholelithiasis what biochemical abnormalities were associated with being symptomatic?
-higher ALPH
-higher GGT
-higher ALT
What location of stone was associated with being symptomatic?
-choledocholithiasis
Was MST different between treatment modality?
NO
Seitz JVIM 2021
What 2 findings were noted in dogs sedated with Dexdomitor for AUS?
GB wall thickening 24%
Peritoneal effusion (5/79)
Dose of 5 mcg/kg
Noted 20-40 min after administration.
Jaffey JVIM 2022
Increased grade of GBM was associated with what finding?
Predictor of death after cholecystectomy?
GB rupture had an interaction with what measurement?
Increased grade of GBM was associated with what finding?
Exhibiting signs
Predictor of death after cholecystectomy?
-age
-Intraop SBP nadir (hypotension)
GB rupture had an interaction with what measurement?
-SBP nadir (hypotension)
Butler JVIM 2022
Which breeds were more disposed to develop GBM?
T/F: Increased biliary sludge score was associated with development of GBM
Which breeds were more disposed to develop GBM?
-Shetland Sheepdogs
-Border Terrier
T/F: Increased biliary sludge score was associated with development of GBM
-True
Simpson Vet Surg 2022
Most common indication for cholecystectomy in cats?
Survival to discharge
Most common indication for cholecystectomy in cats?
-cholelithiasis
Survival to discharge
-78%
Pathophysiologic consequences of EHBO
Hypotension
Decreased myocardial contractility
Acute renal failure
Coagulopathies
GI hemorrhage
Delayed wound healing
Potential complication of cholecystoenterostomy over cholecystoduodenostomy
Duodenal ulceration
-bile in duodenum inhibits gastric acid secretion through hormonal influences
Cholecystotomy incision should be larger than?
2.5 cm
Cotton-Huibregtse biliary stent
If biliary stent does not pass on own, when should it be removed endoscopically?
2-4 months post op
Cholecystotomy tube
-How placed
-How long before removal
Tube placed through liver parenchyma
At least 5-10 days, likely 3-4 weeks
