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Small Animal Surgery > Hepatobiliary and PSS > Flashcards

Hepatobiliary and PSS Flashcards

1
Q

What is the Pringle maneuver?

A
  • temporary occlusion of portal vein and hepatic arteries to aid in identifying source of bleeding
  • 10-15 minutes max
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2
Q

What are the types of primary tumors in the hepatobiliary system?

A
  • hepatocellular
  • cholangiocellular
  • mesenchymal
  • neuroendocrine
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3
Q

What are the most common tumors of the hepatobiliary system?

A

metastatic tumors

- hematopoietic or lymphoid

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4
Q

Liver tumors are more common in dogs or cats?

A

more common in dogs

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5
Q

What are the three forms of a hepatocellular adenocarcinoma and their associated prognosis?

A

massive - good prognosis with excision

nodular - metastasis more likely

diffuse - poor prognosis due to metastasis

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6
Q

What is the #1 malignant liver tumor in cats?

A

cholangiocellular carcinoma

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7
Q

What is the typical signalment for biliary mucoceles?

A
  • primarily seen in dogs
  • median age 9 years
  • small and medium breeds
    (Shetland, Cocker, Mini Schnauzers)
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8
Q

How are biliary mucoceles diagnosed?

A
  • survey radiographs

- ultrasound: “white stripe” and “kiwi” sign

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9
Q

How are biliary mucoceles treated?

A
  • medical: cholerectics
  • cholecystectomy
  • antibiotics
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10
Q

What are the liver biopsy techniques?

A
  • FNA
  • Tru-cut needle
  • laparoscopic
  • skin punch
  • Guillotine
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11
Q

When is a lobectomy indicated?

A
  • biopsy
  • neoplasia
  • trauma
  • abscess
  • cyst
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12
Q

When is choledochal stenting commonly done?

A

to relieve obstruction due to extraluminal compression secondary to pancreatitis

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13
Q

When is a cholecystostomy done?

A

in cases of suspected temporary biliary obstruction

- diverts bile flow externally

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14
Q

What are the indications for a cholecystectomy?

A
  • necrotizing cholecystitis
  • chronic cholecystitis
  • biliary mucocele
  • cholelithiasis
  • neoplasia
  • trauma
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15
Q

What should always be done prior to a cholecystectomy?

A

duodenotomy with catheterization of bile duct to confirm patency of the duct

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16
Q

When is biliary diversion done?

A

when there is irreparable obstruction or trauma of the bile duct

17
Q

What are the complications associated with biliary diversion?

A
  • bile peritonitis
  • stoma stricture
  • ascending infections
  • chronic vomiting and mortality in cats
18
Q

What is a porto-systemic shunt?

A

anatomic anomaly resulting in abnormal communication between the portal vasculature and the systemic vasculature

19
Q

What is the typical signalment for an extrahepatic PSS?

A
  • small dogs and cats

- most < 2 years

20
Q

Describe an extrahepatic PSS

A
  • veins that should join the portal vein enter the caudal vena cava or azygous instead
  • most commonly left gastric and splenic veins
21
Q

What is the typical signalment for an intrahepatic PSS?

A

large breed dogs

22
Q

Describe an intrahepatic PSS

A
  • patent ductus vensosus

- intrahepatic branches of portal vein enter vena cava or hepatic vein, bypassing the hepatic parenchyma

23
Q

What is Portal Vein Hypoplasia/Hepatic Microvascular Dysplasia?

A

small or absent intrahepatic portal vessels and microvascular shunting within the liver

24
Q

How is Hepatic Microvascular Dysplasia diagnosed?

A
  • may have no changes on lab test

- Protein C activity > 70% of normal

25
Q

When does multiple extrahepatic PSS occur and what is it?

A
  • secondary to diseases that cause portal hypertension

- vestigial embyronic communications that open up, preventing lethal portal hypertension

26
Q

What are the clinical signs associated with multiple extrahepatic PSS?

A
  • poor growth rate, weight loss, intolerance to anesthetics/sedatives metabolized by liver
  • nervous system: lethargy, ataxia, behavioral changes, seizures, etc.
  • GIT: vomiting, diarrhea, ptylism, ascites
  • urinary: PU/PD, obstruction, cystitis
27
Q

What changes can we see in cats with multiple extrahepatic PSS?

A
  • ptyalism
  • copper colored iris
  • aggressive behavior
28
Q

How is multiple extrahepatic PSS diagnosed?

A
  • hematoloy/biochem/UA/liver function tests
  • radiographs, portography
  • ultrasound
  • nuclear scintigraphy
  • CT angiography
29
Q

What is the medical management for multiple extrahepatic PSS?

A
  • reduced protein content
  • lactulose
  • anti-microbials
  • seizure control/prevention
30
Q

What are the surgical options for multiple extrahepatic PSS?

A
  • ligation: complete occlusion
  • attenuation: partial occlusion
  • ameroid constrictor
  • cellophane binding
31
Q

How are intrahepatic ducts surgically managed?

A

extravascular occlusion

Small Animal Surgery (26 decks)

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