Hepatobiliary and PSS Flashcards
What is the Pringle maneuver?
- temporary occlusion of portal vein and hepatic arteries to aid in identifying source of bleeding
- 10-15 minutes max
What are the types of primary tumors in the hepatobiliary system?
- hepatocellular
- cholangiocellular
- mesenchymal
- neuroendocrine
What are the most common tumors of the hepatobiliary system?
metastatic tumors
- hematopoietic or lymphoid
Liver tumors are more common in dogs or cats?
more common in dogs
What are the three forms of a hepatocellular adenocarcinoma and their associated prognosis?
massive - good prognosis with excision
nodular - metastasis more likely
diffuse - poor prognosis due to metastasis
What is the #1 malignant liver tumor in cats?
cholangiocellular carcinoma
What is the typical signalment for biliary mucoceles?
- primarily seen in dogs
- median age 9 years
- small and medium breeds
(Shetland, Cocker, Mini Schnauzers)
How are biliary mucoceles diagnosed?
- survey radiographs
- ultrasound: “white stripe” and “kiwi” sign
How are biliary mucoceles treated?
- medical: cholerectics
- cholecystectomy
- antibiotics
What are the liver biopsy techniques?
- FNA
- Tru-cut needle
- laparoscopic
- skin punch
- Guillotine
When is a lobectomy indicated?
- biopsy
- neoplasia
- trauma
- abscess
- cyst
When is choledochal stenting commonly done?
to relieve obstruction due to extraluminal compression secondary to pancreatitis
When is a cholecystostomy done?
in cases of suspected temporary biliary obstruction
- diverts bile flow externally
What are the indications for a cholecystectomy?
- necrotizing cholecystitis
- chronic cholecystitis
- biliary mucocele
- cholelithiasis
- neoplasia
- trauma
What should always be done prior to a cholecystectomy?
duodenotomy with catheterization of bile duct to confirm patency of the duct
When is biliary diversion done?
when there is irreparable obstruction or trauma of the bile duct
What are the complications associated with biliary diversion?
- bile peritonitis
- stoma stricture
- ascending infections
- chronic vomiting and mortality in cats
What is a porto-systemic shunt?
anatomic anomaly resulting in abnormal communication between the portal vasculature and the systemic vasculature
What is the typical signalment for an extrahepatic PSS?
- small dogs and cats
- most < 2 years
Describe an extrahepatic PSS
- veins that should join the portal vein enter the caudal vena cava or azygous instead
- most commonly left gastric and splenic veins
What is the typical signalment for an intrahepatic PSS?
large breed dogs
Describe an intrahepatic PSS
- patent ductus vensosus
- intrahepatic branches of portal vein enter vena cava or hepatic vein, bypassing the hepatic parenchyma
What is Portal Vein Hypoplasia/Hepatic Microvascular Dysplasia?
small or absent intrahepatic portal vessels and microvascular shunting within the liver
How is Hepatic Microvascular Dysplasia diagnosed?
- may have no changes on lab test
- Protein C activity > 70% of normal
When does multiple extrahepatic PSS occur and what is it?
- secondary to diseases that cause portal hypertension
- vestigial embyronic communications that open up, preventing lethal portal hypertension
What are the clinical signs associated with multiple extrahepatic PSS?
- 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
What changes can we see in cats with multiple extrahepatic PSS?
- ptyalism
- copper colored iris
- aggressive behavior
How is multiple extrahepatic PSS diagnosed?
- hematoloy/biochem/UA/liver function tests
- radiographs, portography
- ultrasound
- nuclear scintigraphy
- CT angiography
What is the medical management for multiple extrahepatic PSS?
- reduced protein content
- lactulose
- anti-microbials
- seizure control/prevention
What are the surgical options for multiple extrahepatic PSS?
- ligation: complete occlusion
- attenuation: partial occlusion
- ameroid constrictor
- cellophane binding
How are intrahepatic ducts surgically managed?
extravascular occlusion
