Hepatobiliary Surgery

Question 1

Wormser, Vet Surg, 2016:
Ultrasound to localize solitary hepatic masses

1. Overall sensitivity of ultrasound for predicting the true location of liver masses?
2. Sensitivity of ultrasound to correctly localize masses in the right or left division vs the central division?
3. Specificity of ultrasound to correctly localize masses in the left vs right vs central divisions?

Answer 1

Wormser, Vet Surg, 2016:

1. 52% sensitivity for predicting the true location of liver masses
2. Sensitivity of ultrasound to correctly localize masses in the right or left division was 55% vs 29% for masses in the central division
3. Specificity of ultrasound to correctly localize masses was 98% for the left division vs 89% for the right division vs 87% for the central division

Question 2

Bargellini, VRU, 2016:
Contrast-enhanced ultrasonography for gallbladder necrosis or rupture

Which was more accurate for diagnosing gallbladder wall necrosis/rupture - contrast-enhanced ultrasonography or conventional ultrasonography?

Answer 2

Bargellini, VRU, 2016:

Contrast-enhanced ultrasonography was more accurate for diagnosing gallbladder wall necrosis/rupture

Question 3

Lee, VRU, 2017:
Contrast-enhanced CT of the liver

Effect of contrast injection rate and catheter size on enhancement and image quality?

Answer 3

Lee, VRU, 2017:

Time to peak enhancement and time to scan delay were not significantly affected by injection rates or catheter sizes

Question 4

Cheney, JSAP, 2019:
Ultrasound vs CT for solitary hepatic masses

1. What % of solitary hepatic masses were correctly localized by ultrasound?
2. What % of solitary hepatic masses were correctly localized by CT?
3. Sensitivity was highest for both ultrasound and CT for masses of which division?

Answer 4

Cheney, JSAP, 2019:

1. 74% of solitary hepatic masses were correctly localized by ultrasound
2. 84% of solitary hepatic masses were correctly localized by CT
3. Sensitivity was highest for left division masses

Question 5

Goode, JVIM, 2019:
Blood flow in hepatic tumors

What vessel does the majority of the tumor blood supply arise from?

Answer 5

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

Question 6

Kemp, JVIM, 2015:
Liver biopsy techniques

What was of greater importance than the method of biopsy?

Answer 6

Kemp, JVIM, 2015:

Obtaining multiple samples may be of greater importance than the method of biopsy; the accuracy of all tested biopsy methods was relatively low compared to large necropsy samples

Question 7

Goodman and Casale, JAVMA, 2014:
Self-ligating loop for liver lobectomy

1. What % of cases had suture slippage and what % had suture breakage?
2. Mortality rate?

Answer 7

Goodman and Casale, JAVMA, 2014:

1. 0% had suture slippage and 2% had suture breakage
2. 3% mortality rate

Question 8

Hanson, JAVMA, 2017:
Liver lobectomy and blood transfusions

1. What % of dogs vs cats required a blood transfusion?
2. Blood transfusion requirements based on lobe removed or number of lobes removed?
3. Mortality rate for dogs that received blood transfusions vs dogs that did not receive blood transfusions?
4. Mortality rate for cats that received blood transfusions vs cats that did not receive blood transfusions?

Answer 8

Hanson, JAVMA, 2017:

1. 17% of dogs vs 44% of cats required a blood transfusion
2. Neither the lobe removed nor the number of lobes removed affected the requirement for a blood transfusion
3. Mortality rate in dogs: 2% that received a blood transfusion vs 4% that did not receive a blood transfusion
4. Mortality rate in cats: 22% of cats overall, no difference in survival between those that did or did not receive a blood transfusion

Question 9

Linden, Vet Surg, 2019:
Central division hepatic lobectomies

1. Intra-op complication rate?
2. Immediate post-op complication rate?
3. Peri-op mortality rate?
4. 2-week mortality rate?

Answer 9

Linden, Vet Surg, 2019:

1. Intra-op complication rate: 48%
2. Immediate post-op complication rate: 33%
3. Peri-op mortality rate: 11%
4. 2-week mortality rate: 15%

Question 10

Malek, Vet Surg, 2013:
Gallbladder mucoceles

1. What % of dogs had concurrent hyperadrenocorticism?
2. What % of dogs had concurrent diabetes mellitus?
3. What % of dogs had concurrent hypothyroidism?
4. Cytoprotective agents (SAMe, ursodiol) had no apparent protective effect on survival - true or false?
5. Immediate post-op mortality rate?
6. What was negatively associated with survival?
7. Overall MST?

Answer 10

Malek, Vet Surg, 2013:

1. 9% had concurrent hyperadrenocorticism
2. 12% had concurrent diabetes mellitus
3. 5% had concurrent hypothyroidism
4. True
5. Immediate post-op mortality rate: 7%
6. Overall MST: 7.5 months

Question 11

Jaffey, JVIM, 2018:
Gallbladder mucoceles

1. Sensitivity and specificity of ultrasound for identification of gallbladder rupture?
2. Were positive bacterial cultures associated with survival?
3. Peri-op mortality rate?
4. Association between gallbladder rupture/bile peritonitis and survival?

Answer 11

Jaffey, JVIM, 2018:

1. Ultrasound has a sensitivity of 56% and specificity of 92% for identification of gallbladder rupture
2. Positive bacterial cultures and antibiotic administration were not associated with survival
3. Peri-op mortality rate: 17%
4. Dogs with ruptured gallbladder mucoceles and bile peritonitis at the time of surgery were 2.7 times more likely to die

Question 12

Parkanzy, JVIM, 2019:
Gallbladder mucoceles

1. 2-week mortality rate?
2. MST for surgically treated vs medically treated vs medically then surgically treated dogs?
3. What factor(s) were associated with decreased survival regardless of treatment?

Answer 12

Parkanzy, JVIM, 2019:

1. 2-week mortality rate: 20%
2. MST: 1802 days for surgically treated dogs vs 1340 days for medically treated dogs vs 203 days for medically then surgically treated dogs
3. Increased serum creatinine concentration, hyperphosphatemia, increased ALP activity and increasing severity of gallbladder mucocele type were associated with decreased survival regardless of treatment type

Question 13

Marvel and Monnet, Vet Surg, 2014:
Use of Endoclips vs a vessel sealant device for cholecystectomy

What % of the specimens failed by leakage at the cut surface of the cystic duct in the medium Endoclip group vs the large Endoclip group vs the vessel sealant device group?

Answer 13

Marvel and Monnet, Vet Surg, 2014:

33% of the specimens in the medium Endoclip group vs 0% of the specimens in the large Endoclip and vessel sealant device groups failed by leakage at the cut surface of the cystic duct

Question 14

Youn, JAVMA, 2018:
Cholecystectomy for gallbladder disease

1. What % of dogs had positive bacterial cultures from bile samples?
2. Overall mortality rate?
3. Mortality rate in the non-elective cholecystectomy group vs the elective cholecystectomy group?
4. What factor(s) were associated with mortality?
5. What factor(s) were not associated with mortality?

Answer 14

Youn, JAVMA, 2018:

1. 22% had positive bacterial cultures from bile samples
2. Overall mortality rate: 9%
3. Mortality rate was 20% in the non-elective cholecystectomy group vs 2% in the elective cholecystectomy group
4. Azotemia was associated with mortality
5. Gallbladder rupture was not associated with mortality

Question 15

Berent, JAVMA, 2015:
Endoscopic retrograde cholangiography and endoscopic retrograde biliary stunting

1. Endoscopic retrograde cholangiography was successfully performed in what % of cases?
2. Endoscopic retrograde biliary stenting was achieved in what % of cases?

Answer 15

Berent, JAVMA, 2015:

1. Endoscopic retrograde cholangiography was successfully performed in 67% of cases
2. Endoscopic retrograde biliary stenting was achieved in 56% of cases

Question 16

Guess, JAVMA, 2015:
Anicteric gallbladder rupture

What test could be performed in cases where a diagnosis of gallbladder rupture is challenging or elusive?

Answer 16

Guess, JAVMA, 2015:

Testing of the abdominal fluid for bile acids because bile acids are not freely diffusible and would gradually accumulate in greater quantities and concentrations in peritoneal fluid, whereas high bilirubin concentrations in the abdominal fluid may not necessarily be present in all dogs with gallbladder rupture

Question 17

Lawrence, JAVMA, 2015:
Bacterial cholecystitis and bactibilia

1. Sensitivity and specificity of finding immobile biliary sludge for the diagnosis of bactibilia?
2. What % of the dogs had multidrug-resistant bacterial isolates?

Answer 17

Lawrence, JAVMA, 2015:

1. Immobile biliary sludge was 70% sensitive and 100% specific for the diagnosis of bactibilia
2. 50% of the dogs had multidrug-resistant bacterial isolates

Question 18

Tamborini, JVIM, 2016:
Bacterial cholangitis, cholecystitis or both

1. What sample(s) yielded a higher proportion of positive cultures?
2. What were the most frequent hepatobiliary bacterial isolates?
3. What % of cases had biliary tract rupture?
4. Was biliary tract rupture associated with mortality?

Answer 18

Tamborini, JVIM, 2016:

1. Bile or gallbladder wall samples yielded a higher proportion of positive cultures than liver samples
2. The most frequent hepatobiliary bacterial isolates were E. coli, Enterococcus spp. and Clostridium spp.
3. Biliary tract rupture was present in 30% of the cases
4. Yes, biliary tract rupture was associated with mortality (50% mortality rate)