Hepatobiliary Sx-Exam 2 Flashcards

1
Q

What is the best division of the liver to work in due to lack of gallbladder and blood vessel involvement?

A

Left division (left medial lobe and left lateral lobe)

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2
Q

T/F: The closer the wound is to the hilus, less likely surgery will be necessary

A

FALSE- more likely

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3
Q

Why is the entire shock dose not given to a patient with splenic trauma?

A

Conservative fluid management because we don’t want to disrupt the clot process
Too much fluids will cause high pressure or too much volume

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4
Q

What is the pringle maneuver?

A

stop the blood flow to the liver and bleeding into the abdomen if it is coming from the liver
Intra-op bleeding control

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5
Q

What a/v are in teh epiploic foramen?

A

Hepatic a and portal vein

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6
Q

When is a partial lobectomy indicated?

A

Biopsy, neoplasia, trauma, abscess, cysts

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7
Q

What causes the most blood loss in the liver during partial lobectomy?

A

Parenchymal fracture and most ligations

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8
Q

When will a liver biopsy be diagnostic?

A

When you are concerned about lymphoma- otherwise not very dx

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9
Q

What are the liver biopsy methods?

A

Tru-cut needles
Laparoscopic
Skin punch bx
Guillotine technique

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10
Q

Which liver biopsy method is most helpful when obtaining a sample from the middle of the liver?

A

Skin punch bx

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11
Q

What is surgicel?

A

Methylcellulose absorbable sponge that causes hemostasis in local areas

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12
Q

What is cholecystitis?

A

Inflammation gallbladder

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13
Q

Inflammatory disease, choleliths, choledocholiths, neoplasia, inspissated bile and parasites are examples of what type of biliary obstruction?

A

Intraluminal

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14
Q

Pancreatic disease and duodenal disease are examples of what type of biliary obstruction?

A

Extraluminal

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15
Q

What is the name of the procedure when there is an incision into dilated common bile duct?

A

Choledochotomy

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16
Q

What are the indications for choledochotomy?

A

Choledochoithiasis or biliary sludge

17
Q

Why is bile duct stenting most commonly performed?

A

Relieve obstruction due to extraluminal compression

Temporary diversion of bile after suturing bile duct (can use red rubber catheter)

18
Q

What is biliary diversion?

A

Diversion of bile from liver down to intestine

19
Q

What must be present in order to perform a biliary diversion?

A

Intact gallbladder

20
Q

What is the initial size of stoma for cholecystoduodenostomy?

A

2.5-3 cm

21
Q

What is a complication in dogs with biliary obstruction?

A

ascending infection and bleeding at stoma site

22
Q

What is the main CS of biliary mucocele?

A

Icterus

23
Q

Overdistension of gallbladder can result in rupture- this is evident grossly in ___% of cases and>____% in histo cases

A

50%

70%

24
Q

What is the common signalment for a patient with biliary mucocele?

A

Older (9 yrs)

Small/medium dogs

25
Q

What are some breeds that are listed to commonly get biliary mucocele?

A

Shelties and cocker spaniels

26
Q

What is a biochemical abnormality that is important to pay close attention to in biliary mucocele dx?

A

Total bilirubin

27
Q

What is the sign seen on US that is definitive for biliary mucocele?

A

Kiwi sign- striated or steallate pattern

28
Q

What is the medical and sx treatment for biliary mucocele?

A

Medical: choleretics
Sx: cholecystectomy- confirm patent bile duct first!

29
Q

What is the difference in sterile bile and infected bile in terms of peritonitis?

A

Sterile: chemical peritonitis (good prognosis)
Infected: septic peritonitis (guarded-poor prognosis)

30
Q

When diagnosing bile peritonitis- when can we say they are positive?

A

Abdominal effusion fluid > 2x serum bilirubin