Hepatology - liver surgery Flashcards
How many lobes does a dog liver have? What are they?
6
R/L medial lobes
R/L lateral lobes
Quadrate lobe
Caudate lobe
Should you give antibiotics when doing liver surgery?
Yes - IV peri-operative antibiotics are indicated even if only biopsying
Potentiated amoxycillin
What are the 3 surgical liver biopsy techniques?
Crushing/haemostat technique
Guillotine technique
Biopsy punch
What is the crushing/haemostat liver biopsy technique?
Clamp across tip of liver lobe, then cut after 5 mins
What is the guillotine liver biopsy technique?
Suture around peripheral liver lobe
Cut after suture
What is the punch liver biopsy technique? When is it used?
Punch hole in surface of liver - for focal lesions/masses
What are the indications for liver lobectomy?
Biopsy
Remove mass lesion/neoplasm
Abcess
Liver lobe torsion
How much of the liver can you remove?
Up to 70%
Which side of the liver is easier to perform a lobectomy on? Why?
Left easier - more pedunculated so easier to ligate
Right side is close to vena cava
What are the different liver lobectomy techniques?
Finger fracture - break down soft liver tissue and ligate vessels found
Mass ligation - around whole neck of lobe
Linear stapler
Overlapping mattress suture
Electrocautery
Where is the gall bladder located?
Between the right medial lobe and quadrate lobe
What is the difference in the cystic duct in the biliary tract anatomy in the cat and dog?
The bile flows into the gallbladder via the cystic duct which is:
Shorter and straighter in the dog
More tortuous in the cat
What is the difference in where the bile duct enters the GI tract in dogs and cats?
Canine bile duct - enters duodenum near the pancreatic duct, doesnt join
Feline bile duct - joins the pancreatic duct before entering duodenum
What are the indications for biliary tract surgery?
Extrahepatic biliary tract obstruction
eg. Cholelithiasis, gall bladder mucocele, pancreatitis, neoplasia
Biliary tract rupture and bile peritonitis
What are the two surgical strategies for biliary tract surgery?
Cholecystectomy - remove gall bladder
Cholecystoenterostomy - secure gall bladder to intestine
What is the most important structure to conserve in biliary tract surgery?
The common bile duct - better to conserve than the gall bladder
When do you perform a cholecystectomy?
For treatment of gall bladder disease or traumatic rupture
When do you perform a cholecystotomy?
Removing choleliths and bile sludge
Flushing cystic and common bile ducts
(rarely indicated)
When do you perform a cholecystoenterostomy?
When there is complete and irreversible obstruction/rupture of the common bile duct
But gall bladder still healthy
What are the risks of cholecystoenterostomy?
Leakage
Stricture
Ascendign cholangiohepatitis
What is an alternative to cholecystoenterostomy?
Common bile duct stenting
What is the prognosis of extrahepatic biliary tract surgery/
Significant mortality
Require intensive post op care
What are the goals of congenital portosystemic shunt surgery?
Attenuate (close) shunt
Restore normal portal blood flow
Resolve hepatic insufficiency and clinical signs
What is the problem with acute attenuation of the portosystemic shunt?
Concern of portal hypertension - increased pressure in GI tract causing haemorrhagic diarrhoea, abdominal bloating, death
