Kapitel 95 - The liver and biliary system

Question 1

Name the important differences in hepatobiliary and pancreatic ductal anatomy of dogs and cats (6)

Answer 1

dogs:
common bile duct enters duodenum at major duodenal papilla adjacent to pancreatic duct
smooth muscle fibers surround the two ducts as they emerge into the duodenum, forming sphincter of Oddi
accessory pancreatic duct enters at minor duodenal papilla
accessory pancreatic duct is principal conduit for pancreatic secretion
cats:
common bile duct and pancreatic duct conjoin just before their entry into the duodenum at major duodenal papilla
only about 20% of cats have an accessory pancreatic duct exiting at minor duodenal papilla

Question 2

Protein metabolism is one of the most important functions of the liver. The liver is responsible for approximately ____ of the total body protein production

Answer 2

20%

Question 3

Which coagulation factors are not produced in the liver?

Answer 3

factor VIII
von Willebrand factor

Question 4

How many percent of animals with hepatic disease hemorrhage spontaneously?

Answer 4

2%

Question 5

How many percent of the total liver volume can be acutely removed?

Answer 5

70%

Question 6

Which posthepatectomy portal pressure resulted in significantly lower survival and liver regeneration rates?

Answer 6

greater than 16mmHG (about 21cm water)

Question 7

What is hepatic arterial buffer response?

Answer 7

Disruption in portal perfusion to the liver results in increased hepatic arterial perfusion because of an intrinsic regulatory mechanism.
(believed to occur secondary to a lack of washout of adenosine via the portal circulation, which triggers a compensatory increase in arterial perfusion)

Question 8

Name factors which have negative impact on hepatic regeneration

Answer 8

• biliary obstruction
  
  • diabetes mellitus
  • malnutrition
  • male gender
  • older age

Question 9

Where does leakage almost always happens after blunt trauma to the liver and biliary system

Answer 9

• common bile duct
• hepatic ducts

Question 10

Most common causes of exrahepatic biliary obstruction include:

Answer 10

Dogs:
- pancreatitis
- neoplasia
- gallbladder mucoceles
- cholangitis
- cholelithiasis
cats:
- pancreatitis
- cholangioheptitis
- cholecystitis with or without cholelithiasis
- neoplasia

Question 11

Which pathophysiologic consequences do you have to consider when performing surgery on an animal with extrahepatic biliary obstruction?

Answer 11

• hypotension
• decreased myocardial contractility
• acute renal failure
• coagulopathies
• intestinal hemorrhage
• delayed wound healing

Question 12

Name the most common underlying causes of bile peritonitis in
dogs?

Answer 12

dogs:
trauma
necrotizing cholecystitis
ruptured gallbladder mucoceles

cats:
trauma

Question 13

50% of canine choleliths consisits of ___

Answer 13

calcium bilirubinate

Question 14

80% of feline choleliths are composed of

Answer 14

calcium carbonate

Question 15

Common topical hemostatic agents used for capsular hemorrhage include:

Answer 15

gelatin sponge
oxidized regenerated cellulose
cyanoacrylate glue
fibrin glues

Question 16

How can you characterize vascular occlusion techniques when extensive haemorrhage occurs?

Answer 16

(1) control of central venous pressure (CVP)
(2) occlusion of liver inflow
(3) occlusion of liver inflow and outflow

Question 17

Explain the Pringle Maneuver

Answer 17

locate epiploic foramen
(located at the caudodorsal aspect of the liver near porta hepatis between caudal vena cava dorsally and portal vein ventrally, caudal aspect of epiploic foramen is celiac artery)
placement of a finger through epiploic foramen
gentle finger pressure simultaneously compresses portal vein and hepatic arterial supply to the liver
can be continuous to intermittent
intermittent -> more blood loss, but less reperfusion injury

Question 18

Name the relative hepatic volumes in dogs:

Answer 18

• the right lateral and caudate lobes: 28%
• the right medial and quadrate lobes: 28%
• left lateral and medial lobes: 44%

Question 19

Why is especially the liver suitable for intravascular techniques in animals with liver tumors which are not resectable or diffuse?

Answer 19

liver tumors obtain 95% of their blood supply from the hepatic artery
embolization of the hepatic artery removes majority of blood flow to the tumor

Question 20

Name the most common laboratory abnormalities seen in patients with extraheptic biliary obstruction

Answer 20

• decreased albumin
• increased bilirubin, cholesterol, serum alkaline phosphatase (ALP), alanine aminotransferase (ALT), and γ-glutamyl transferase
• leucocytosis
• urin: bilirubinuria or bilirubin crystals
• abnormal OSPT and PIVKA (proteins induced by absence of vitamin K)

Question 21

Name the most common bacteria cultured from the biliary tract:

Answer 21

E. coli, Enterococcus spp., Enterobacter spp., Clostridium spp., and Bacteroides spp.

Question 22

In which patients is cholecystectomy advised for the treatment of?

Answer 22

• cholelithiasis
• biliary mucocele
• gallbladder neoplasia
• Trauma to the gallbladder

Question 23

How should the cystic duct and artery be ligated?

Answer 23

0 or 2-0, nonabsorbable suture
Double ligation

Question 24

What are the current indications for laparoscopic cholecystectomy?

Answer 24

• Uncomplicated gallbladder mucocele
• Symptomatic cholelithiasis
• Cholecystitis not associated with extrahepatic biliary obstruction, gallbladder rupture, or choledocholithiasis

Question 25

Which length should a stoma of a cholecystoenterostomy have?

Answer 25

At least 2.5cm

Question 26

What are the most common indication for choledochal stenting in dogs and cats?

Answer 26

Temporary reversible extrahepatic biliary tract obstruction caused by pancreatitis or cholangiohepatitis

Question 27

Which rubber size is appropriate to catheterize the major duodenal papilla to assess patency of the duct?

Answer 27

Dogs: 8- to 12-Fr
Cats: 3.5- to 5-Fr

Question 28

Clinical signs and laboratory findings of animals with hepatic abscesses and cysts

Answer 28

middle-aged to older age
nonspecific clinical signs
most commonly anorexia, lethargy, vomiting
fever, abdominal pain, dehydration

increased serum alkaline phosphatase activity
increased liver enzyme activity
increased white blood cell counts with neutrophilia and left shift
thrombocytopenia
prolonged prothrombin and partial thromboplastin times

Question 29

Bacterial culture most often identified in hepatic abcesses?

Answer 29

E. coli
Staphylococcus spp
Enterococcus spp
Kelbsiella spp

Question 30

Torsion of which liver lobe most commonly occurs?

Answer 30

left lateral lobe

Question 31

Which breed is predisposed to gallbladder disease?

Answer 31

Shetland sheepdogs

Question 32

A recent report found to have an association with gallbladder mucocele and which other disease or diseases

Answer 32

Hyperadrenocorticism
Hypothyroidism

Question 33

Name the postoperative complications of cholecystectomy due to gallbladder mucocele?

Answer 33

Further leakage of bile from surgery site
Pancreatitis
Re-obstruction of common bile duct with gelatinous bile

Question 34

How many general types of hepatobiliary tumors exists? Please name them.

Answer 34

hepatocellular
cholangiocellular
neuroendocrine
mesenchymal

Question 35

Name the most common secondary tumors?

Answer 35

Hematopoetic tumors
Lymphoid tumors
Epithelial tumors
Mesenchymal tumors

Question 36

Hepatocellular carcinomas present as one of three forms. Please name them and the percentace how often they occur?

Answer 36

massive (61%)
nodular (29%)
diffuse (10%)

Question 37

Why is surgery not recommended for diffuse or nodular forms of the disease in dogs?

Answer 37

Incomplete surgical resection is common
High metastatic rate

Question 38

Which tumor type(s) is/are the most common metastazing to the liver?

Answer 38

Lymphosarcoma
Other lymphoid tumors