Kapitel 95 - The liver and biliary system Flashcards
Name the important differences in hepatobiliary and pancreatic ductal anatomy of dogs and cats (6)
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
Protein metabolism is one of the most important functions of the liver. The liver is responsible for approximately ____ of the total body protein production
20%
Which coagulation factors are not produced in the liver?
factor VIII
von Willebrand factor
How many percent of animals with hepatic disease hemorrhage spontaneously?
2%
How many percent of the total liver volume can be acutely removed?
70%
Which posthepatectomy portal pressure resulted in significantly lower survival and liver regeneration rates?
greater than 16mmHG (about 21cm water)
What is hepatic arterial buffer response?
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)
Name factors which have negative impact on hepatic regeneration
- biliary obstruction
- diabetes mellitus
- malnutrition
- male gender
- older age
Where does leakage almost always happens after blunt trauma to the liver and biliary system
- common bile duct
- hepatic ducts
Most common causes of exrahepatic biliary obstruction include:
Dogs:
- pancreatitis
- neoplasia
- gallbladder mucoceles
- cholangitis
- cholelithiasis
cats:
- pancreatitis
- cholangioheptitis
- cholecystitis with or without cholelithiasis
- neoplasia
Which pathophysiologic consequences do you have to consider when performing surgery on an animal with extrahepatic biliary obstruction?
- hypotension
- decreased myocardial contractility
- acute renal failure
- coagulopathies
- intestinal hemorrhage
- delayed wound healing
Name the most common underlying causes of bile peritonitis in
dogs?
dogs:
trauma
necrotizing cholecystitis
ruptured gallbladder mucoceles
cats:
trauma
50% of canine choleliths consisits of ___
calcium bilirubinate
80% of feline choleliths are composed of
calcium carbonate
Common topical hemostatic agents used for capsular hemorrhage include:
gelatin sponge
oxidized regenerated cellulose
cyanoacrylate glue
fibrin glues
How can you characterize vascular occlusion techniques when extensive haemorrhage occurs?
(1) control of central venous pressure (CVP)
(2) occlusion of liver inflow
(3) occlusion of liver inflow and outflow
Explain the Pringle Maneuver
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
Name the relative hepatic volumes in dogs:
- the right lateral and caudate lobes: 28%
- the right medial and quadrate lobes: 28%
- left lateral and medial lobes: 44%
Why is especially the liver suitable for intravascular techniques in animals with liver tumors which are not resectable or diffuse?
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
Name the most common laboratory abnormalities seen in patients with extraheptic biliary obstruction
- 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)
Name the most common bacteria cultured from the biliary tract:
E. coli, Enterococcus spp., Enterobacter spp., Clostridium spp., and Bacteroides spp.
In which patients is cholecystectomy advised for the treatment of?
- cholelithiasis
- biliary mucocele
- gallbladder neoplasia
- Trauma to the gallbladder
How should the cystic duct and artery be ligated?
0 or 2-0, nonabsorbable suture
Double ligation
What are the current indications for laparoscopic cholecystectomy?
- Uncomplicated gallbladder mucocele
- Symptomatic cholelithiasis
- Cholecystitis not associated with extrahepatic biliary obstruction, gallbladder rupture, or choledocholithiasis
