Liver Flashcards
T/F You may need to remove multiple lobes of the liver because you can’t remove one without sacrificing blood flow to another
true
where does 80% of the liver’s blood supply come from
portal VEIN
What is the most common liver biopsy done? when would you use it?
Guillotine technique use if you have diffuse or lesion at the periphery of the lobe
-3-0 absorb braided will cut through the liver well
When would you use a punch biopsy?
lesion that is more central or closer to the hilus
NEEDS to be closer to the surface and you need to get multiple samples
When would you use laparoscopy biopsy?
more common at universities one down fall is that you cant feel the tissue
can do a true cut or guiletine style
What are the two non surgical biopsy techniques
percutaneous tru cut-good sliver or core tissue
fine needle aspirate and cytology- neoplastic lesions may exfoliate this has a POOR diagnostic yield
When may you need to do a complete and partial liver lobectomy?
neoplasia, trauma, abscess, cysts
Complete liver lobectomy should be done on what liver lobes and with what technique?
left lateral and left medial in SMALL dogs and cats
use the guiletine technique go up to the hilus and with one swoop tie off the vessels
What is a TA stapler
thoracoabdominal stapler that fires multiple rows of staples to crush the tissue and blood supply before you release your cut.
can use it for complete or partial lobectomies
Parital liver lobectomy- what is a parenchymal fracture and ligation
cut through the capsule at the lvl of proposed excision
- crush or aspirate parenchyma
- ligate or cauterize the vessels
- ***results in the greatest blood loss
T/F the parenchymal fracture and ligation done for a partial lobectomy results in the greatest blood loss
true
What are overlapping sutures
full thickness series of overlappng guillotine sutures and make sure they overlap so no vessels are left unoccluded
What are the two big complications you are worried about with sx of the liver?
Hemorrhage
accidental ligation or occlusion of portal veins and cystic ducts of the remaining lobes—->necrosis of the lobe
T/F tumors in the liver are most likely primary tumors
false most of them are metastatic
What are the two types of hepatocellular tumors?
Adenomas - tumors in cats benign may show cs if space occupying
Adenocarcinomas- MOST common primary malignant tumor in dogs
what are the three forms of hepatocellular adenocarcinomas
Massive-malignant but good prog because in left lateral and left medial liver lobs
Nodular- poor prog metastasis likely and complete excise hard
Diffuse- poor prog mets in lymphnodes and lungs
What are the cholangiocellular tumors in dogs and cats?
dogs- second most common primary malignancy most will be intrahepatic and mets of 88%
cats MOST common primary hepatobiliary tumor
50% are adenomas (benign
50% carcinoma number one malignant liver tumor in cats poor prog with mets GROUND GLASS
T/F liver and splenic trauma is usually self limiting and does not require sx
TRUE :)
How are you going to treat trauma of the liver
supportive care with fluids and a possible trasfusion
Where would trauma to the liver have to be to need sx?
closer to the hilus use the PRINGLE maneuver
What is a cholecystectomy ?
incising the gall bladder
When do you need to do a cholecystectomy?
Mucocele
necrotizing, chronic, lihiasis, tumor, trauma
Biliary mucoceles what are they
hyperplasia of mucous secreting cells line the gall bladder -more distension can lead to rupture
What is the signalment and clinical signs of biliary mucoceles
dogs around 9 small and med breeds including cockers, min schnauzer
vomit, anorexia, lethargy, PU/PD D+
With a cholecystectomy you want to ensure patency of ________ before removing gall bladder
bile duct
What are the two ways you can go in to remove the gall bladder? where are you ligating?
retro or normograde both are hard
ligate the cystic duct DO NOT get hepatic duct
What are the two complications from cholecystotomy
bile peritonitis
bleeding
What if I have a biliary obstruction how am I going to fix it?
Choledochotomy
incise into the common bile duct and remove the stones, sludge
When would I need bile duct stenting
do this in chronic pancreatitis
-pass catheter from major duodenal papilla up the common bile duct and suture to duodenal wall
When would I need a bliary diversion? best one?
Irreparable obstruciton or trauma of the common bile duct
best is the cholecystoduodenostomy because its the most physiologic
What do you have to make sure about the size of the stoma in a cholecystoduodenostomy? what is the number one complication?
make it 2.5-3cm because it will close by 50%
leakage :/ —> septic peritonitis
infection, stricture,
CATS DO WORSE
If I have an obstruction of the common bile duct that will resolve but my stent placement isn’t working what is my other option?
Cholecystostomy -with a folley or pig tail catheter
place it into the gall bladder and through the body wall
allows the gall bladder to be out of the body and into the GI tract
What is most of the blood supply to the spleen coming from?
celiac
-splenic is a major contributer that supplies the pancreas
What is a splenorrhaphy?
suturing a rupture spleen
rare to be done for lacerations and puncture
use 4 or 5-0
when would you use a partial splenectomy?
focal benign dz
abscess laceration, infaction, biopsy
When would you do a complete splenectomy?
Severe trauma, torsion, neoplasm, infiltrative dz, immune
Two techniques for a splenectomy?
non emergent- individual ligation of hilar vessels
Emergent- rapid 3 clamp techniniqe
what are the two surgical approaches for the splenectomy?
ventral midline celiotomy
Laparoscopic assisted
What are the big post op complications with splenectomy?
hemorrhag, compromise to the kidney, arrhythmias VPC), DIC
Dogs neoplasias 50% of their malignant tumors are_______ and 75% will present with _______
hemangiosarcoma
hemoabdomen
cats ____% splenic masses are malignant
75%
When doing a splenectomy due to a tumor what do you also want to remove
any omentum adhered to the tumor and perform a thorough explore to look for evidence of mets
Hemangiosarcoma is the most common splenic neoplasia in _____
dogs its a neoplasm of endothelial cells invasive highly mets
What is the prognosis of hemangiosarcoma?
sx alone stage I and II 86 days less than 6% survive passed one year
Who gets splenic torsion
uncommon in dogs NOT in cats
>large giant male dogs may be associated with GDV
How are you going to DX a splenic torsion?
xray
ULTRASOUND :)))))
How do you treat splenic torsion?
DO NOT UNTORSE
do a splenectomy and maybe a gastropexy better prog for chronic torsion
What are you going to do for a splenic trauma?
conservative monitor PCV and abdominal fluid
What are your two types of biopsy of the pancreas?
laparoscopic and celiotomy
What are the techniques used for biopsy of the pancreas? diffuse dz?
guillotine-isolate at periphery and ligate at base
lobar dissection- dissect small group lobules from surrounding tissue
***right distal limb for diffuse dz
when would you do a partial pancreatectomy?
tumor removal or biopsy of large lesion
Pseudocysts happens in who? dx? tx
middle age to older animals more common in dogs similar signs to pancreatitis and may have palpable mass
dx ultrasound and cytology
tx three options
us guid percut aspiration, surgical resect, debride drain and omentalize
Abscess in the pancreas occurs as a sequela to _____
pancreatitis
How do you tx pancreatic abscess
ER sx with debride and omentalize vs resection
-debride has significantly less morbidity
What is the most common pancreatic tumor of dogs and cats?
Exocrine pancreatic adenocarcinoma
highly malignant locally invasive and early mets
POOR PROG
what is the tumor of non beta islet cells in the pancreas
gastinoma may be from pancreas, dudenum, ln or mesentery
mets at time of dx in 70%
dx with fasting gasrin and sx resection may be wanted
PROG 1w-18m
What is an insulinoma
adenocarcinoma of the beta islaet cells secrete insulin in spite of hypoglycemia show weak, seize, collapse dx US SERUM insulin SX resect all abnorm tissue
