Liver/Biliary and Hepatic Vascular Anomalies Flashcards
Which of the following is false regarding the anatomy and physiology of the hepatobiliary system?
A. The caudate process of the caudate liver lobe is the most caudal part of the liver and usually extends to the 12th intercostal space
B. The portal vein is created by the confluence of the cranial and caudal mesenteric veins at the level of the left pancreatic limb
C. The number of hepatic ducts in dogs varies from 2 to 8
D. The major duodenal papilla is usually located 1 to 2 cm oral from where the common bile duct appears to join the duodenum
D 1-2 cm ABORAL
2. Approximately what percentage of cats have an accessory pancreatic duct which exits at the minor duodenal papilla A. 20% B. 25% C. 35% D. 40%
A 20%
After acute cystic duct ligation in dogs, ultrasonographically detectable common bile duct dilatation and increase in serum bilirubin concentration are present within ___-____ hours.
24 to 48
The normal diameter of the common bile duct is approximately ___-___ in dogs and cats.
3 to 4 mm
One of the earliest signs of extrahepatic biliary obstruction is distention of the common bile duct, which occurs within ___ hours.
48
T/F:When common bile duct strictures are present, lack of dilation of the CBD confirms patency.
F: lack of dilation of the CBD that does NOT always confirm patency.
Which of the following is true regarding portal anatomy?
a. The portal vein supplies 75-80% of the efferent blood
b. The hepatic artery provides 60% of the oxygenated blood to the liver
c. The tributaries of the portal vein from caudal to cranial are: mesenteric vessels, cranial mesenteric vein, caudal mesenteric vein, splenic vein, left gastric vein, gastroduedenal vein
d. The largest tributary to the portal vein is the caudal mesenteric
A (afferent)
B (50%, shared with portal vein)
C TRUE
D (False, cranial)
Which is true for hepatotoxins?
A Ammonia is toxic due to neural inhibition by hyperpolarizing the neuronal membrane
B Endogenous benzodiazepines increase brain tryptophan and glutamine, and increased glycolysis
C Bile acids uncouple oxidative phosphorylation
D Tryptophan is directly neurotoxic and increases serotonin through neuroinhibition
D true
A (endogenous benzos) is toxic due to neural inhibition by hyperpolarizing
B (Ammonia) increase brain tryptophan and glutamine, and increased glycolysis (also increases neuronal and cellular excitability)
C uncouple oxidative phosphorylation (SCFAs)
Which is most true?
A. Overactivation of the glycine receptors, mainly NMDA, are implicated in hepatic encephalopathy-induced seizures
B The degree of encephalopathy is not well correlated with blood ammonia levels in dogs
C Spontaneous hemorrhage is uncommon, and approximately 43% of dogs with congenital PSS are hypercoaguable based on TEG.
D GABA works via neural inhibition and depolarizes the neuronal membrane, and increases blood-brain barrier permeability to GABA
C true
A (glutamate)
B (in humans)
D GABA (hyperpolarizes)
Which is true?
A. The gene WEE1 is expressed in extrahepatic PSS, and VCAM1 in intrahepatic PSS
B Cairn terriers and Yorkshire terriers are overrepresented in PVH-MVD, and inherited component is likely.
C Males may be overrepresented in dogs, but there is no gender predisposition for cats
D Polyuria and polydipsia are uncommon historical findings in patients with PSS
B is true
A WEE1 –> intra and VCAM1–> extrahepatic
C cats: males may be overrepresented
D common
What % of liver function lost before hypoalbuminemia clinical?
70-80%
Which coagulation factors are NOT produced in the liver?
vWF and factor VIII (produced by vascular endothelium)
What are Kupffer cells?
hepatic macrophages distributed throughout the hepatic sinusoids= principal reticuloendothelial system cell
Name 2 functions of bile salts
emulsify fats
bind endotoxin in intestine
When does the hepatic arterial buffer response occur?
disruption in portal perfusion –> lack of washout of adenosine –> vasodilation
What factors contribute to liver regeneration? potent?
IL-6, TNFa
HGF, EGF, TGF-B
NO, PGE2
insulin estrogen
What are the 3 venous systems that contribute to abdominal cavity
umbilical
vitelline
cardinal
What does the ductus venous connect? Where is the shunt if it stay open?
left umbilical and right vitelline
left-sided intrahepatic
What embryonic veins contributes to caudal vena cava?
paired cardinal veins, cranial segment of right vitelline
What leads to portoazygous or extrahepatic portocaval shunts?
connections between cardial and vitelline systems
Where does the portal vein come from?
vitelline vein anastomoses atrophy and reform
True or false: Functional closure of the ductus Venosus is usually within 2-6 days after birth, and structural closure is delayed (up to 3 wks out)
true
What percentage of single congenital shunts are extrahepatic?
66-75%
What % of liver function lost to see hepatic encephalopathy?
70%
T/f in dogs the major duodenal papilla adjacent to the pancreatic duct is where the common bile duct empties
True
What occurs in phase 1 biotransformation in the liver?
Hydrolyzes/introduces a polar group group
What happens in phase 2 liver biotransformation?
Conjugation which introduces further hydrophilicity
What is a good antibiotic prior to biliary sx
Second gen cephalosporin like cefoxitin plus ampicillin for enterococcus species
What are 2 features of nsaid induced idiosyncratic injury?
Not dose related
Rare and unpredictable with vague clinical Signs
What vein drains the spleen to portal?
Splenic —> gastosplenic —> portal
