liver/biliary/panc Flashcards
- Chan, VRU 2024. Canine primary liver tumors treated with stereotactic body radiation therapy: A case series
-clinical improvement %
-tumor dec %
-MST?
o clinical improvement in 33% dogs treated with SBRT
~50% dec in tumor volume
o MST= 164 d /5mo
- Mcalexander, JAVMA 2024. Diagnostic and surgical treatment for traumatic bile peritonitis in dogs and cats
survival rate?
site of rupture in cats vs dogs?
o 88.2% survival
o most frequent site of rupture: CBD = dogs ; cystic duct = cats
- Bentley, VRU 2024. Intra‐ and interobserver agreement in computed tomography localization of primary nonhematopoietic hepatic masses and comparison with surgical and histopathological outcomes in 21 cats
most common tumor in cats? what division?
o left hepatic division (54%)»
o most common = biliary cystadenoma (52%) and hepatocellular adenoma (29%) – benign tumors!
- Moore et al, Vet surg 2023. Association between divisional location and short-term outcome of liver mass resection in 124 dogs
-what 3 things were associated with dec complications?
-intraop comps inc __x if not using TA?
-odds of complication w R divisional mass?
o decreased likelihood of postop comps if: used a TA stapler, specialist surgeon, or larger/heavier dogs
odds of intraop complications were 19x higher if sx performed without a TA stapler
o RIGHT divisional mass = 88% higher chance of intraoperative complications
- Bergen, vet surg 2023. Clinical use of uncovered balloon‐expandable metallic biliary stents for treatment of extrahepatic biliary tract obstructions in cats and dogs: 11 cases (2012–2022)
complications?
obstruction w/ choledocholiths, recurr cholangiohepatitis
- Dobberstein, vet surg 2023. Comparison of the diagnostic yield of 3 and 5 mm laparoscopic liver biopsy forceps in cats
which size and “technique” recc?
5mm cup forceps; twist or pull tech
- Smola et al, JAVMA 2023. Computed tomography angiography aids in predicting resectability of isolated liver tumors in dogs.
3 factors affecting resectability?
3 factors affecting resectablity:
Major vascular involvement
multilobar involvement
right-sided laterality negatively affected resectability
- Jablonski, JVIM 2023. Concurrent hepatopathy in dogs with gallbladder mucocele: Prevalence, predictors, and impact on long‐term outcome
% of dogs w hepatic abN?
o 98% dogs with GBM had at least 1 hepatic histologic abnormality (fibrosis most common)
- Cleary, JAVMA 2023. Features, management, and long-term outcome in dogs with pancreatitis and bile duct obstruction treated medically and surgically: 41 dogs (2015–2021)
survival rate for sx vs medical ?
o Survival rate: surgery = 95% surgery vs 57% medical mgmt
- Burke, JVECC 2023. Hepatic abscessation in dogs: A multicenter study of 56 cases (2010–2019)
most common bacteria?
% w cancer?
survival rate?
how is this different than dickerson 2023 paper?
o E coli = most common
o 21% had neoplasia
o 71% survived to discharge –hypoglycemia & multifocal abscessation were assoc w dec survival
dickerson 2023 = 30% neoplasia, E colli most common, 63% survival
SIMILAR
- Ullal, JAVMA 2023. Increasing age and severe intraoperative hypotension associated with nonsurvival in dogs with gallbladder mucocele undergoing cholecystectomy
% survival to discharge?
2 factors associated with w/ nonsurvival?
76% survived
inc age & BP <65mmgh assoc w/ nonsurvival
- Larose, vet surg 2023. Near‐infrared fluorescence cholangiography in dogs: A pilot study
indication?
ID of biliary tears / bile leakage
- Brunori, JVIM 2023. Occurrence and clinical relevance of postoperative hypernatremia in dogs undergoing cholecystectomy
relationship bw hypernatremia and odds of death?
Na above what conc didn’t survive?
conclusion?
dvlpt of hypernatremia within 6 hours postop = 7.7 higher odds of nonsurvival
Change in Na >10 mEq = 3.3x higher odds of mortality
postop Na>160 mEq/L did not survive
hypernatremia common and may be associated with death – RELEVANT finding
- Dickerson et al, vet surg 2023. Outcome in 38 dogs surgically treated for hepatic abscessation.
most common bacteria?
% w cancer?
survival rate?
what comorbitidis were associated with inc risk for abscess dvlpt?
e coli; 30% cancer; 63% survived
(burke had similar)
o diabetes mellitus, hepatobiliary disease & panc = inc risk of developing hepatic abscessation
- Brunet, JVIM 2023. Prevalence and clinical relevance of cholelithiasis in cats: A multicenter retrospective study of 98 cases
% symptomatic vs incidental
o Incidental = 41% ; symptomatic = 59%
~60% symptomatic – mutliplle choleliths or EHBDO signs
- Hernon, vet surg 2023. The effect of flushing of the common bile duct on hepatobiliary markers and short‐term outcomes in dogs undergoing cholecystectomy for the management of gall bladder mucocele: A randomized controlled prospective study
mortality rate? findings?
o no difference in Tbili or LES bw flush vs no flush
o mortality rate = 9.7%
o findings of the study do not support routine flushing of the CBD during cholecystectomy
- Simpson, vet surg 2022. Cholecystectomy in 23 cats (2005‐2021)
mortality?
mortality rate = 21.7%
- Reist et al, JAVMA 2022. Histopathologic findings and survival outcomes of dogs undergoing liver lobectomy as treatment for spontaneous hemoabdomen secondary to a ruptured liver mass :retrospective analysis of 200 cases (2012–2020)
most common dx?
prognostic factors?
MST for HCC vs HSA?
o HCC (36%)» benign masses (27.5%)> hemangiosarcoma (25.5%)
o px factors for survival: histo dx, increased ALT, anemia, and whether a transfusion was received
o 64% of dogs with spont hemoab d/t liver mass had well-differentiated HCC or a benign process
MST: HCC 897d (2.5y) vs HSA 45d
- Piegols, vet surg 2021. Association between biliary tree manipulation and outcome in dogs undergoing cholecystectomy for gallbladder mucocele: A multi‐institutional retrospective study
what complications was associated with catheterization?
catheterized dogs were more likely to (3 things)
o Catheterized dogs = higher ASA scores, higher Tbili, and dilated CBD at time of sx
o pancreatitis assoc w/ CBD catheterization – not different bw normograde / retrograde catheterization
o Hernon 2023 recc no biliary flushing
- Griffin, JVIM 2021. Choledochal stenting for treatment of extrahepatic bile duct obstruction in cats
survival rate? recur rate? what was associated with recurrence
o Survival = 78%
o Recurrence = 38% – Cholelithiasis assoc w/ recurrence
- Center, JAVMA 2021. Clinical features, concurrent disorders, and survival time in cats with suppurative cholangitis-cholangiohepatitis syndrome.
postive bilary cultures?
sx vs med mgmt recc?
o + bacterial cultures = 69%
o Cholelithiasis (+/- EHBDO) and cholecystectomy were associated with survival advantages – cholecystoenterostomy had no survival impact sx = significant survival advantage
- Friesen, JSAP 2021. Clinical findings for dogs undergoing elective and nonelective cholecystectomies for gall bladder mucoceles
mortality rate
o 6% for elective cholecystectomy and 23% for nonelective
- Putterman, vet surg 2021. Influence of normograde versus retrograde catheterization of bile ducts in dogs treated for gallbladder mucocele
recc?
o retrograde = more complications than normograde
o Tbili decreased: 70% normograde vs 40% retro
o recommend NG > retrograde catheterization
(hernon 2023 = no benefit to flushing)
- Linden et al. Vet surg 2019. Outcomes and prognostic variables associated with central division hepatic lobectomies: 61 dogs
mortality? hemorrhage?
o hemorrhage = 33%
o mortality rate = 11%
- sweiton, VS 2024. Outcome of 21 dogs treated for the portocaval subtype of extrahepatic portosystemic shunts
sx outcomes vs med mgmt? sx outcomes vs other shunts (generally speaking)
o sx outcomes= 80% fair, 20% poor vs med mgmt = 50/50 fair and poor
o sx treated dogs had improved BW - better clinical outcomes vs med mgmt BUT surgical outcomes worse overall vs other shunts
- Janas, vet surg 2023. Clinical outcomes for 20 cats with congenital extrahepatic portosystemic shunts treated with ameroid constrictor ring attenuation (2002–2020)
complication rate?
o complications = 25%: blindness (10%) > ascites, head pressing, sz, death
Periop complication lower than hx reported for using ARC (prev bw 33-75%)
- Spies, vet surg 2023. Clinical presentation and short‐term outcomes of dogs ≥15 kg with extrahepatic portosystemic shunts
complication rate? outcomes vs large breed?
o Portocaval (26%) and splenocaval (24%), golden retrievers = most common
o Complications = 35%
o sx management of single EHPSS in large dogs ≥15 kg had similar clinical short-term outcomes as small breed dogs
- Burger, JAVMA 2023. Dogs with congenital extrahepatic portosystemic shunts that have persistent shunting (MAPSS) after surgery have a higher prevalence of urolithiasis
% dogs with stones for closed pss vs mapss
Urolithiasis: closed PSS = 5% and MAPSS = 67%
50% of dogs w MAPSS had new uroliths
o ammonium urate uroliths might dissolve if PSS ceases to exist
- Mullins, vet surg 2023. Postattenuation neurologic signs after surgical correction of congenital portosystemic shunts in cats: A narrative review
incident of PANS vs postattneuation sz?
o Incidence of PANS (15-60%) and postattenuation seizures (0-30%)
Persistence/recurrence of neurologic signs in the long-term is common
- Serrano. JVIM 2022. Comparison of diet, lactulose, and metronidazole combinations in the control of pre‐surgical clinical signs in dogs with congenital extrahepatic portosystemic shunts
recc for hepatic diet vs lactulose vs metro? (recc combo)
o adding metronidazole to HSD + lactulose did not result in further improvement of clinical score
o Combined HSD + lactulose seems sufficient for pre-surgical cEHPSS stabilization»_space; unlike sole HSD or HSD + metronidazole
- Wallace, JAVMA 2022. Dogs ≥ five years of age at the time of congenital extrahepatic portosystemic shunt diagnosis have better long-term outcomes with surgical attenuation than with medical management alone
conclusion? mortality rate? survival time for med vs sx?
o Survival time was longer with surgery than medical management (Med= 3 yr; Sx= 11yr)
o Continued CS: med = 40% vs sx =14%
o mortality rate = 7.3%
- Mullins, vet surg 2022. Postattenuation neurologic signs after surgical attenuation of congenital portosystemic shunts in dogs: A review
incidence of PANS vs sz?
o PANS = 2-25% and incidence of seizures = 0%-20%
o prophylactic antiepileptic drugs do not prevent PANS
o Mortality associated with PANS d/t sz activity
- Glenn, JSAP 2022. Short‐ and long‐term outcomes of polyethylene band attenuation of congenital extrahepatic portosystemic shunts in dogs: 60 cases (2010‐2020)
persistent shunting? mortality?
o mortality = 6% (other papers ~9%)
o Persistent shunting = 17%
- Economu, JFMS 2022. Surgical treatment and outcome of intrahepatic shunts in 12 cats
incidence of PANS?
50% = PANS –17% died d/t PANS
- Anglin, JAVMA 2021. Clinical characteristics of, prognostic factors for, and long-term outcome of dogs with multiple acquired portosystemic shunts: 72 cases (2000-2018).
factors associated with w death? MST?
o Factors assoc w/ death: body weight, dec liver pseudofxn markers (albumin, chol, TS, glucose)
o MST = 580d (1.5yr)
o Dogs with MAPSSs & liver dysfunction more likely to die of causes related to MAPSSs
- Strickland, Vet surg 2021. Incidence and risk factors for neurologic signs after attenuation of a single congenital portosystemic shunt in 50 cats.
incidence of pans? mortality?
o PANS =62% – Keppra doesn’t help for preventing PANS
o Mortality = 10%
- Carrera, JAVMA 2021. Long-term outcome and quality of life of dogs that developed neurologic signs after surgical treatment of a congenital portosystemic shunt: 50 cases (2005–2020)
resolution of neuro signs? recurrence ?
o Neuro signs resolved in 48% dogs
o Seizures reoccurred in 50% w/ PANS
- Otomo, vet surg 2020. Long‐term clinical outcomes of dogs with single congenital extrahepatic portosystemic shunts attenuated with thin film banding or ameroid ring constrictors
survival to discharge? persistent shunting? (what about other papers?)
o no difference in survival to discharge – TFB =95% and ARC =97%
o no dog w/ TFB req revision sx
Matiasovic VS 2019 – 31% TFB =persistent shunting
Glenn JSAP 2022 = 17% TFB =persistent shunting
- Matiasovic, vet surg 2020. Outcomes of dogs treated for extrahepatic congenital portosystemic shunts with thin film banding or ameroid ring constrictor
complications? mortality bw groups? revision sx for TFB?
o Complications: TFB = 28% vs AC = 35%
o Mortality: TFB = 9% vs AC = 4%
o Revision sx for persistent shunting: TFB = 29% vs AC = 0% use of AC is more reliable
- Mullins, vet surg 2020. Prognostic factors for short‐term survival of dogs that experience postattenuation seizures after surgical correction of single congenital extrahepatic portosystemic shunts: 93 cases (2005‐2018)
survival rate w/ PAS
o Survival rate (30 days) = 32%
- Mullins, vet surg 2019. Effect of prophylactic treatment with levetiracetam on the incidence of postattenuation seizures in dogs undergoing surgical management of single congenital extrahepatic portosystemic shunts
incidence of PAS?
o incidence of PAS = 8%
o Prophylactic treatment with LEV according to the protocols was not assoc with a reduced incidence of PAS
- Strickland, vet surg 2018. Incidence and risk factors for neurological signs after attenuation of single congenital portosystemic shunts in 253 dogs
risk factors for pans? mortality rate?
o Incidence of PANS = 11%
preop HE and inc age = inc odds of PANS
o Mortality rate = 18%
- Cleary, JAVMA 2023. Features, management, and long-term outcome in dogs with pancreatitis and bile duct obstruction treated medically and surgically: 41 dogs (2015–2021)
survival rates?
o Survival: surgery = 95% vs medical = 57%
- Veytsman, vet surg 2023. Retrospective study of 20 cats surgically treated for insulinoma
negative prognostic indicators? mortality rate?
o Negative prognostic factors: young age, low serum glucose concentrations, metastasis at time of surgery, tumor invasion, and shorter time to euglycemia
o mortality rate = 10%; median OST = 863 d (2yr)– similar to canine
- Collgros et al. JAVMA 2022. Blood glucose monitoring during surgery in dogs to assess completeness of surgical resection of insulinoma: 11 cases
recc for surgery ?
o Sx considered complete when BG rose to normal and consistently rising
- Wolfe, JSAP 2022. Perioperative outcomes in dogs and cats undergoing pancreatic surgery: 81 cases (2008‐2019)
mortality rate bw cats vs dogs?
dogs = 10%, cats =20%
- Ryan, JSAP 2021. Clinical findings, neurological manifestations and survival of dogs with insulinoma: 116 cases (2009‐2020)
correlation bw neuro exam and px?
o Abnormalities in the neurological examination did not correlate with prognosis
- Busto, JVIM 2020. Incidence of postoperative complications and outcome of 48 dogs undergoing surgical management of insulinoma
-Dec survival?
-MST?
-post ADE
o Factors assoc with dec survival: Stage of disease, postop hypoglycemia
o MST = 372 days (1yr) – longer MST if no mets (652d) vs stg 2/3 (320d
o postoperative DM in 33% 20% permanent
What is the effect of tunneling under the digastricus muscle during sialoadenectomy in dogs? Marsh, Vet surg 2013.
Increases the length of rostral salivary duct and glandular tissue that can be removed
Residual polystomatic sublingual salivary tissue remains after resection without tunneling.
What is the absolute indication for surgery in cases of temporomandibular joint fractures? Arzi et al, JAVMA 2023.
Severe/displaced fractures of mandibular fossa +/- condylar process preventing mouth opening/closing
Displacement of the condylar process into the auditory system also indicates surgery.
What percentage of complications were noted overall following mandibulectomy and maxillectomy in dogs? Cray et al, JAVMA 2022
Overall, 37% of the cases had complications.
What is the median survival time (MST) for cats with feline maxillary sarcoma? Harvey, JFMS 2022.
70 days
Most cats were euthanized due to local recurrence following incomplete tumor excision.
What factors are associated with complications following mandibulectomy and maxillectomy? Cray et al, JAVMA 2022
- Incision time
- Preoperative radiation therapy or chemotherapy
- Having a maxillectomy
Each factor significantly increases complication odds.
What are the factors associated with failure to discharge with esophageal foreign body surgery in dogs? Beer et al, JAVMA 2022.
- Esophageal perforation
- Thoracotomy
- Placement of gastrostomy tube
Presence of esophageal perforation is a significant factor associated with death.
What surgical technique was used for managing gastroesophageal junction abnormalities in dogs with brachycephalic syndrome? Hosgood et al, JAVMA 2021.
Circumferential esophageal hiatal rim reconstruction
This technique substantially reduced regurgitation frequency by 90%.
What are the treatment options for lower esophageal sphincter achalasia-like syndrome? Winston et al. Vet surg 2023
- Mechanical dilation
- Functional dilation with botulinum toxin A injections
- Modified Heller myotomy with Dor fundoplication
These options aim to alleviate symptoms associated with esophageal dilation and peristalsis disruption.
What was the success rate of endoscopic retrieval of esophageal foreign bodies in dogs? Brisson et al. JAVMA 2018.
84% success rate
Endoscopic retrieval remains the initial treatment option provided perforation does not require surgery.
What is the most common vascular ring anomaly in cats? Basscunan, VS 2020
Persistent right aortic arch
This condition is the most frequently observed vascular ring anomaly.
What anatomical esophageal feature is correlated with gastroesophageal reflux in brachycephalic dogs? Conte, VS 2020.
Larger esophageal hiatus cross-sectional surface area
This feature can contribute to functional gastrointestinal alterations.
What was the outcome of using NIRF to assess gastric viability in dogs with gastric dilatation volvulus? Mullen et al, Vet surg 2023.
NIRF was sensitive in nonviable gastric tissue and altered surgical resection in 15% of cases
It supports the implementation of NIRF as an adjunct to gross examination.
What is the typical survival rate for dogs undergoing surgery for gastric dilatation volvulus after immediate stabilization vs delayed? Lhuillery et al. Vet surg 2022.
78% survival rate = immediate
82% delayed
Delayed surgery showed a slightly higher survival rate of 82%, indicating the importance of timely intervention.
What percentage of dogs with esophageal strictures had a good outcome with balloon dilatation alone? riz, JSAP 2021.
59% had good outcome with ballooning alone
Stenting as a rescue therapy was also evaluated, but discomfort was frequent.
What are the two techniques mentioned for pyloroplasty in dogs and cats? Maurice, JSAP 2024
- Finney pyloroplasty
- Jaboulay pyloroplasty
Finney is handsewn, while Jaboulay uses endoGIA.
What percentage of dogs survived to discharge after gastroduodenal perforations d/t nsaids? Dobberstein et al. Vet surg 2022.
73%
All gastroduodenal perforations were found in the upper gastrointestinal tract.
What was the survival rate for dogs undergoing surgical management of intrathoracic wooden skewers? Garcia pertierra et al. JSAP 2022
91%
27% complication rate.
What factors were associated with mortality in dogs with gastric dilatation-volvulus according to White et al. 2021?
- Gastric necrosis
- Single lactate concentration
- Percentage change in lactate
What technique was evaluated and recommended for staple line reinforcement after partial gastrectomy closure? Duffy et al. Vet surg 2021.
Double-layer suture closure
Superior biomechanical properties vs stapling.
What was the conversion rate for laparoscopic correction of sliding hiatal hernia in dogs? Monnet et al. vet surg 2021.
50%
Due to anatomic difficulties preventing reduction of hernia.
What are some factors associated with gastroduodenal ulceration or erosion in dogs? Pavlova, JVIM 2021.
- NSAID/steroids
- Neoplasia
- Mechanical disease
- Working breeds
What was the survival to discharge percentage for dogs with gastroesophageal intussusception? Grimes et al, JAVMA 2020.
88%
Most common in young males, particularly German Shepherd Dogs.