liver surgery Flashcards
1
Q
liver pathological lesions
A
- cavitary lesion: abscess, cyst
- neoplasia
2
Q
surgical techniques for the liver
A
- heapatic biopsy
- lobectomy
*
3
Q
pathology of the gall bladder
A
- cholecystitis
- cholelithiasis
- gall bladder mucocele
4
Q
sx technique for the gallbladder
A
cholecistectomy
5
Q
characteristics of the liver which makes it hard to perform sx
A
- friable tissue
- requires different technique compared to the ones used in other paranchymatous organs
- difficult hemostasis
- biliary leaks
- _portal system,_low pressure,supplies 4/5 of the blood that enters the liver
- arterial system, high pressure, 2-5 arteries branches from hepatic artery.
6
Q
discuss the portal system of the liver
A
- low pressure,
- supplies 4/5 of the blood that enters the liver
7
Q
discuss the arterial system of the liver
A
- high pressure
- 2-5 arteries,
- branches from hepartic artery
8
Q
liver fxns
A
- synthesisi of plasma proteins
- maintainance of carbohydrates and lipid metabolism
- coagulation factors
- bile production
- hormone production(gastrin)
- storage(vit, fat,glycogen,minerals)
- clearance organ(drugs and toxins)
9
Q
liver characteristics
A
- no signal of dz till advanced stage
- difficult to palpate
- hepatic failure affect many other systems;
- CNs,kidney,intestines
- heart,coagulation,
- wound healing
10
Q
dx techniques for the liver
A
- radiology(abdominal and thoraci)
- US(biopsy) doppler and contrast enhanced US
- CT scan
- blood work:lab abnormalities (OFTEN NOT DIAGNOSTOC)
11
Q
Closed cavity within the hepatic parenchyma filled with pus
A
hepatic abscess
12
Q
closed cavity covered by a secretory epithelium filled with fluid
A
hepatic cyst
13
Q
cs for an abscess
A
- anorexia
- lethargy
- wt loss
- intermitent abdominal pain
14
Q
cs for a cyst
A
- aymptomatic
- abdominal distention
- if secondary infection behaves like an abscess
15
Q
dx cavitary lesions(cysts,abscess)
A
- US
- most effective ancilliary method for dx
- careful with guarded bipsy -diffuse peritonitis
16
Q
tx for cavitational lesions P
A
- Partial hepatectomy
- antibiotics for 7-10 days careful with peritonitis
17
Q
what % are primary liver neoplasia
A
- 1%
- primary neoplasias are very infrequent in cats and dogs
- but liver is a common site for metastasisi
18
Q
list hepatocellular tumors
A
adenomas
carcinomas
19
Q
cholangiocellular tumors
A
carcinomas
20
Q
cs for primary neoplasia
A
- lethargy
- weakness
- anorexia
- wt loss
- vomits
21
Q
cs for 2ndary neoplasia
A
variable
22
Q
discuss tx for hepatocellular neoplasia
A
- partial/total lobectomy
- neoplasia rarely respond to chemo or radiotherapy
- prognosis is grave
23
Q
presurgical considerations for biliary obstruction
A
- biliary obstruction alters vit. absoption
- COAGULUGRAM
24
Q
ANTIBIOTICS FOR BILIARY OBSTRUCTION
A
- ANAEROBIC FLORA NORMAL INHABITANT (CLOSP)
- WIDE SPECTRUM PREFERED
25
HOW TO CONTROL HARMORRHAGE IN LIVER
* pringle maneuver
* occludes portal trid
* **portal vein**
* **hepatic artery and**
* **common bile duct ******
* **up to 20'**
26
sx procedures for liver
* FNA
* biopsy
* percutaneous
* transthoracic
* transabdominal
* laparoscopy
* surgical
27
discuss total lobectomy
* left lobes more detectable
* right lateral and caudal lobes require dissection around vena cava
* rummel touniquet
* stapler
28
complications of total lobectomy
hemorrhages
bacterial proliferation
biliary peritonitis
sepsis
partial hyperextension
ascites
coagulopathy
29
main cause of extrahepatic biliary obstruction in cats
pancreatic pathology
30
discuss extrahepatic biliary obstruction
* **pancreatic pathology main cause in cats**
* partial/total
* intra or extraluminal/mural
* ascending infection
* necrotizing colecycystitis
* peritonitis→peritonitis
31
cs of cholecystitis
* vomiting
* anorexia
* jaundice
* abdominal pain
* fever→cholecystitis
32
dx for gallbladder mucocele
* rads can be non diagnostic
* ulteasound"kiwi sign'
* antibiotic therapy based on culture and sensitivity
* paracostal incision
33
discuss characteristics of cholelithiasis
* female,adult,small breed dogs
* bacterial infection
* biliary stasis
* less frequent?
* failure in recognising it
34
etiology of cholelithiasis
* little known
* formation mechanism:little known
* cholesterole,bilirrubin,ca,mg,oxaletes
* early billirrubinuria
35
when should u treat for choleliathesis
tx only when cs are present
36
discuss biliary salts
* mild irritants
* sterile unless associated to hepatic dz
* death by biliary peritonitis require bacteria
* changes in permability
