STS Journals - Liver, pancreas etc Flashcards
Dickerson VS 2023 - Outcome in 38 dogs surgically treated for hepatic abscessation
How did the majority of dogs present?
What was the m.common treatment?
Causitive agent?
Hepatic neoplasia was observed in what %?
MST?
What peri-op complications were seen?
Septic peritonitis
Liver lobectomy
E.Coli
30%
638d (~2y)
Regurg, pancreatitis, asp pneumonia, pancreatitis, death
peri-op comp in 1/3. Intra and peri-op mortality 21%
McAlexander JAVMA 2024 - Diagnostic and surgical treatment for traumatic bile peritonitis in dogs and cats
What was the overall survival rate?
M.common site of rupture in dogs? and cats?
88%
Dogs - CBD
Cats - cystic duct
Larose VS 2024 - Comparing 3 mm and 5 mm laparoscopic liver biopsy samples in dogs
What was the mean number of portal triads obtained by 3 and 5mm biopsy forceps?
3mm - 12
5mm - 18
In humans, a minimum of 6–11 portal triads per biopsy specimen is recommended to achieve appropriate histopathologic assessment
Sellier VS 2020 - Use of a cavitron ultrasonic surgical aspirator for parenchyma-sparing and complex liver resections in dogs
What function does the CUSA not do?
Coagulate
Shropshire JSAP 2022 - Multiplate platelet aggregometry in dogs undergoing laparoscopic liver biopsy for diagnosis of chronic hepatopathy
What % of chronic hepatopathy dogs have decreased platelet function?
67%
Dean JSAP 2020 - Diaphragmotomy to aid exposure during hepatobiliary surgery: a multi-centre retrospective review of 31 dogs
What % of complications were attributable to diaphragmotomy?
25% of complications - septic pleural effusion, hypoxia and haemothorax
Horikirizono JSAP 2024 - Intraoperative hypertensive crisis in a dog with functional paraganglioma of the gall bladder
What is a paraganglioma?
What IHC stain is used?
Extra-adrenal pheochromocytoma
Synaptophysin and chromogranin A
VS 2022 - Cholecystectomy in 23 cats (2005-2021)
What was the main indication for cholecystectomy?
Peri-op mortality in what %?
What were the most common short and long term complications?
Cholelithiasis (followed by cholecystitis)
22%
Vomiting and vomiting
Bergen VS 2024 - Clinical use of uncovered balloon-expandable metallic biliary stents for treatment of extrahepatic biliary tract obstructions in cats and dogs: 11 cases (2012–2022)
How was the BEMBS stent placed?
For how long was bile duct patency maintained?
Retrograde catheterisation w. duodenostomy and then fluoro guided
Cats - 446d - 1.25y
Dogs - 650d - 1.75y
Hernon VS 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
What breed was most common?
What was the outcome?
Border terrier
No difference between groups. No short-term clinical or clinico-pathological benefits were identified when flushing the CBD in dogs undergoing cholecystectomy for GBM.
Piegols VS 2021 - Association between biliary tree manipulation and outcome in dogs undergoing cholecystectomy for gallbladder mucocele: A multi-institutional retrospective study
What was CBD catheterisation associated with?
Post-op pancreatitis (regardless if normo or retrograde)
While catheterization of the CBD should still be pursued in light of specific concerns such as lack of integrity or patency of the CBD, routine catheterization in dogs undergoing a cholecystectomy for GBM should be questioned because of possible morbidity.
Putterman VS 2021 - Influence of normograde versus retrograde catheterization of bile ducts in dogs treated for gallbladder mucocele
What was identified?
What complications were associated with this finding?
Retrograde catheterisation (via duodenotomy) increased postop complication risk.
No difference in survival.
Persistence of GI signs
Friesen JSAP 2021 - Clinical findings for dogs undergoing elective and nonelective cholecystectomies for gall bladder mucoceles
What was the complication rates for elective and non-elective chole?
What was the mortality rate of elective cholecystectomy? and non-elective?
What complication was seen most frequently in cases that had retrograde flushing?
52% elective
52% non-elective
6% elective
23% non-elective
Post-op hyperthermia
Hattersley JSAP 2020 - Impact of intra-operative hypotension on mortality rates and post-operative complications in dogs undergoing cholecystectomy
What was the mortality rate? What factors were associated with mortality?
How did intra-op hypotension affect mortality?
17% - ASA grade, post-op ileus and pancreatitis
Hypotension did NOT affect mortality
Wennogle JSAP 2019 - Eubacterial fluorescence in situ hybridisation and histologic features in 25 dogs with gallbladder mucocele
In what % of cases was bacteria identified within or adherent to gall bladder wall?
What was the most common histopath diagnosis?
32% - interestingly culture was only +ve in 1 dog (/25)
Cystic mucinous hyperplasia with concurrent cholecystitis
Ullal JAVMA 2023 - Increasing age and severe intraoperative hypotension associated with nonsurvival in dogs with gallbladder mucocele undergoing cholecystectomy
What intraop systolic BP level was associated with nonsurvival?
<65mmHg
Simon VS 2020 - Laparoscopic cholecystectomy with single port access system in 15 dogs
Where was the initial port placed? And 2nd port?
Conversion rate? Factors ass. with conversion rate?
What do the authors recommend?
1cm caudal to umbilicus
Left or right abdo wall at level of umbilicus
20% - reduced risk w. increasing surgeon experience and placement of a 2nd cannula
Placement of a 2nd cannula at the start of the procedure
Kondo JSAP 2023 - Laparoscopic cholecystectomy using the subserosal layer dissection technique in dogs: 34 cases (2015-2021)
Location of lap ports?
What was the most frequent pre-op diagnosis?
Conversion was required in what %?
See pic
Cholecystolithiasis
9%
Barker JSAP 2020 - Serological markers of gluten sensitivity in Border terriers with gall bladder mucocoeles
What was identified in this study? What is the clinical significance of this?
Reduced Cholecystokinin
Increased transglutaminase-2-IgA autoantibodies
Suggest an immunological disease w. impaired cholecystokinin release impairing gall bladder motility
Takagi VS 2022 - Computed angiographic variations in hepatic venous vasculature in dogs
What is the most common drainage pattern for each lobe?
Rlat 2 vessels - CVC
Caudate 2v - CVC
Rmed 2v - LHV
Quadrate 1v (closely ass with Rmed) - LHV
Lmed 1v-LHV
Llat 2v - LHV
Fontes JAVMA 2023 - Central and left division hepatectomies in two dogs
What % of the total liver volume in a normal dog, would the central and left division hepatic lobes make up?
What is the % of liver that Tobias suggests can be removed in an acute setting?
Left, central, and right—make up 44%, 28%, and 28%
72%
70%
Oishi JSAP 2019 - Transcatheter arterial embolization in four dogs with hepatocellular carcinoma
How was it embolised?
How long does this embolism material last?
MST?
What complication was observed?
Gelatin sponge particles (gelfoam)
Days to weeks
469d (~1.5y)
Sx tx ~1400d (3y)
Med tx 270d (3/4 yr)
Pancreatitis 1/4 (25%)
Clinical, diagnostic, and pathologic features and surgical outcomes of combined hepatocellular- cholangiocarcinoma in dogs: 14 cases (2009-2021)
What CT features did this mass have?
MST?
What IHC stain was utilised?
Massive hepatic mass with cyst-like lesions within mass
700d
Cytokeratin 19
Moore VS 2023 -Association between divisional location and short-term outcome of liver mass resection in 124 dogs
What was the intra-op complication rate? What factors influenced intra-op complication rate?
What was post-op complication rate? What factors influenced post-op comp rate?
What liver lobes were associated with an increased risk of intraop complications?
11% - not using stapler increased risk 19x
29% - increased risk if incision extended to thorax
decreased if stapler used, specialist performed sx or heavier dog
Right division - Right lat and Caudate process
Reist JAVMA 2022 - Histopathologic findings and survival outcomes of dogs undergoing liver lobectomy as treatment for spontaenous hemoabdomen secondary to a ruptured liver mass: retrospective analysis of 200 cases (2012–2020)
What % were benign or well-differentiated HCC? What was the MST for these dx?
What were the identified prognostic factors for survival?
64% - 900d
Increased preop ALT (ST for increased ALT 644d vs 63d with normal values)
Anaemia and requirement for transfusion
ALT elevations are commonly seen in HCC, less so in hepatic adenomas and not seen in HSA
Smola JAVMA 2023 - Computed tomography angiography aids in predicting resectability of isolated liver tumors in dogs
What factors were negatively associated with resectability?
Major vascular involvement, multilobar involvement and right sided laterality
Fabres JSAP 2020 - Limy bile syndrome in a dog
What is the suspected etiopathogenesis?
Bile stasis 2ndry to acute pancreatitis
Janas VS 2024 - Clinical outcomes for 20 cats with congenital extrahepatic portosystemic shunts treated with ameroid constrictor ring attenuation (2002–2020)
What was the complication rate?
What was the good-excellent long term outcome?
25%
89%
Excellent 83%, good 6%
Strickland VS 2021 - Incidence and risk factors for neurological signs after attenuation of a single congenital portosystemic shunt in 50 cats
What % had PANS? And what % of the PANS cats not survive to discharge?
Which of the following was associated with the development of PANS?
- Type of shunt
- Degree of attenuation
- Use of peri-op Leve
- Pre-op hepatic encephalopathy
- Low osmolality @ 24hr post-op
62% of which 16% did not survive
Low post-op osmolality (rest of options not associated)
Freund VS 2020 - Thin film occlusion of an intra-abdominal vein in cats
What was the conclusion of this study?
Vascular occlusion was inconsistent and often incomplete by 8 weeks based on CT angiography despite abundant perivascular fibrous tissue on histo.
Terai JSAP 2022 - Congenital portopulmonary shunt in a cat
Economu JFMS 2022 - Surgical treatment and outcome of intrahepatic shunts in 12 cats
What % tolerated complete suture attenuation?
What % developed PANS? What % died due to PANS?
Of the cats surviving to discharge, what % had excellent outcome?
25%
50%
17% of total population (1/3 of those that had PANS)
63% (5/8)
Culp JAVMA 2020 - Use of percutaneous transvenous coil embolization in the treatment of intrahepatic portosystemic shunts in four cats
What was the rate of PANS?
What major long term complication was observed?
0%
Development of an acquired EHPSS in 1 cat
Chen VS 2024 - Accuracy, precision, and interobserver and intraobserver agreements related to pressure-measurement devices
What pressure-measurement devices do the authors recommend use of?
Water manometer with built in gauge OR Water manometer with ruler
Devriendt VS 2022 - Evaluation of different blood tests in dogs with extrahepatic portosystemic shunts to assess shunt closure after surgical treatment
Which test had the greatest sensitivity?
Which test had the greatest specificity?
What tests do the authors recommend?
Fasting Ammonia
Serum Hyaluronic acid, MEGX
Monoethylglycylxylidide (15 mins after lidocaine administration) with SHA, FA or postprandial bile acids
Sunlight VS 2022 - Protein C and comparative biochemical changes in dogs treated with percutaneous transvenous coil embolization of congenital intrahepatic portosystemic shunts
What is protein C?
What was higher post-operative protein C associated with?
Protein C (PC) is a liver-synthesized glycoprotein that causes antithrombotic effects through the inactivation of factors Va and VIIIa.
Better ultimate clinical status
Complete occlusion
Spies VS 2024 - Clinical presentation and short-term outcomes of dogs ≥15 kg with extrahepatic portosystemic shunts
What was the most common breed affected?
What were the two most common shunt morphologies?
Short term complication rate?
Shunt-related mortality?
Medical management discontinued in what % managed with surgical attenuation?
Golden retrievers
Portocaval, Splenocaval
36%
7%
38%
Reduced in 23%
White JSAP 2020 - Classification of portosystemic shunts entering the caudal vena cava at the omental foramen in dogs
What was the last vessel communicating with the caudal vena cava in all the shunt morphologies?
What was the most common shunt? How did it differ to the others?
Left gastric vein
LGV subtype RGV (-) (see pic)
No shunt flow through RGV
Glenn JSAP 2020 - Short- and long-term outcomes of polyethylene band attenuation of congenital extrahepatic portosystemic shunts in dogs: 60 cases (2010-2020)
Complication rate %?
Peri-op mortality %?
Persistent shunting %?
Excellent-good outcome %?
17%
7%
17%
82%
68% did not require ongoing medications
Joffe VS 2019 - Evaluation of different methods of securing cellophane bands for portosystemic shunt attenuation
Which was the most secure way of securing cellophane bands?
- 3-layer cellophane with medium-large titanium ligature clip
- 4-layer cellophane with medium polymer locking ligation clip
- 3-layer cellophane with medium polymer locking ligature clip
- 4-layer cellophane with medium-large titanium ligature clip
- 4-layer cellophane with medium-large polymer lockingligatureclip
4-layer cellophane with medium polymer locking ligation clip
3-layer cellophane bands more likely to fail (vs 4 layer)
Medium-large clips failed more often (c.f. medium clip)
Ligature clip material did not affect strength
Burger JAVMA 2023 - Dogs with congenital extrahepatic portosystemic shunts that have persistent shunting after surgery have a higher prevalence of urolithiasis
What % of dogs with MAPSS had urolithiasis at long term follow up?
67%
Nephroliths got smaller in the closed EHPSS group
Solari JSAP 2024 - Outcome of dogs diagnosed with concurrent intrahepatic portosystemic shunts and vertebral lesions: six cases (2016-2022)
What tx was performed?
Cephalexin or Amoxiclav for 4months and @2m endovascular attenuation
Tinoco-Najera JSAP 2021 - Risk factors for urinary bacterial growth in dogs with congenital portosystemic shunts: 66 cases (1997-2019)
What % of dogs had urinary tract abnormalities on US?
75% (pyuria, bacteriuria and haematuria)
Bacteriuria was associated with a greater risk of +ve culture
Carrera JAVMA 2022 - 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)
What % of PANS resolved by discharge?
Recurrence of seizures observed in what %?
48% (69% of remaining dog’s PANS resolved over time)
Recurrence of seizures in 50%
But 90% of dogs survived >6m
ONLY DOGS THAT SURVIVED UP TO 30 DAYS WERE INCLUDED
Carroll VS 2021 - Feasibility of thoracoscopic attenuation of the azygos vein as a model for portoazygos shunts: A canine cadaveric study
Describe the thoracoscopy port positions used
Three thoracoscopic ports were established in the right hemithorax at the mid-10th intercostal space and dorsal third of the ninth and 11th intercostal spaces
Mullins VS 2020 - Prognostic factors for short-term survival of dogs that experience post-attenuation seizures after surgical correction of single congenital extrahepatic portosystemic shunts: 93 cases (2005-2018)
What % survived to 30 days?
What was associated with short term survival?
32%
Hx of pre-op seizures, development of focal post-attenuation seizures (c.f. generalised)
Solari JAVMA 2020 - Percutaneous transvenous coil embolization of congenital intrahepatic portosystemic shunts in small and toy-breed dogs: 20 cases (2015–2021)
What was the intra-op complication rate?
20%
Otomo VS 2020 - Long-term clinical outcomes of dogs with single congenital extrahepatic portosystemic shunts attenuated with thin film banding or ameroid ring constrictors
What was the conclusion?
Gradual attenuation of a single CEHPSS with either TFB or ARC resulted in similar long-term clinical outcomes and low postoperative morbidity and mortality rates.
Matiasovic VS 2019 - Outcomes of dogs treated for extrahepatic congenital portosystemic shunts with thin film banding or ameroid ring constrictor
What was observed?
Persistent shunting requiring revision surgery was more common with TFB (29%) than ameroid constrictor (0%)
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
What was the reported peri-op mortality rate?
Survival time was longer with surgery (10.9y) than medical management (3.4y).
Continued clinical signs at 6-12 months after more common with medical management.
7%
Anglin JAVMA 2021 - Clinical characteristics of, prognostic factors for, and long-term outcome of dogs with multiple acquired portosystemic shunts: 72 cases (2000–2018)
What was the MST for MAPSS?
What factors were associated with less risk of dying from MAPSS?
580d
@ time of 1st presentation - not being on medical management or having normal mentation
Veytsman VS 2023 - Retrospective study of 20 cats surgically treated for insulinoma
What were the most common presenting signs?
What % had immediate normal or raised Glu post-op?
MST?
Negative px factors included
100% hypoGlu
90% neuro signs
90%
863d (2.5y)
Young age, low serum [Glu], mets @ time of surgery, tumour invasion and shorter time to euglycaemia
Brad Case VS 2024 - Laparoscopic partial pancreatectomy of the left limb using a harmonic scalpel in nine cats
What two complications were observed? How were they managed?
What was the long term effect of this biopsy technique?
Intraop haemorrhage (caudal splenic vein) and post-op sterile pancreatitis
TLI decreased by 37%
Myers-Nodes JSAP 2022 - Combined surgical and medical management of a cat with gastrinoma
What cell is implicated in the formation of a gastrinoma?
What is the IHC marker for gastrinoma?
What is the secondary condition that occurs with gastric ulceration and gastrinoma?
What chemotherapy was used?
Delta cells - usually secrete somatostatin but with neoplastic transformation they secrete gastrin
Gastrin
Zollinger-Ellison syndrome
Toceranib (can use octerotide)
Coss JSAP 2021 - The appearance of canine insulinoma on dual phase computed tomographic angiography
What is the common appearance of canine insulinoma on dual phase computed tomographic angiography?
82% of insulinomas are hyperattenuating on arterial phase
Ryan JSAP 2021 - Clinical findings, neurological manifestations and survival of dogs with insulinoma: 116 cases (2009-2020)
What were the most common clinical signs?
What was the MST for surgery and medical management?
What factor was ass. with survival?
Weakness, seizures, change in conciousness/behaviour
Sx - 20m
Med - 8m
Performing surgery improved survival
Presence of mets reduced survival
Poggi VS 2024 - Laparoscopic resection of pancreatic masses in 12 dogs
What was the conversion rate?
Intra-op complication rate?
Post-op complication rate?
What do the authors recommend regarding case selection?
0%
3/12 - 25% - 2x minor bleeding, 1x loss of pneumoperitoneum
4/12 - 33% - vomiting, seizure, hyperglycaemia
Small (<60mm diameter) neoplasms in right or left pancreatic lobe that have not invaded vital structures or metastasized.
Wolfe JSAP 2022 - Perioperative outcomes in dogs and cats undergoing pancreatic surgery: 81 cases (2008-2019)
What were the most common diagnoses for dogs and cats?
Mortality rate for dogs and cats?
Islet cell carcinoma - dogs
Pancreatitis - cats
11% dogs, 21% cats
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)
How did the survival rates compare between medical and surgical patients?
No stat difference - 95% surgical patients survived vs 57% medical
BUT @ 2 and 12m, significantly more surgical patients alive
Cruciani VS 2022 - Left pancreaticoduodenostomy after removal of the right lobe and the head of the pancreas in a cat
How does the pancreatic duct anatomy differ in a cat than a dog?
80% of cats have a single pancreatic duct which fuses to the CBD proximal to the major duodenal papillae
Griffin VS 2020 - Percutaneous radiologically guided gastrostomy tubes: Procedural description and biomechanical comparison in a canine model
Briefly describe placement of the G-tube
What was the conclusion of the study?
Orogastric tube placed & stomach insufflated. 3 T-fasteners placed to pexy stomach to body wall caudal to last rib. Gastrostomy tube inserted using Seldinger technique & fluoro used to confirm position.
RGT placed flaster than PEG tubes AND had a greater construct strength
Elmenhorst JSAP 2020 - Retrospective study of complications associated with surgically-placed gastrostomy tubes in 43 dogs with septic peritonitis
What 2 gastrostomy tubes are assessed?
What was the major complication rate?
What was the minor complication rate? Name some of the minor complications seen?
De Pezzer - mushroom tip
Foley
0% major
25% minor
Discharge around tube site, tube tip separated at time of removal (passed in faeces)
Camacho JSAP 2024 - Complication rates associated with nasoesophageal versus nasogastric feeding tube placement in dogs and cats: a randomised controlled trial
What % of tubes were misplaced in resp tract?
What was the most consistent way to check if tube was in oesophagus? and trachea?
Overall rate of complications was?
3%
Presence of negative pressure (86%)
Capnograph
26%
Perondi JSAP 2021 - Oesophagostomy tube complications in azotaemic dogs: 139 cases (2015 to 2019)
What was the overall complication rate? How were they split minor/major?
What factors were associated with the risk for complications?
50%
Minor 89% Major 11%
O-tube indwelling time and use of haemodialysis
