SURGERY OF THE LIVER

Question 1

Large, vascular, glandular, organ, Responsible for metabolism, Filter
Just behind the xiphoid

Answer 1

liver

Question 2

indications for liver sx

Answer 2

tumor removal, biopsy, trauma

Question 3

52% of liver surgeries

Answer 3

tumor removal

Question 4

drug that lowers seizure threshold

Answer 4

acepromazine

Question 5

Intravenous ___ should be avoided in dogs with liver dysfunction, because it can cause severe congestion → poor blood flow, poor oxygen perfusion → death of a lobe (would require removal of the dead lobe)

Answer 5

morphine

Question 6

pre-op concerns for patients with impaired liver function

Answer 6

hepatic condition
drugs - acep,morphine, ketamine, barbiturates
sedative type

Question 7

Matt’s choice for sedative

Answer 7

isoflurane

Question 8

Safer to be given as sedative VS ketamine in liver patients

Answer 8

diazepam

Question 9

good choice antibiotics

Answer 9

Penicillins, metronidazole, clindamycin

Question 10

Avoid hepatotoxic antibiotics like

Answer 10

chloramphenicol, erythromycin, chlortetracycline

Question 11

keep in mind that complcications may arise from the ff

Answer 11

friable tissue
sharp dissection
hemorrhage
pathogens

Question 12

incision approach

Answer 12

cranial high, below last strenebrae

Question 13

How can you remove a lobe or mass w/out causing massive bleeding if you do not have electrocautery/ cryogenic cautery?

Answer 13

do the guillotine technique

Question 14

when doing guillotine technique, cut _mm distal to ligature

Answer 14

5

Question 15

For non-apex/non-distal mass removal
Saves healthy tissue

Answer 15

Overlapping Guillotine Method

Question 16

How to know if you are poking the right area?

Answer 16

ultrasound
smt endoscope

Question 17

has High yield tissue acquisition
Get a lot of good tissue through just poking; no need to cut

Answer 17

non-excisional biopsies needle

Question 18

IX:
Peripheral hepatic arteriovenous fistulae
Focal hepatic neoplasia
Hepatic abscess
Hepatic trauma

Answer 18

HEPATECTOMY/PARTIAL LOBECTOMY

Question 19

IX:
Focal hepatic lesions involving > 1 hepatic lobe (larger)
Encompasses 1 hepatic lobe
Traumatic lacerations of the liver
fights/severe injuries
Hepatic arteriovenous fistula
Wala ng nagfoflow na oxygen
Removal of the entire lobe that is necrotic

Answer 19

COMPLETE LOBECTOMY AND HEPATECTOMY

Question 20

left lobe:
____ ligature
secure ligation at ____ of lobe

Answer 20

encircling
base

Question 21

right lobe:
careful dissection and

Answer 21

Isolate & ligate specific blood vessels and ducts

Question 22

occlusion supplies

Answer 22

umbilical tape
sterile/surgical rubber tubing

Question 23

liver is regenerative

Answer 23

liver

Question 24

ideal color liver and GB

Answer 24

brown
liget to dark green

Question 25

Definition of terms: 1. Chole- / Chol(o) 2. Cholelith/iasis 3. Cholecystitis 4. Choledocho 5. Cholangitis 6. Cholangiole

Answer 25

1. [Gr] Bile 2. Gallstones — formation in the gall bladder 3. Gall bladder inflammation 4 [Gr.] Bile ducts 5 Bile duct inflammation 6 Smallest duct collecting bile

Question 26

Opening of the GB (common)

Answer 26

cholecystotomy

Question 27

GB removal

Answer 27

cholecystectomy

Question 28

Common bile duct incision

Answer 28

choledochotomy

Question 29

Common bile duct & duodenum anastomosis

Answer 29

Chole-docho-duodenostomy

Question 30

GB to duodenum anastomosis

Answer 30

Chole-cysto-duodenostomy

Question 31

GB to jejunum anastomosis

Answer 31

Chole-cysto-jejunostomy

Question 32

gallbladder sludge that becomes (in excess) thick and gelatinous making the outflow of bile impaired

Answer 32

mucocoele

Question 33

GB surgery IX

Answer 33

biliary obstruction bile leakage neoplasia

Question 34

common cause for biliary obstruction

Answer 34

triaditis

Question 35

incision approach gb sx

Answer 35

Midline, inferior to umbilicus

Question 36

most common ix of GB sx

Answer 36

CHOLECYSTECTOMY

Question 37

cut __ to the ligation

Answer 37

distal

Question 38

indicated when Outflow not good

Answer 38

cholecystectomy

Question 39

matt's reco suture material

Answer 39

vicryl mono prone to slipping

Question 40

Avoid non-absorbable sutures in:

Answer 40

Biliary tree, hepatic surgery can be cause of infection and nidus/stone formation