Surgery of the Liver and Extrahepatic Biliary Tract Flashcards
when would a liver lobectomy be useful?
abscess
neoplasia
what is the most common surgery of the liver?
liver biopsy
are cats or dogs more likely to get concurrent inflammation of liver, pancreas and more hepatobiliary complications/
cats
what are some indications for surgery?
extrahepatic obstructive disease
rupture of biliary tract
diseased gallbladder with impending rupture
can your physical exam or routine diagnostics differentiate intra-hepatic from post-hepatic icterus?
no
what can be seen on radiographs with extra-hepatic biliary tract disease?
hepatomegaly
mineralization of or stones in gallbladder
abdominal gas/fluid
gas in gallbladder
what is the best diagnostic tool for extra-hepatic biliary tract disease?
abdominal ultrasound
what can cause non-septic inflammation in abdominocentesis?
bile peritonitis
pancreatitis
other inflammatory disorders
how does cholecystitis happen?
bloodborne bacteria from hepatic circulation
duodenopancreatic reflux
what causes a temporary obstruction in chronic pancreatitis?
pancreatic inflammation
what is a gall bladder mucocele?
mucosal hyperplasia
mucin hypersecretion
when and where is cholecystokinin released?
fat-induced from enterochromaffin cells in proximal duodenum
what does cholecystokinin do?
decreases gastrointestinal motility
contracts gall bladder
when is a cholecystotomy indicated for a gall bladder mucocele?
symptomatic
which endocrine disease are mucocele dogs more likely to have?
hyperadrenocorticism
what should you check prior to performing a cholecytectomy?
patency of common bile duct
what are the complications of a diversion?
stricture of stoma
recurrent infections
recurrence of adenoma/adenocarcinoma
where does blood come from in the normal portal system?
stomach
intestines
spleen
pancreas
what happens in a portosystemic shunt?
blood from gastrointestinal tract bypasses the liver and goes straight to the systemic circulation
which portosystemic shunts are small dogs most likely to get?
extrahepatic single congenital
which portosystemic shunts are not surgical?
microvascular dysplasia
which breeds are predisposed to extrahepatic portosystemic shunts?
yorkshire terriers
miniature schnauzers
cairn terrier
maltese
pug
where is a portocaval extrahepatic shunt?
between portal vein and vena cava
what does high blood ammonia in a shunt cause?
cerebral edema: hepatic encephalopathy
why is stranguria seen with a portosystemic shunt?
ammonium biurate urolithiasis: increased excretion of ammonia and uric acid
what on a chemistry panel would make a portosystemic shunt more likely?
decreased albumin and BUN
maybe decreased cholesterol and glucose
bilirubin normal
what can you use to attenuate the vessel in a portosystemic shunt?
ameroid constrictor
cellophane band
what type of portosystemic shunts are most common in cats?
extrahepatic: left gastric vein to left phrenic
what provides blood supply to the liver?
hepatic artery: 20%
portal vein: 80%
how often is an FNA of the liver accurate?
30%
what are the most common liver neoplasias?
hepatocellular adenoma
hepatocellular carcinoma
between which liver lobes is the gallbladder?
quadrate and right medial lobes
where do the common bile duct and pancreatic duct empty into thee duodenum in cats?
both into major duodenal papilla
accessory pancreatic duct absent
what is a specific sign of extrahepatic biliary tract disease?
icterus
not specific to extrahepatic or intrahepatic
what is a gallbladder mucocele potentially secondary to?
biliary stasis
where is the rupture usually with cholecystitis?
gall bladder
what are the two surgeries of the biliary tract?
cholecystoduodenostomy
cholecystojejunostomy
what leads to multiple acquired portosystemic shunts?
portal hypertension
which portosystemic shunts are large dogs likely to get?
intrahepatic
what is the success rate with abdominal ultrasound finding a portosystemic shunt?
100% with intrahepatic
85% with extrahepatic
how can you medically manage hepatic encephalopathy?
clavamox
lactulose
high quality, low protein diet
what does portal hypertension result in?
sludging of venous blood, splanchnic ischemia
death
hypovolemic/endotoxic shock
what is the mortality of surgery for an intrahepatic shunt?
10-25%
