Surgery of the Liver and Extrahepatic Biliary Tract

Question 1

when would a liver lobectomy be useful?

Answer 1

abscess
neoplasia

Question 2

what is the most common surgery of the liver?

Answer 2

liver biopsy

Question 3

are cats or dogs more likely to get concurrent inflammation of liver, pancreas and more hepatobiliary complications/

Answer 3

cats

Question 4

what are some indications for surgery?

Answer 4

extrahepatic obstructive disease
rupture of biliary tract
diseased gallbladder with impending rupture

Question 5

can your physical exam or routine diagnostics differentiate intra-hepatic from post-hepatic icterus?

Answer 5

no

Question 6

what can be seen on radiographs with extra-hepatic biliary tract disease?

Answer 6

hepatomegaly
mineralization of or stones in gallbladder
abdominal gas/fluid
gas in gallbladder

Question 7

what is the best diagnostic tool for extra-hepatic biliary tract disease?

Answer 7

abdominal ultrasound

Question 8

what can cause non-septic inflammation in abdominocentesis?

Answer 8

bile peritonitis
pancreatitis
other inflammatory disorders

Question 9

how does cholecystitis happen?

Answer 9

bloodborne bacteria from hepatic circulation
duodenopancreatic reflux

Question 10

what causes a temporary obstruction in chronic pancreatitis?

Answer 10

pancreatic inflammation

Question 11

what is a gall bladder mucocele?

Answer 11

mucosal hyperplasia
mucin hypersecretion

Question 12

when and where is cholecystokinin released?

Answer 12

fat-induced from enterochromaffin cells in proximal duodenum

Question 13

what does cholecystokinin do?

Answer 13

decreases gastrointestinal motility
contracts gall bladder

Question 14

when is a cholecystotomy indicated for a gall bladder mucocele?

Answer 14

symptomatic

Question 15

which endocrine disease are mucocele dogs more likely to have?

Answer 15

hyperadrenocorticism

Question 16

what should you check prior to performing a cholecytectomy?

Answer 16

patency of common bile duct

Question 17

what are the complications of a diversion?

Answer 17

stricture of stoma
recurrent infections
recurrence of adenoma/adenocarcinoma

Question 18

where does blood come from in the normal portal system?

Answer 18

stomach
intestines
spleen
pancreas

Question 19

what happens in a portosystemic shunt?

Answer 19

blood from gastrointestinal tract bypasses the liver and goes straight to the systemic circulation

Question 20

which portosystemic shunts are small dogs most likely to get?

Answer 20

extrahepatic single congenital

Question 21

which portosystemic shunts are not surgical?

Answer 21

microvascular dysplasia

Question 22

which breeds are predisposed to extrahepatic portosystemic shunts?

Answer 22

yorkshire terriers
miniature schnauzers
cairn terrier
maltese
pug

Question 23

where is a portocaval extrahepatic shunt?

Answer 23

between portal vein and vena cava

Question 24

what does high blood ammonia in a shunt cause?

Answer 24

cerebral edema: hepatic encephalopathy

Question 25

why is stranguria seen with a portosystemic shunt?

Answer 25

ammonium biurate urolithiasis: increased excretion of ammonia and uric acid

Question 26

what on a chemistry panel would make a portosystemic shunt more likely?

Answer 26

decreased albumin and BUN
maybe decreased cholesterol and glucose
bilirubin normal

Question 27

what can you use to attenuate the vessel in a portosystemic shunt?

Answer 27

ameroid constrictor
cellophane band

Question 28

what type of portosystemic shunts are most common in cats?

Answer 28

extrahepatic: left gastric vein to left phrenic

Question 29

what provides blood supply to the liver?

Answer 29

hepatic artery: 20%
portal vein: 80%

Question 30

how often is an FNA of the liver accurate?

Answer 30

30%

Question 31

what are the most common liver neoplasias?

Answer 31

hepatocellular adenoma
hepatocellular carcinoma

Question 32

between which liver lobes is the gallbladder?

Answer 32

quadrate and right medial lobes

Question 33

where do the common bile duct and pancreatic duct empty into thee duodenum in cats?

Answer 33

both into major duodenal papilla
accessory pancreatic duct absent

Question 34

what is a specific sign of extrahepatic biliary tract disease?

Answer 34

icterus
not specific to extrahepatic or intrahepatic

Question 35

what is a gallbladder mucocele potentially secondary to?

Answer 35

biliary stasis

Question 36

where is the rupture usually with cholecystitis?

Answer 36

gall bladder

Question 37

what are the two surgeries of the biliary tract?

Answer 37

cholecystoduodenostomy
cholecystojejunostomy

Question 38

what leads to multiple acquired portosystemic shunts?

Answer 38

portal hypertension

Question 39

which portosystemic shunts are large dogs likely to get?

Answer 39

intrahepatic

Question 40

what is the success rate with abdominal ultrasound finding a portosystemic shunt?

Answer 40

100% with intrahepatic
85% with extrahepatic

Question 41

how can you medically manage hepatic encephalopathy?

Answer 41

clavamox
lactulose
high quality, low protein diet

Question 42

what does portal hypertension result in?

Answer 42

sludging of venous blood, splanchnic ischemia
death
hypovolemic/endotoxic shock

Question 43

what is the mortality of surgery for an intrahepatic shunt?

Answer 43

10-25%