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Year 1/2 > Digestion & Metabolism 2: Liver & Pancreas Sx > Flashcards

Digestion & Metabolism 2: Liver & Pancreas Sx Flashcards

1
Q

LEFT vision of the liver makes up ____% of hepatic volume

CENTRAL DIVISION…
1. what 2 lobes?
2. surrounds WHAT?

RIGHT division 2 lobes?

A

50%

CENTRAL VISION…
1. RIGHT MEDIAL & QUADRATE lobe
2. surrounds GALLBLADDER

RIGHT division…
1. RIGHT LATERAL LOBE
2. CAUDATE PROCESS of CAUDATE LOBE

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2
Q

HEPATORENAL LIGAMENT attaches…

we need to remove this WHEN

A

attaches CAUDATE PROCESS of LIVER LOBE to RIGHT KIDNEY

we need to remove this WHEN REMOVING THE KIDNEY

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3
Q

LEFT TRIANGULAR LIGAMENT LOCATION & WHAT IT ATTACHES

A

found on the LEFT AND RIGHT side of liver and ATTACH LIVER LOBES TO DIAPHRAGM

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4
Q

the HEPATIC artery is derived from the ____ ____, which comes off of the ____

supplies WHICH divisions of the liver?

A

CELIAC ARTERY, AORTA

supplies RIGHT, CENTRAL & LEFT portions

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5
Q

PORTAL VEIN is high in ____ factors, called ___ & ____ which are IMPORTANT for _____ _____

PORTAL VEIN made up of WHAT 4 other vessels? what do they drain?
–> which vessel is ONLY IN DOGS & NOT CAT

A

HEPATOTROPHIC, GLUCAGON & INSULIN, LIVER DEVELOPMENT

4 vessels that make up portal vein?
1. CRANIAL MESENTERIC VEINS
2. CAUDAL MESENTERIC VEINS
3. GASTROSPLENIC VEINS
4. GASTRODUODENAL VEIN (DOGS ONLY)

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6
Q

liver starts REGENERATION within ____ following RESECTION

with STAGED hepatectomies, can allow for up to ____% of hepatic volume

A

HOURS, 95%

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7
Q

4 indications for LIVER SURGICAL INTERVENTION?

which one is COMMONLY DONE?

A
  1. DIAGNOSTIC BIOPSY (COMMONLY DONE)
  2. LOBAR DZ
    –> NEOPLASIA
    –> ABSCESS
    –> TORSION of LIVER LOBE
  3. TRAUMA
  4. CONGENITAL ABNORMALITY such as PORTOSYSTEMIC SHUNT
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8
Q

SCREENING B/W FINDINGS for PRIOR to LIVER SURGERY? (4)

A
  1. ELEVATION in HEPATOCELLULAR ENZYMES ALT, AST
  2. HYPERBILIRUBINEMIA
  3. HYPOGLYCEMIA
  4. DECREASED BUN
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9
Q

if liver LOBE TORSION or ABSCESSATION, what CBC finding can we expect?

A

LEUKOCYTOSIS

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10
Q

if LARGE LIVER TUMOR, can cause _____ syndrome & WHAT CBC finding?

A

PARANEOPLASTIC, THROMBOCYTOSIS

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11
Q

what 3 PREOP diagnostics should we do for the LIVER?

A
  1. SCREENING B/W
  2. COAGULATION PROFILES
  3. URINALYSIS
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12
Q

on _____ RADS for LIVER DISEASE, what 3 things should we look for?

A

THORACIC rads

3 things?
1. SPACE OCCUPYING MASS
2. EFFUSION/loss of abdominal detail
3. evidence of METASTASIS

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13
Q

CONTRAST ENHANCED HARMONIC US…

what 2 things are administered?

why is the second thing given?

what is overall shown?

A

2 things?
1. CONTRAST MEDIA
2. GAS-FILLED MICROBUBBLES

micro bubbles given because they HAVE A HIGH DEGREE OF ECHOGENICITY

can help IMAGE BLOOD FLOW & TUMORS that TAKE UP A LOT OF BLOOD

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14
Q

on US, ____ DISEASED liver should be ____echoic CENTER with ____RIM

A

MALIGNANT

HYPERECHOIC center with HYPOECHOIC RIM

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15
Q

when are CTs performed for liver patients?

A

usually for LARGE LIVER TUMORS to ensure NO METASTASIS

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16
Q

how is a LIVER BIOPSY PERFORMED on SUPERFICIAL PERIPHERAL LIVER TUMOR? (2 easy steps)

A
  1. take HEMOSTAT & CRUSH TISSUE around TUMOR
  2. then, CUT IT OFF
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17
Q

liver biopsy steps for DEEPER lesion? (3 steps, last is what occurs at the site)

A
  1. DERMAL PUNCH
  2. fill hole with HEMOSTATIC AGENT
  3. promotes HEMOSTASIS at site
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18
Q

what is the MOST COMMON PROCEDURE for SA LIVER?

4 indications?

WHAT dictates the TECHNIQUE? (2)

what DIVISION of the liver is BEST SUITED FOR THIS?

A

MOST COMMON = LIVER LOBECTOMIES

4 indications?
1. NEOPLASIA
2. ABSCESSES
3. LIVER LOBE TORSION
4. METASTASIS

TECHNIQUE dictated by…
1. LOCATION of tumor
2. SIZE of tumor

the LEFT division of the liver BEST FOR COMPLETE LOBECTOMY

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19
Q

most RIGHT and CENTRAL division of liver get THIS kind of surgery….

if CENTRAL, usually ALSO REQUIRES…

A

RIGHT & CENTRAL = make PARTIAL LOBECTOMIES

if CENTRAL, usually ALSO REQUIRE GALLBLADDER REMOVAL

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20
Q

if there’s a HEPATIC NEOPLASIA, tends to be ___

most common PRIMARY hepatic neoplasia in…
DOGS = ???
CATS = ???

what 3 OTHER primary neoplasias are possible?

A

METASTATIC

PRIMARY hepatic neoplasia in…

DOGS = HEPATOCELLULAR ADENOCARCINOMA

CATS = BILIARY ADENOCARCINOMA

other 3 primary?
1. HEPATOCELLULAR ADENOMA
2. NEUROENDOCRINE CARCINOMA
3. MESENCHYMAL TUMORS

21
Q

HEPATIC NEOPLASIA…

common age?

4 ___-___ clinical signs…

possibly can PALPATE….

HEMOABDOMEN common in ____ > ____

3 clinical signs secondary to LIVER FAILURE?

A

age = 9-12 YEARS

4 NON-SPECIFIC signs…
1. LETHARGY
2. ANOREXIA
3. WEIGHT LOSS
4. VOMITING

possibly can PALPATE abdominal mass

HEMOABDOMEN common in CATS > DOGS

3 clinical signs secondary to LIVER FAILURE…
1. ICTERUS
2. POOR BODY CONDITION
3. ASCITES

22
Q

HEPATOCELLULAR CARCINOMA…

most common PRIMARY liver tumor in ___

tends to show ___ necrosis, but can also have these other 2 types

most commonly affects the ___ LOBE

most common site of metastasis?

PROGNOSIS?

A

DOGS

tends to show MASSIVE necrosis, but also…
1. MULTIFOCAL
2. DIFFUSE

most commonly affects the LEFT lobe

LNs most common site of METASTASIS

PROGNOSIS for MASSIVE GENERALLY GOOD if SURGICAL INTERVENTION

23
Q

NEUROENDOCRINE CARCINOMA…

AKA?

categorize this!

involved with ______ SYNTHESIS

___ involvement of the liver

commonality?

metastasis?

prognosis?

A

AKA CARCINOID

involved with HORMONE SYNTHESIS

PRIMARY liver neoplasia

DIFFUSE involvement of the liver

RARE in DOGS/CATS

HIGH rate of metastasis

POOR prognosis

24
Q

MESENCHYMAL TUMORS…

can RARELY be ___, mostly ____

tends to be ____ & involve MULTIPLE ____

treatment?

prognosis?

A

can RARELY be PRIMARY, mostly SECONDARY/COMMON SITE OF METASTASIS

tends to be NODULAR & involve MULTIPLE LOBES

treatment = SURGERY

prognosis = GUARDED

25
Q

HEPATIC ABSCESS…

commonality?

risk factor?

1 clinical sign in DOGS & 1 in CATS?

what is a common cause?

in DOGS, presents as ___ lesions but ___ lesions in cats

higher MORTALITY ___ > ___

A

RARE in dogs & cats

DIABETES is risk factor

clinical signs?
DOGS = PYREXIA
CATS = HYPOTHERMIC

a common cause is E. COLI

in DOGS, presents as SOLITARY, while in CATS it’s MULTIFOCAL

higher MORTALITY CATS > DOGS

26
Q

LIVER LOBE TORSION…

commonality?

more common in ___ ____ liver lobe

see what 2 CBC findings?

on PE, can see what 2 signs?

treatment & response?

A

RARE

more common in LEFT LATERAL liver lobe

CBC…
1. LEUKOCYTOSIS
2. INCREASED ALT

on PE…
1. CRANIAL ABDOMINAL MASS
2. ABDOMINAL PAIN

respond VERY WELL To RESECTION

27
Q

what is the MOST COMMON COMPLICATION for LIVER PROCEDURES?

what 2 INCISION locations would be adequate for a LARGE RIGHT-SIDED TUMOR?

what 4 things should we keep nearby during liver sx?

what CBC complication can we see with liver sx?

A

MOST COMMON COMPLICATION = HEMORRHAGE

2 INCISION locations for LARGE R-SIDED TUMOR..
1. STERNOTOMY
2. PARACOSTAL INCISION

4 things NEARBY…
1. BLOOD PRODUCTS
2. VITAMIN K
3. VENTILATOR SUPPORT
4. ANTIBIOTICS

CBC…
–> HYPOGLYCEMIA

28
Q

why does HEPATIC disease cause an INCREASED RISK for HEMORRHAGE and THROMBOSIS?

A

liver helps produce PROCOAGULANT (vitamin K) and ANTICOAGULANT SUBSTANCES, so either CLOTS or BLEEDS TOO MUCH

29
Q

what 3 blood products should we PRETREAT patients with PRIOR to liver surgery?

A
  1. FRESH WHOLE BLOOD
  2. FRESH FROZEN PLASMA
  3. VITAMIN K
30
Q

HYPOGLYCEMIA & HEPATIC dz…

commonality?

likely in WHAT AGE patients? also more likely in 2 other patient scenarios?

A

UNCOMMON

more likely in…
1. YOUNG animals
2. SMALL DEBILITATED patients
3. patients undergoing EXTENSIVE HEPATECTOMY

31
Q

what kinds of drugs should we AVOID giving to an animal with hepatic disease?

what’s a SPECIFIC example?

A

avoid drugs that undergo EXTENSIVE HEPATIC METABOLISM

SPECIFIC example = DIAZEPAM

32
Q

what is the MOST COMMON bacteria found in liver?

what other bacteria can be present?

A

MOST COMMON BACTERIA = CLOSTRIDIUM PERFRINGENS

can also see STAPH

33
Q

in HEPATOBILIARY disease, cats tended to have HIGHER LIKELIHOOD of ____ ____, with most of the ____ originating from the _____

requires WHAT treatment?

A

BACTERIAL INFECTION, BACTERIA, GI

requires BROAD-SPECTRUM COVERAGE DURING LIVER SX

34
Q

WHERE should we place LAPAROTOMY sponges for LIVER SURGERY?

if a patient has NEGATIVE PRESSURE in THORACIC CAVITY, can do WHAT?

___ ___ sutures can help IMPROVE LIVER ACCESS

A

place LAP sponges between DIAPHRAGM & LIVER

if a patient has NEGATIVE PRESSURE in THORACIC CAVITY, can MAKE AN INCISION to relieve

use GASTRIC STAY SUTURES can help IMPROVE LIVER ACCESS

35
Q

3 examples of HEMOSTATIC agents?

what do they aim to do?

A

3 examples?
1. GELATIN SPONGE
2. OXIDIZED REGENERATED CELLULOSE (promotes platelet aggregation
3. FIBRIN GLUE

aim to promote HEMOSTASIS & STOP BLEEDING

36
Q

PRINGLE MANEUVER…

when is it used?

2 steps?

how long should we hold it?

A

used for EXTENSIVE HEMORRHAGE?

2 steps…
1. place finger through EPIPLOIC FORAMEN
2. put GENTLE PRESSURE to SIMULTANEOUSLY COMPRESS PORTAL VEIN & HEPATIC ARTERY

hold for <20 MINUTES

37
Q

TOTAL HEPATIC VASCULAR OCCLUSION should be done if…

A

if there’s EXTENSIVE HEMORRHAGE

38
Q

if there’s an INTRACTABLE hemorrhage, what should we do? (2)

A
  1. HEPATIC ARTERY LIGATION
  2. +/- REMOVE GALLBLADDER
39
Q

PARTIAL hepatic LOBECTOMY…

tends to be for WHAT kinds of lesions?

can use WHAT kind of device?

perform ____ ____ of vessels

WHAT part of the liver is NOT EASILY ACCESSIBLE for this?

A

tends to be for SMALL, PERIPHERAL lesions

can use SURGICAL STAPLING device

perform BLUNT DISSECTION of vessels

HILUM is NOT EASILY ACCESSIBLE

40
Q

ID LESION

A

LARGE LIVER TUMOR

41
Q

COMPLETE hepatic LOBECTOMY…

usually performed at WHAT part of the liver?

make sure to take off the ____ LIGAMENTS

A

usually performed on the HILUS

make sure to take off the TRIANGULAR ligaments

42
Q

COMPLICATION rate of LIVER Sx is ____

what 3 structures can ACCIDENTALLY be LIGATED when performing liver sx?

A

HIGH

3 structures?
1. PORTAL VEIN
2. COMMON BILE DUCT
3. VESSELS in ADJACENT LIVER LOBE

43
Q

what should we monitor POST OP & WHY?

what should we look for on ECG?

A

monitor HEMORRHAGE post-op because MIGHT NOT BE SEEN UNDER GA

on ECG, should look for VENTRICULAR ARRHYTHMIAS/VTAC

44
Q

if a cat has PANCREATITIS, likely also has a ____ ____ ____ because most of pancreatic excretions occur through the ____ ____

A

BILE DUCT OBSTRUCTION, PANCREATIC DUCT

45
Q

3 surgical diseases of the PANCREAS?

what disease DOES NOT require sx?

A
  1. PANCREATIC ABSCESS
  2. PANCREATIC PSEUDOCYST
  3. NEOPLASIA

PANCREATITIS DOESN’T REQUIRE SX

46
Q

EXOCRINE PANCREATIC NEOPLASIA…

what is the MOST COMMON exocrine pancreatic neoplasia in dogs?

2 structures in the pancreas that are AFFECTED?

SEX, AGE & BREED likely in dogs?

age likely in CATS?

4 clinical signs?

prognosis?

A

what is the MOST COMMON exocrine pancreatic neoplasia in dogs? = ADENOCARCINOMA

2 structures in the pancreas that are AFFECTED?
1. ACINAR CELLS
2. DUCTAL EPITHELIUM

SEX, AGE & BREED likely in dogs?
1. FEMALE
2. OLDER
3. AIRDALES

age likely in CATS? = OLDER

4 clinical signs?
1. VOMITING
2. ANOREXIA
3. WEIGHT LOSS
4. ICTERUS

prognosis? = EXTREMELY POOR

47
Q

for PANCREATIC SURGERY….

should use ____ surgical technique because…

it has a ____ blood supply with the ____

need to preserve AT LEAST ONE ____ ___ in ____

A

METICULOUS surgical technique because CAN CAUSE PANCREATITIS

it has a SHARED blood supply with DUODENUM

need to preserve AT LEAST ONE EXCRETORY DUCT in DOGS

48
Q

2 SURGICAL techniques & descriptions for PANCREATIC SURGERY?

A
  1. DISSECTION & LIGATION
    –> go into LOBULES and with HEMOSTAT, ligate VESSELS/DUCTS when RESECTING
  2. SUTURE FRACTURE TECHNIQUE
    –> CRUSH through PARENCHYMA and TIE IT OFF

Year 1/2 (139 decks)

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