95. Liver and Biliary System questions Flashcards
(100 cards)
1
Q
What makes surgery of the liver and extrahepatic biliary tract technically challenging in small animals?
A
Limited mobility, high vascularity, friable hepatic tissue, and physiologically compromised patients.
2
Q
What is the approximate right-to-left mass proportion of the liver in dogs?
A
Approximately 3:2.
3
Q
Name the four main lobes of the liver in dogs and cats.
A
Left, right, quadrate, and caudate lobes.
4
Q
Which lobe is the largest in the liver of dogs and cats?
A
The left lobe.
5
Q
What separates the left lateral and medial lobes of the liver in dogs?
A
A substantial cleft.
6
Q
Which lobe of the liver forms part of the gallbladder fossa?
A
The quadrate lobe.
7
Q
Where is the caudate process of the caudate lobe usually located?
A
Near the level of the twelfth intercostal space.
8
Q
What ligament attaches the liver to the diaphragm?
A
The coronary ligament.
9
Q
Which ligament attaches the caudate lobe of the liver to the right kidney?
A
The hepatorenal ligament.
10
Q
What are the primary blood supplies to the liver?
A
The hepatic artery and portal vein.
11
Q
What percentage of blood volume and oxygen does the hepatic artery supply to the liver?
A
20% of blood volume and 50% of oxygen.
12
Q
What percentage of blood flow and oxygen does the portal vein supply to the liver?
A
80% of blood flow and 50% of oxygen.
13
Q
What does the cystic artery supply?
A
The gallbladder.
14
Q
What veins form the portal vein in dogs?
A
The cranial and caudal mesenteric veins.
15
Q
What are the main divisions of the portal vein as it enters the liver in dogs?
A
Right and left main branches.
16
Q
What is the role of Kupffer cells in the liver?
A
Phagocytosis of harmful endogenous and foreign substances.
17
Q
Which cells are responsible for bile production in the liver?
A
Hepatocytes.
18
Q
Where does the common bile duct enter the duodenum in dogs?
A
At the major duodenal papilla.
19
Q
Which vitamin is essential for coagulation factor activation in the liver?
A
Vitamin K.
20
Q
What is the hepatic arterial buffer response?
A
A compensatory mechanism where decreased portal flow increases hepatic arterial perfusion.
21
Q
Which substance’s washout is believed to influence the hepatic arterial buffer response?
A
Adenosine.
22
Q
What complication can result from bile spillage in the peritoneal cavity?
A
Bile peritonitis.
23
Q
What is the main imaging modality for evaluating the liver and biliary tract in small animals?
A
Ultrasonography.
24
Q
What is a typical sign of extrahepatic biliary obstruction on ultrasound?
A
Distention of the common bile duct.
25
What are common causes of extrahepatic biliary obstruction in dogs?
Pancreatitis, neoplasia, gallbladder mucoceles, cholangitis, and cholelithiasis.
26
What is the Pringle maneuver?
A technique involving temporary compression of the hepatic artery and portal vein to control hemorrhage.
27
What is the composition of bile?
Bile acids, bilirubin, cholesterol, phospholipids, water, bicarbonate, and other ions.
28
What pigment gives feces its brown color and results from bile breakdown?
Stercobilin.
29
What is the main function of bile salts in the intestine?
Emulsification of fats for digestion and absorption.
30
Which species has a conjoined bile and pancreatic duct just before entering the duodenum?
Cats.
31
What is the role of the sphincter of Oddi?
Regulates the flow of bile and pancreatic secretions into the duodenum.
32
Which imaging modality is commonly used for assessing hepatic blood flow and vascular anomalies?
Color-flow Doppler ultrasonography.
33
What are the three hepatic divisions in cats based on portal vein supply?
Right, central, and left divisions.
34
What role does the liver play in glucose metabolism?
Maintains plasma glucose through gluconeogenesis and glycogenolysis.
35
What occurs in cases of severe hepatic disease concerning plasma proteins?
Hypoalbuminemia due to loss of hepatic functional capacity.
36
Which liver function test is crucial before invasive procedures in animals with liver disease?
Coagulation screening.
37
What is the most common cause of extrahepatic biliary tract trauma in dogs?
Blunt abdominal trauma, often from motor vehicle accidents.
38
What imaging technique provides functional evaluation of the extrahepatic biliary tract in humans but is less common in veterinary use?
Magnetic resonance cholangiopancreatography.
39
What is a common complication in cats with extrahepatic biliary obstruction during anesthesia?
Hypotension and poor response to vasopressor agents.
40
What causes “kiwi fruit” gallbladder appearance on ultrasound?
Gallbladder mucocele.
41
How is bile peritonitis confirmed in an animal?
By comparing bilirubin concentration in abdominal fluid to peripheral blood.
42
What is a transjugular liver biopsy?
A biopsy technique performed through the jugular vein to avoid penetrating the liver capsule.
43
Which coagulation factors are synthesized in the liver but are vitamin K-dependent?
Factors II, VII, IX, and X.
44
Which liver biopsy technique is considered the least invasive?
Fine needle aspiration.
45
What is the most common complication of liver surgery?
Hemorrhage.
46
What is the purpose of bile salt supplementation in patients with biliary obstruction?
To prevent endotoxemia and improve fat emulsification in the intestine.
47
How soon after extrahepatic biliary obstruction does bile duct dilation occur in dogs?
Within 24 to 48 hours.
48
What is the main surgical approach to hepatic masses requiring complete lobectomy?
Blunt dissection with ligation, surgical stapling, or vessel sealing devices.
49
What is the likely outcome if an animal undergoes 80% hepatectomy?
Increased risk of death due to portal hypertension rather than liver failure.
50
What imaging feature distinguishes malignant from benign focal hepatic lesions in MRI?
High sensitivity (100%) and specificity (86%) in one study.
51
Which liver lobe is most commonly divided into two sublobes? Options: A) Right medial | B) Left lateral | C) Left medial | D) Quadrate
B) Left lateral
52
What is the primary attachment of the liver to the diaphragm? Options: A) Hepatorenal ligament | B) Hepatoduodenal ligament | C) Coronary ligament | D) Gastrohepatic ligament
C) Coronary ligament
53
What is the usual location of the right lateral lobe of the liver in relation to the median plane in dogs? Options: A) To the right of the median plane | B) To the left of the median plane | C) Directly on the median plane | D) Near the caudate process
A) To the right of the median plane
54
The caudate process of the caudate lobe extends to which intercostal space? Options: A) 8th | B) 10th | C) 12th | D) 14th
C) 12th
55
Which blood vessel supplies the most oxygen to the liver? Options: A) Portal vein | B) Hepatic artery | C) Vena cava | D) Mesenteric artery
B) Hepatic artery
56
The right middle branch of the hepatic artery supplies which liver lobe? Options: A) Left medial lobe | B) Caudate lobe | C) Right medial lobe | D) Left lateral lobe
C) Right medial lobe
57
Which ligament loosely surrounds the papillary process of the liver? Options: A) Hepatoduodenal ligament | B) Lesser omentum | C) Coronary ligament | D) Hepatorenal ligament
B) Lesser omentum
58
What percentage of blood flow to the liver is provided by the portal vein? Options: A) 10% | B) 20% | C) 50% | D) 80%
D) 80%
59
In dogs, how many branches does the portal vein usually divide into upon entering the liver? Options: A) One | B) Two | C) Three | D) Four
B) Two
60
What is the primary function of bile salts? Options: A) Emulsify fats | B) Maintain blood pressure | C) Regulate blood sugar | D) Provide immune defense
A) Emulsify fats
61
In cats, which duct merges with the bile duct just before entering the duodenum? Options: A) Accessory pancreatic duct | B) Primary pancreatic duct | C) Hepatic duct | D) Mesenteric duct
B) Primary pancreatic duct
62
Which structure regulates the flow of bile and pancreatic secretions into the duodenum? Options: A) Portal vein | B) Sphincter of Oddi | C) Hepatogastric ligament | D) Hepatic duct
B) Sphincter of Oddi
63
Kupffer cells in the liver are primarily responsible for which function? Options: A) Producing bile | B) Storing glycogen | C) Phagocytosis | D) Blood pressure regulation
C) Phagocytosis
64
Which coagulation factors are dependent on vitamin K for activation? Options: A) I, II, III, IV | B) II, VII, IX, X | C) III, V, VIII, IX | D) VI, VIII, XI, XII
B) II, VII, IX, X
65
A significant liver injury due to blunt trauma in dogs often results in damage to which area? Options: A) Left medial lobe | B) Right medial lobe | C) Common bile duct | D) Quadrate lobe
C) Common bile duct
66
Which imaging modality is most effective for detecting focal liver lesions? Options: A) CT scan | B) Radiography | C) Ultrasonography | D) MRI
C) Ultrasonography
67
The Pringle maneuver temporarily compresses which two structures? Options: A) Hepatic artery and portal vein | B) Vena cava and hepatic artery | C) Common bile duct and portal vein | D) Coronary ligament and vena cava
A) Hepatic artery and portal vein
68
Which imaging technique is least useful for assessing liver size in dogs? Options: A) Radiography | B) Ultrasonography | C) MRI | D) Scintigraphy
A) Radiography
69
What is the primary cause of extrahepatic biliary obstruction in dogs? Options: A) Tumors | B) Pancreatitis | C) Trauma | D) Gallbladder mucoceles
B) Pancreatitis
70
What is a major indicator of bile peritonitis in abdominal fluid? Options: A) High glucose level | B) Low bilirubin concentration | C) Elevated bilirubin concentration | D) High albumin level
C) Elevated bilirubin concentration
71
What is the function of bile pigments in the intestines? Options: A) Digestion of proteins | B) Converting fats to amino acids | C) Forming urobilinogen | D) Stimulating acid secretion
C) Forming urobilinogen
72
Which artery branches to form the hepatic artery? Options: A) Mesenteric artery | B) Aorta | C) Renal artery | D) Celiac artery
D) Celiac artery
73
Which imaging technique is used to visualize hepatic blood flow? Options: A) Doppler ultrasonography | B) Plain radiography | C) MRI | D) CT scan
A) Doppler ultrasonography
74
The majority of bile is reabsorbed and returned to the liver through which vein? Options: A) Splenic vein | B) Hepatic vein | C) Portal vein | D) Mesenteric vein
C) Portal vein
75
What commonly causes 'kiwi fruit' gallbladder appearance on ultrasound? Options: A) Cholecystitis | B) Gallbladder mucocele | C) Bile duct stricture | D) Liver tumor
B) Gallbladder mucocele
76
What liver function is associated with the production of bile acids? Options: A) Gluconeogenesis | B) Cholesterol metabolism | C) Lipogenesis | D) Protein synthesis
B) Cholesterol metabolism
77
Which technique is used to sample liver tissue through a jugular approach? Options: A) Fine needle aspiration | B) Wedge biopsy | C) Transjugular biopsy | D) Punch biopsy
C) Transjugular biopsy
78
Which type of liver biopsy is least invasive? Options: A) Transjugular biopsy | B) Wedge biopsy | C) Tru-Cut needle biopsy | D) Punch biopsy
C) Tru-Cut needle biopsy
79
Which of the following is NOT typically stored in the liver? Options: A) Glycogen | B) Vitamins | C) Glucose | D) Fat
C) Glucose
80
The accessory pancreatic duct is usually larger in which species? Options: A) Cats | B) Dogs | C) Rabbits | D) Horses
B) Dogs
81
Bile duct obstructions are most commonly seen in cats due to: Options: A) Pancreatitis and cholangiohepatitis | B) Trauma and tumors | C) Gallstones and mucoceles | D) Foreign body ingestion
A) Pancreatitis and cholangiohepatitis
82
Hypoalbuminemia in liver disease is due to: Options: A) Reduced bile flow | B) Reduced protein synthesis | C) Increased blood flow | D) Hepatic artery occlusion
B) Reduced protein synthesis
83
Which ligament attaches the liver to the lesser curvature of the stomach? Options: A) Hepatorenal ligament | B) Gastroduodenal ligament | C) Hepatogastric ligament | D) Hepatoduodenal ligament
C) Hepatogastric ligament
84
What is the role of albumin in the blood? Options: A) Store iron | B) Bind and transport molecules | C) Produce bile | D) Coagulate blood
B) Bind and transport molecules
85
What does the hepatic arterial buffer response do? Options: A) Regulates bile secretion | B) Increases arterial perfusion in response to decreased portal flow | C) Stores glucose | D) Increases portal flow to manage systemic blood pressure
B) Increases arterial perfusion in response to decreased portal flow
86
Which vitamin deficiency is most likely to affect coagulation factors due to liver dysfunction? Options: A) Vitamin A | B) Vitamin D | C) Vitamin E | D) Vitamin K
D) Vitamin K
87
What structure does the hepatic artery pass through before reaching the liver? Options: A) Epiploic foramen | B) Coronary ligament | C) Hepatogastric ligament | D) Hepatorenal ligament
A) Epiploic foramen
88
Which hepatic ligament is most commonly involved in attaching the liver to the diaphragm? Options: A) Left triangular ligament | B) Hepatoduodenal ligament | C) Coronary ligament | D) Hepatorenal ligament
C) Coronary ligament
89
Which liver lobe is most commonly associated with gallbladder attachment? Options: A) Right lateral lobe | B) Quadrate lobe | C) Caudate lobe | D) Left medial lobe
B) Quadrate lobe
90
Which enzyme level is typically elevated in dogs with bile duct obstruction? Options: A) Amylase | B) Creatinine | C) Alkaline phosphatase | D) Lipase
C) Alkaline phosphatase
91
What is the purpose of the Pringle maneuver during liver surgery? Options: A) Control hemorrhage | B) Increase liver blood flow | C) Stimulate bile secretion | D) Decompress the portal vein
A) Control hemorrhage
92
In cats, which pancreatic duct is usually absent? Options: A) Accessory pancreatic duct | B) Primary pancreatic duct | C) Cystic duct | D) Hepatic duct
A) Accessory pancreatic duct
93
How does obstructive jaundice affect liver function? Options: A) Increases glycogen storage | B) Impairs Kupffer cell activity | C) Enhances bile production | D) Reduces cholesterol synthesis
B) Impairs Kupffer cell activity
94
What is the most common cause of bile peritonitis in dogs? Options: A) Trauma | B) Liver tumor | C) Pancreatitis | D) Hepatic cysts
A) Trauma
95
Which vessel provides 95% of blood supply to liver tumors? Options: A) Hepatic artery | B) Portal vein | C) Vena cava | D) Splenic artery
A) Hepatic artery
96
Which technique is used to control capsular hemorrhage during liver surgery? Options: A) Hemostatic sponges | B) Portal vein ligation | C) Blunt dissection | D) Pringle maneuver
A) Hemostatic sponges
97
What is a common side effect of extensive liver resection in dogs? Options: A) Hypercalcemia | B) Hypoglycemia | C) Cardiac arrhythmia | D) Renal failure
B) Hypoglycemia
98
What substance is produced by hepatocytes to aid in fat digestion? Options: A) Bilirubin | B) Gastrin | C) Bile acids | D) Glucagon
C) Bile acids
99
Which diagnostic test is most sensitive for assessing liver function in dogs? Options: A) CT scan | B) MRI | C) Scintigraphy | D) Blood glucose level
C) Scintigraphy
100
What is a common finding in abdominal ultrasound of a dog with extrahepatic biliary obstruction? Options: A) Enlarged spleen | B) Distended common bile duct | C) Dilated renal pelvis | D) Shrunken liver lobes
B) Distended common bile duct
