Ch 95 Liver and biliary system Flashcards

Question

Cholecystectomy

Answer 1

Traditional “Open” Cholecystectomy - Demonstration of common bile duct patency by duct catheterization is recommended - gallbladder is usually dissected out of the hepatic fossa before ligation of the cystic duct - cotton-tipped applicators or the single-port inner cannula of a Poole suction tip - haemostasis - Double ligation of the cystic duct and artery should be performed with 0 or 2-0 +/- over sew - area is thoroughly lavaged before closure - histopath and C&S Laparoscopic - A four-port technique (subumbilical camera port (10 mm) and three instrument ports (5 mm)) or single-port device placed at the umbilicus - Cranial retraction of the gallbladder so that the cystic duct is visible - cystic duct and artery ligation ( intracorporeal suturing, vessel sealing devices, hemostatic clips, or extracorporeally tied knots) - gallbladder is dissected out of its fossa with the aid of a vessel sealing device

Answer 2

- Cholecystoduodenostomy and cholecystojejunostomy - reroute the biliary system because the CBD is usually too small and friable to permit choledochoduodenostomy - Physiologically, a cholecystoduodenostomy should be chosen > allowing bile to continue into duodenum allows control (inhibitory feedback) of gastric acid secretion + prevent duodenal ulceration Sx - gallbladder must first be mobilized from the hepatic fossa - antimesenteric border of the duodenum. The duodenocolic ligament can be transected to increase duodenal mobility - previous flushing, that same incision in the duodenum can usually be used for anastomosis - 3-0 or 4-0 monofilament absorbable material in a separate simple continuous pattern on each side - small stoma (<2.5 cm) may predispose to obstruction from stricture formation - 30-mm Endo GIA device Complications - hemorrhage, - incisional dehiscence, - stricture of the stoma, - ascending cholangitis, - gastric ulceration

Answer 3

22 cats Fourteen cats survived long enough to be discharged from the hospital, but only 6 survived > 6 months after surgery, all of which had chronic inflammatory disease. Median survival time for cats with neoplasia (14 days) was significantly shorter than that for cats with inflammatory disease (255 days). overall prognosis for cats with EHBTO undergoing cholecystoenterostomy must be considered guarded to poor, and the incidence of perioperative complications is high.

Answer 4

- treatment of temporary, reversible extrahepatic biliary tract obstruction caused by pancreatitis or cholangiohepatitis - Palliation of malignancy and temporary drainage “Open” Choledochal Stenting Technique - A red rubber catheter of appropriate size - Care should be taken not to enter the pancreatic duct - consider small hydrophilic 0.018- or 0.035-inch guide wire - cholecystoenterostomy should be considered if not patent - cut long enough to bridge the constriction while leaving 2 to 4 cm of stent residing in the duodenum - sutured to the duodenal submucosa with one or two sutures of 2-0 or 3-0 absorbable monofilament - human stent > flaps to prevent migration - success in dogs > no extrahepatic biliary tract reobstructions occurred - cats > small lumen prone to reobstruction - Spontaneous passage of the stent in the feces was documented - If the stent remains in place, stent removal by endoscopy 2 to 4 months postoperatively Endoscopic Retrograde Choledochal Stenting Technique - A sphincterotome is used to cannulate the major duodenal papilla, and a guide wire is advanced - successful experimentally

Answer 5

- thin walled, dehiscence after choledochotomy is of great concern. - cholelith is lodged in the common bile duct - attempt can be made to break down the often brittle choleliths through the wall of the common bile duct and milk them into the duodenum - duct incision is closed with 4-0 to 6-0 monofilament +/- stent

Answer 6

- affected animals are middle-aged to older and have nonspecific clinical signs, often include fever, abdominal pain - increased serum alkaline phosphatase, leukocytosis - Abdominal ultrasonography appears to be a sensitive tool for diagnosis - Bacterial culture most often identified E. coli - broad-spectrum antibiotics should be instituted, TX - some dogs responded well to systemic antibiotic treatment alone - ultrasound-guided drainage - surgical resection - 10 of 13 animals had a favorable outcome with various tx - Abscess recurrence was reported in some patients - percutaneous drainage and alcoholization of focal hepatic abscesses cats - multiple macroabscessation or microabscessation more common - solitary abscesses were located in the right liver lobes in cats - Cats also tended to have a worse prognosis, with 11 of 14 (79%) cats in this study being euthanized or dying

Answer 7

- middle-aged to older large-breed dogs - concurrently with liver abscessation, diaphragmatic hernia, tumor, GDV - vomiting, lethargy, and anorexia with concurrent increased serum hepatic enzyme activities and a mature neutrophilia - Doppler ultrasonography > identifying hepatic vessels with decreased blood flow. - **Torsion of the left lateral lobe** is most commonly reported - surgical emergency to avoid further hepatic necrosis, hepatic abscessation, and related sequelae > lobectomy - risk in large-breed dogs and possible ligamentous laxity > prophylactic gastropexy - Prognosis is considered excellent after prompt diagnosis

Answer 8

- underlying lesion = cystic mucosal hyperplasia. - Hypersecretion of mucus leads to an accumulation of thick, gelatinous bile within the gallbladder - Increased viscosity over weeks or months leads to filling of the entire gallbladder lumen + common bile duct and hepatic ducts. - may lead to obstruction or bile peritonitis secondary to gallbladder rupture. cause - largely unknown, but genetic factors may play a role. - Shetland Sheepdogs predisposed though not specifically to mucoceles. - A gene mutation linked to cholestatic disorders in humans was also found in dogs - Studies suggest that cholestasis, could contribute to the disease’s development. - observed association between endocrinopathies: Dogs with hypothyroidism are 3x more likely, and those with hyperadrenocorticism are 29x more likely; However, no causal relationship has been established from these studies.

Answer 9

odds of a dog with hyperadrenocorticism having a mucocele was 29.0 times greater - 21% of dogs with gallbladder mucocele had hyperadrenocorticism, compared with 2% in the control group

Answer 10

- alanine aminotransferase, alkaline phosphatase, and aspartate aminotransferase levels. - Serum bilirubin concentration is increased in most affected dogs but is often normal in early cases. - A leukocytosis is present in half of the cases ultrasonography - contains echogenic material with a typical stellate or finely striated bile pattern (“kiwi fruit” gallbladder) that differs from biliary sludge by the absence of gravity-dependent bile movement - rupture is suggested by gallbladder wall discontinuity, the presence of pericholecystic hyperechoic fat, or accumulation of fluid in the abdomen - sensitivity of ultrasonography for gallbladder rupture is 85.7% - Study, dogs with the most advanced ultrasonographic signs of mucocele were not necessarily the most likely to rupture, suggesting that ultrasonographic appearance should not be used as a sole basis for making treatment recommendations centesis - if fluid present

Answer 11

ursodiol S-adenosylmethionine famotidine - unknown success rate

Answer 12

- controversial. - Care must be taken to avoid confusing early mucocele formation with the presence of biliary sludge - No controlled studies exist to compare surgical and conservative management of incidentally discovered mucoceles - Friesen et al: death 6% elective vs 23% non-elective

Answer 13

- gallbladder mucocele is cholecystectomy - gallbladders not healthy enough to allow a viable cholecystoduodenostomy; progressive wall necrosis has been reported - Evidence is somewhat conflicting as to whether infection is common - positive cultures 0-75% - Gallbladder rupture with subsequent bile peritonitis is encountered in 23% to 60% - ensure the common bile duct is free of congealed mucus (evidence of obstruction, hyperbilirubinemia or duct distension) - Concurrent extrahepatic biliary obstruction in up to 30% of cases

Answer 14

- leakage of bile from the surgery site, - pancreatitis - reobstruction of duct with gelatinous bile - death - peritonitis - hypotension - pulmonary thromboembolism - aspiration pneumonia, - sepsis and multiple organ failure

Answer 15

- mortality rates from cholecystectomy 16% to 40% - for mucocoele 21-28% - prognosis thought to be favorable when dogs are treated early > however mortality rate still quite high! - mortality rate within 2 weeks after surgery was 7% but increased to 26% by 2 months after surgery - recent found higher death rate with non-elective compared to elective

Answer 16

- present in fewer than 1% of dogs with biliary tract disease - formation differs significantly from humans. - bile is much less saturated with cholesterol in dogs, and choleliths are typically made up of calcium carbonate (cats) or calcium bilirubinate. - Factors such as cholestasis, infection, and other conditions may contribute - In dogs, blocking the bile duct experimentally leads to cholelith formation quickly - Obstruction results in bile sludge = precursor to cholelith formation - mucoceles > overproduction of mucin forms the stones. - Infections linked to cholelith formation - Studies show high rates of positive cultures - Bile in healthy dogs is sterile, bacteria may indicate pathology. - Some bacteria produce enzymes that convert soluble bilirubin to insoluble forms

Answer 17

- one study, 26% of dogs were asymptomatic - some visible on plain abdominal radiography - Abdominal ultrasonography is an effective diagnostic imaging tool

Answer 18

- Cholecystectomy is the treatment of choice for removal of choleliths and prevention of their recurrence - choledochal choleliths are first flushed back into the gallbladder and that the patency of the common bile duct is confirmed - choledochotomy or cholecystoenterostomy may be required - mortality 3-25% - Recurrence of cholelithiasis after cholecystectomy has not been reported, fter cholecystoenterostomy has been seen

Answer 19

- four general types: hepatocellular, cholangiocellular, neuroendocrine, or mesenchymal. - Metastatic tumors are more common - Mast cell tumors found as primary or secondary tumors - usually nonspecific signs or may be secondary to hepatic failure - Laboratory abnormalities are also very variable - Hypoglycemia paraneoplastic syndrome - coagulation profile recommended > 21% of dogs with hepatocellular carcinoma had abnormal coagulation parameters

Answer 20

- rads may confirm mass - ultrasonography is useful for evaluating hepatobiliary neoplasia and to discern focal, multifocal, and diffuse disease - Contrast-enhanced harmonic ultrasonography increases the ability to differentiate between benign and malignant hepatic nodules, with sensitivity and specificity, respectively, of 100% and 94.1% - MRI and triple-phase helical computed tomography (CT) may be able to differentiate between benign and malignant biopsy - fine needle aspiration of cells, needle core biopsy, laparoscopic liver biopsy, or “open” surgical biopsy - aspirates and needle core biopsies are often not concordant - one study, only 70% of histopathologic results from needle core samples were concordant with surgical biopsy

Answer 21

Benign: - About 30% are benign adenomas, - usually asymptomatic and found incidentally Hepatocellular carcinomas (HCCs) - most common malignant - three forms: massive (61%), nodular (29%), or diffuse (10%) - The massive form in left lobe in ~ 67% of cases - low metastasis rate (4.8%) but higher at necroscopy 36%, >90% for nodular/diffuse - metastasis affects the lymph nodes (39%), lungs (38%), and peritoneum (18%). Surgery - preferred treatment for massive tumors, - MST >1460 days in one study - perioperative mortality rate was 4.8%. - not a good option for diffuse and nodular forms > incomplete surgical resection is common and the metastatic rate is high Chemotherapy and radiation therapy - generally not considered effective - Chemoembolization may be promising for nonresectable or diffuse tumors. prognosis - Dogs with nonresectable HCC have a poorer prognosis, though some can live for extended periods despite disease progression. - MST >1460 days in one study with sx for HCC Hepatocellular Tumors in Cats: - less common - adenomas more frequent than carcinomas. - Metastasis observed in 25% - There is limited information on optimal treatment and prognosis in cats.

Answer 22

* Cholangiocellular adenomas are benign bile duct tumors, accounting for 12% of primary liver tumors in dogs. * Cholangiocellular carcinoma makes up 22% of primary liver tumors in dogs. * Most bile duct carcinomas (79-92%) are intrahepatic, while 4-21% are extrahepatic, and 1-4% originate from the gallbladder. * Metastatic disease was found in 88% of cases in one necropsy study. * Carcinomas are categorized as massive (46-50%), nodular (28-54%), and diffuse (22%). * A link between cholangiocellular carcinoma and Chinese liver fluke infection exists in humans and was reported in one canine case, though evidence in most dogs and cats is lacking.

Answer 23

* Bile duct tumors are the most common primary hepatic neoplasms in cats. * Benign bile duct adenomas (biliary cystadenomas) are twice as common as bile duct carcinomas. * Prognosis for benign biliary cystadenomas is good with surgical excision, but some cases show precancerous changes. * Malignant biliary tumors have a poor prognosis, with 100% perioperative mortality in one surgical study. * Metastasis was present in 67% of cases in one necropsy study.

Answer 24

Dogs: * Hemangioma of the liver is rare, while hemangiosarcoma is more common but usually metastatic from other organs. * Primary hepatic hemangiosarcoma is present in 6% of cases and may behave differently than metastatic forms. * Other mesenchymal liver tumors in dogs include leiomyosarcoma, osteosarcoma, fibrosarcoma, mesenchymoma, and chondrosarcoma. * Surgery is the preferred treatment, but prognosis is poor due to frequent metastasis. * In a study on hepatic leiomyosarcoma, all cases had diffuse disease, and all dogs died or were euthanized in the perioperative period. Cats: * Hemangiosarcoma is the most common followed by leiomyosarcoma, rhabdomyosarcoma, osteosarcoma, and fibrosarcoma. * 35% of cats with visceral hemangiosarcoma had liver involvement, with multifocal disease being common. * Prognosis is poor, with 71% of cats euthanized perioperatively and the rest having a median survival of 77 days (range: 23-296 days).

Answer 25

- because mast cell tumor involving the liver is part of a disseminated disease process, few cases are amenable to surgery - In dogs, visceral involving the liver usually holds a grave prognosis, with no dogs surviving beyond 2 months after admission in one study. - In cats, most cases of visceral mast cell tumor originate in the spleen or intestine - cats splenectomy: MST 19 months reported, even in cases in which metastatic spread was present

Answer 26

* Rare tumors dogs: * 100% of cases involve diffuse liver involvement. * Some cases affect the gallbladder. * Metastasis occurs in 93% of cases, often spreading to the peritoneum and lymph nodes. cats: * More cases are extrahepatic, bile ducts, though some involve the gallbladder. * Metastasis is common * In some cats, (cholecystectomy) has been associated with longer survival. Prognosis - poor in both species due to the diffuse nature of the disease, making surgical excision unfeasible. * No studies exist on the effectiveness of chemotherapy or radiation therapy for these tumors.

Answer 27

Retrospective single institutional study. Animals: Eight dogs and three cats Median duration of short-term follow up was 16 days (6–45 days). Improved biochemical abnormalities and resolution of clinical signs were recorded in 10/11 cases. Two dogs died within 2 weeks of surgery Bile-duct patency was maintained for (median: 446 days) in three cats and (median: 650.5 days) in four dogs uncovered balloon-expandable metallic biliary stents should be considered as an alternative to temporary choledochal luminal stenting or cholecystoenterostomy to manage EHBO

Answer 28

NIRF cholangiography in dogs: A pilot study intraoperative cholangiography (IOC) using indocyanine green to determine the patency of the common bile duct during cholecystectomy 0.05 mg/kg of ICG administered at anesthetic premedication, or as early as 3 h prior to laparoscopic surgery should yield optimal fluorescence images.

Answer 29

Concurrent hepatopathy in dogs with gallbladder mucocele. Retrospective. 51/52 98% dogs with GBM had at least 1 hepatic histologic abnormality. Hepatic fibrosis, biliary hyperplasia and portal inflammation most common. A higher portal fibrosis score might be associated with shortened long-term survival after cholecystectomy for dogs with GBM

Answer 30

Endo GIA surgical stapling device with a vascular cartridge oozing from the transected liver parenchyma in 6/13 dogs All patients survived until discharge and were alive at the 2-week left hepatic division and in this study had low rates of intra-operative and post-operative complications.

Answer 31

The median survival time was 419 days The mean reduction percentage was 51% ± 40% History of intra-abdominal hemorrhage and large pre-TAE tumor volume/ body weight ratio could be predictive factors for adverse outcomes after TAE

Answer 32

34. Laparoscopic cholecystectomy using the subserosal layer dissection technique. fundic dissection-first technique, commonly used in human LC when excessive adhesions impede access to the cystic duct Cholecystolithiasis (n=29). Operative time was 190 minutes Subserosal layer dissection > 90% of the gall bladder bed was achieved in (79%) dogs. Conversion to open (8.8%) dogs. There were no cases of intraoperative bleeding, bile duct injury, or reoperation laparoscopic > uncomplicated cases (mucoceles and cholecystitis) conventional LC > unsatisfactory completion and complication rates reported a 20-30% open conversion rate intraoperative complications > bleeding from the liver parenchyma

Answer 33

Well-differentiated hepatocellular carcinoma, benign masses, hemangiosarcoma, and other malignant tumors accounted for 36% (72/200), 27.5% (55/200), 25.5% (51/200), and 11% (22/200) of cases, respectively. Overall survival time for all dogs was 356 days and for the above categories was 897 days, 905 days, 45 days, and 109 days The majority of dogs (63.5%) were diagnosed with well-differentiated hepatocellular carcinoma or a benign process, resulting in favorable long-term survival

Answer 34

Prospective study of 20 dogs with 21 isolated hepatic masses The radiologist was more accurate in lesion localization compared to the surgeon (P = .023). Seventeen (17/21) masses were grossly resectable in surgery. Two additional (2/21) masses that were deemed grossly resectable were incompletely excised on histopathologic analysis. Both the surgeon and radiologist were accurate in their prediction of gross resectability and complete excision. Major vascular involvement, multilobar involvement, and right-sided laterality negatively affected resectability.

Answer 35

18 of 19 (95%) surgical patients survived, while 12 of 21 (57%) medical patients survived The mortality rate of surgery for EHBO secondary to pancreatitis may be lower than previously described, and in this cohort of dogs, those treated surgically had improved survival at 2 and 12 months compared to those treated medically. 12 cholecystoduodenostomies and 3 cholecystojejunostomies. 2 CBD flushed, 1 stent There was no difference in the common bile duct diameter between the medical (mean, 7.2 mm; range, 3.4 to 11 mm) or surgical (mean, 7.1 mm; range, 3.4 to 19 mm) groups or between survivors (mean, 7 mm; range, 3.4 to 19 mm) and nonsurvivors (mean, 7.7 mm; range, 4.7 to 11 mm). In conclusion, the optimal management for pancreatitis-associated biliary obstruction remains unknown. alleviation of biliary obstruction via surgical decompression may be a reasonable therapeutic option.

Answer 36

A prospective, multicenter cohort study 25 dogs that underwent cholecystectomy for removal of GBM and 20 healthy control dogs. 76% (19/25) and 68% (17/25) of dogs survived Gallbladder perforation not associated with increase mortality

Answer 37

Retrospective. Peritoneal effusion was documented in 32/38 dogs preoperatively, with septic peritonitis confirmed in 21/23 samples A single organism was cultured in 24/35 dogs, most commonly Escherichia coli. Hepatic neoplasia was identified in 11/36 dogs. Two dogs died intraoperatively, and 6 dogs died prior to discharge. No abscess recurrence was noted Dogs treated surgically for hepatic abscessation have a high risk of perioperative complications but favorable long-term prognosis and apparent low risk of recurrence Further research is needed to determine indications for surgical treatment versus medical therapy alone

Answer 38

Retrospective. divisional location and short-term outcome.124 dogs more common in the left (72) division, central (34) and right (18) Intraoperative complications (11.3%) postoperative complications (28.7%) > more likely if the incision extended to the thorax, less likely with (TA) stapler (P = .005), by a specialist surgeon (P = .033) No association was between location and mortality (6.5%). Blood products (26.6%). intraop/postop blood transfusion occurred in 7 dogs, injury to major blood vessel occurred in 11 dogs. Right divisional masses were prone to intraoperative (haemorrgahe, greater vessel injury) but not postoperative complications. increased risk of intraoperative complications when planning treatment of right divisional masses

Answer 39

Prospective. 32 effect of flushing common bile duct during GBM Sx Flushing > normograde, routine cholecystectomy Border terriers were overrepresented (20/31). marked reductions from preoperative to 3 days postop> bilirubin, ALP ALT, GGT no difference in any marker between groups. Survival to discharge was 90.3% Postoperative complications high 58.1% overall No short-term clinical or clinico-pathological benefits > study do not support routine flushing presence of peritoneal fluid indicator of rupture low sensitivity (29%)

Answer 40

Clinical significance: PT and aPTT testing is low yield as an elective preoperative screening test in dogs with primary liver tumors except in dogs where there is a hemoabdomen or high suspicion for hepatic hemangiosarcoma.

Answer 41

Retrospective. Animals: A total of 67 client-owned dogs Overall accuracy of mass localization was 217/292 (74.3%) by lobe and 264/300 (88%) by division. This study supports CT as a useful modality for liver mass localization based on division. CT localization to specific lobes should be interpreted with some caution.

Answer 42

Enteritis was present in 85.9% (61/71) of cases with the majority being lymphoplasmacytic (53.5%). Twelve dogs (16.9%) underwent gastrointestinal biopsies from multiple sites, which revealed the same enteritis type at each location. A total of 87.3% (n = 62) dogs survived, including 90.4% elective and 86% emergent cases. No significant differences in enteritis severity or patient survival were found between elective and emergent cases

Answer 43

bleeding was classified as minor or major when the absolute change in packed cell volume (ΔPCV) was <0 and >-6% or ⩽-6%, respectively. Complications were defined as physiologic compromise necessitating an intervention, or death. All cats had a decrease in PCV after biopsy Minor and major bleeding occurred in 13/30 (43.3%) and 17/30 (56.7%) Complications occurred in 5/30 (16.7%) cats. A transfusion or resuscitative fluids were required in three and two cats, respectively

Answer 44

Cholelithiasis was the major indication for cholecystectomy followed by cholecystitis. Intraoperative hypotension and postoperative anemia were commonly encountered. Nine cats required a postoperative blood product transfusion. Cardiopulmonary arrest and death occurred in five cats. Eighteen cats (78.3%) survived to discharge Fifteen cats survived over 6 months Perioperative mortality rate was 21.7%.

Answer 45

total mortality was 19 dogs (17%). Hypotension lasting over 10 minutes during general anaesthesia occurred in 65 dogs (54.6%), Intra-operative hypotension or the number of hypotensive episodes did not appear to be associated with in-hospital or 28-day mortality

Answer 46

Retrospective. catheterisation vs not and outcome in GBM 252. Catheterized > higher ASA, bilirubin and dilated CBD major and minor intraop complications was similar between the two groups postoperative pancreatitis > performing CBD catheterization > not different between normograde and retrograde catheterization > not more rapid rate of decline of serum bilirubin better mortality rates recently > trend toward earlier treatment catheterisation may cause reflux or temporary inflammation/occlusion

Answer 47

normograde versus retrograde catheterization of bile ducts in GBM Retrospective.117. Retrograde more postoperative concerns than normograde, but similar survival times. diplomates minimize complications. Overall mortality 13% RG > more likely to experience any postoperative complication including persistence of gastrointestinal signs Total bilirubin decreased by 70.3% after NG compared to 39.1% RG entry into the GIT tract for RG > morbidity, contributing to ileus, persistent vomiting, regurgitation, ptyalism, diarrhea, or anorexia

Answer 48

A multi-institutional retrospective case series The mortality rate was 2 (6%) out of 31 for dogs undergoing an elective cholecystectomy and 21 (23%) out of 90 for dogs undergoing a nonelective cholecystectomy. The complication rate was 52% for the elective cholecystectomy and 50% for nonelective cholecystectomy. - mortality rate: elective 2/31 (6%) vs 21/90 (23%) non-elective - 33% with gallbladder rupture - complication rate: elective 52%, non-elective 50% - majority minor - method of catheterisation: post-op hyperthermia in 35% retrograde, 4% normograde, 7% no catheterisation

Answer 49

Larger maximum dimensions and volume (positive SMD), and lower attenuation values (negative SMD) were more associated with malignancy. This meta-analysis provides the evidence base for the interpreting CT imaging in the characterization of FLL.

Answer 50

Diaphragmotomy appears safe and increases abdominal exposure of hepatobiliary lesions. The benefit of improved exposure must be carefully weighed up against the risks inherent in inducing pneumothorax. Peri-operative mortality rate was 9.7% (3/31 cases) though none of these deaths were considered attributable to diaphragmotomy. Post-operative complications were encountered in 67.9% (19/28) cases that survived the peri-operative period, of which 25.0% (7/28) suffered complications that were considered attributable or likely attributable to diaphragmotomy. These seven complications resolved following non-surgical intervention

Answer 51

Prospective cross-sectional study. Animals: Canine cadavers (n = 10). 40 mL/kg of 2.5% iohexol When assessment of all fissures was combined, measurements were obtained in 96 to 108 of 120 (80%-90%) positive contrast studies, 56 to 96 of 120 (47%-80%) negative contrast studies, and 12 to 32 of 120 (10%-27%) precontrast CT images. These results justify further studies to determine the ability to locate large hepatic masses in dogs with positive CT. Positive contrast CT peritoneography may assist treatment planning in dogs with large hepatic tumors.

Answer 52

- CUSA enables removal of parenchyma/nodules whilst preserving vasculature - blood loss: median 77ml (9.9-161) → 4.3% (0.8-23.2%) blood volume - complications: cholangiohepatitis (resolved with medical management), necrotising pancreatitis (death) - segmentectomy performed according to Couinaud classification of hepatic segments - left lateral → cranial, middle, distal segments - left medial - quadrate - caudate process, papillary process - right medial → ventral, dorsal segments - right lateral - portal branches and corresponding hepatic veins for each listed segment

Answer 53

An additional cannula was added in 12 cases. In the last 10 cases, the additional cannula was placed at the beginning of the procedure. Dissection began at the cystic duct in 11 dogs (73%). In three cases (20%), the SPAS procedure was converted to a laparotomy; two of these conversions were elective, and one was emergent. no icterus or peritonitis The rate of conversion to laparotomy was 20% Fourteen dogs were discharged from the hospital (93%) survival Short-term mortality rates between 0% and 5% have been reported after laparoscopic cholecystectomy for nonobstructed gallbladder disease. Elective cholecystectomy with laparotomy has been associated with a mortality rate of 2%.20

Ch 95 Liver and biliary system Flashcards

(80 cards)