E2: Hepatobilliary (incl PSS) Flashcards Preview

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Flashcards in E2: Hepatobilliary (incl PSS) Deck (40)
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1

Between which liver lobes is the gallbladder? In which division?

Quadrate and right medial lobe

Central division

2

What is the Pringle maneuver? When is it used?

Blocking, digitally or with clamp, the portal vein and hepatic artery (main blood supply to liver) in the epiloic foramen

 

Way to occlude blood flow to the liver temporarily (for max 10-15 min) to control bleeding

3

What is a choledolchotomy?

Incision into the gall bladder duct 

4

When could you use the Guillotine technique for a liver biopsy?

When want to biopsy the periphery/margin of a liver lobe

When suspect generalzed disease and want to obtain a large sample 

5

What biopsy techniques would you use for a focal lesion, such as a tumor?

Percutaneous 

FNA

6

What should you make sure is fairly normal in texture and consistency before taking a liver biopsy via Parenchymal Fracture? What is a major disadvantage of this technique?

Liver parenchyma

Disadvantage: if bleeding occurs after hemostats are removed, it can be difficult to control; technique generally associated with greatest amount of blood loss of all biopsy techniques

7

What type of biopsy would you take if the lesion is more centrally located on the liver lobe? Which surface of the liver should biopsies be taken and why?

Punch biopsy

Convex surface (across from diaphragm), larger vessels are closer to the concave surface

Also do not penetrate more than half the thickness of the lobe

8

What can you use to control the bleeding after a small biopsy of the liver?

Absorbable gelatin sponge

 

9

What techniques can you use to prevent bleeding after a partial lobectomy?

Overlapping sutures 

Staples 

Surgities 

10

What are some common indications for a partial or complete lobectomy?

Trauma

Infection

Neoplasia

Arteriovenous fistula

11

What are the 4 main types of neoplasms that are found in the liver?

Hepatocellular

Cholangiocellular

Mesenchymal

Neuroendocrine

12

What is the most common benign liver neoplasia in the dog? Cat?

Dogs: Hepatoma

Cats: Cholangiocellular adenoma

13

What malignant neoplasm of the canine liver caries the best prognosis? Worst?

Massive adenocarcinoma of LEFT lobes

Worst: Diffuse

14

T/F: Metastatic tumors, such as HSA, are more common than primary tumors in the liver.

True

15

What is the most common cause of extrahepatic biliary tract obstruction in dogs?

Pancreatitis 

16

What dog breeds are predisposed to the development of gallbladder mucoceles?

Shelties 

Cocker Spaniels

17

What are the steps for performing a cholecystectomy?

1. Confirm patency of bile duct before removing the GB: Perform duodenostomy and catheterize major duodenal papilla (2cm distal to pylorus) and flush

2. Mobilize GB from hepatic fossa

3. Ligate cystic artery and cystic duct, remove GB

4. Flush common bile duct again and check for leakage

 

18

What are the complications associated with cholecystectomy?

Bile peritonitis- failure to adequately ligate bile duct or small ducts entering cystic duct

Bleeding- failure to ligate cystic artery

19

T/F: Incision into the common bile duct, choledochotomy, is only performed when the duct is dilated. Choleliths are often pushed into the gallbladder and a cholecystectomy is performed.

True

20

What procedure is done to temproarily relieve obstruction due to extraluminal compression? How is this done?

Bile duct stenting

Place red rubber catheter and suture into common bile duct (keeping the duct open from the inside) using an absorbable suture to the intestinal wall

When the suture disolves it dislodges the catheter into the intestines

21

What procedure can you perform if you do not have a patent bile duct, such as due to an obstruction or significant stricutre? What are complications in dogs? Cats? Who has a worse prognosis?

Biliary diversion- Cholecystoduodenostomy 

Make corresponding incisions into the duodenum and the gallbladder, then suture together so bile would flow from gallbladder into intestines

Complications- both: Leakage 

Complications-Dogs: Ascending infections, bleeding at stoma site 

Complications-Cats: High morbidity and mortality, chronic vomiting

22

When performing biliary surgery, what diagnostic samples should be obtained?

Bile (for culture)

23

How do you diagnose a bile peritonitis?

Compare fluid and serum bilirubin

If fluid >2x serum then have bile peritontis 

24

What is performed if a cholecystoduodenostomy is not possible?

Cholecystoenterostomy (attach to jejunum as far proximally as possible)

25

What are the classifications for congenital PSS?

Macrovascular - intra or extrahepatic 

Microvascular- intrahepatic

26

What are the classifications for acquired PSS? How are they caused?

Single shunt- trauma or iatrogenic

Multiple shunts- diseases causing portal hypertension

27

What is the classic signalment for extra vs intrahepatic PSS?

Extra: Small dogs and cats 

Intra: Large breed dogs 

28

Extrahepatic shunts occur when veins that should join the ____ vein, enter the __________ or ________ vein instead. 

Portal

Caudal vena cava

Azygous

29

Which veins are most commonly involved with extrahepatic PSS?

Left gastric and splenic/gastrosplenic veins 

30

An intrahepatic shunt is usually a patent ____ _____.

Ductus venosus