Hepatology - liver surgery

Question 1

How many lobes does a dog liver have? What are they?

Answer 1

6
R/L medial lobes
R/L lateral lobes
Quadrate lobe
Caudate lobe

Question 2

Should you give antibiotics when doing liver surgery?

Answer 2

Yes - IV peri-operative antibiotics are indicated even if only biopsying
Potentiated amoxycillin

Question 3

What are the 3 surgical liver biopsy techniques?

Answer 3

Crushing/haemostat technique
Guillotine technique
Biopsy punch

Question 4

What is the crushing/haemostat liver biopsy technique?

Answer 4

Clamp across tip of liver lobe, then cut after 5 mins

Question 5

What is the guillotine liver biopsy technique?

Answer 5

Suture around peripheral liver lobe
Cut after suture

Question 6

What is the punch liver biopsy technique? When is it used?

Answer 6

Punch hole in surface of liver - for focal lesions/masses

Question 7

What are the indications for liver lobectomy?

Answer 7

Biopsy
Remove mass lesion/neoplasm
Abcess
Liver lobe torsion

Question 8

How much of the liver can you remove?

Answer 8

Up to 70%

Question 9

Which side of the liver is easier to perform a lobectomy on? Why?

Answer 9

Left easier - more pedunculated so easier to ligate
Right side is close to vena cava

Question 10

What are the different liver lobectomy techniques?

Answer 10

Finger fracture - break down soft liver tissue and ligate vessels found
Mass ligation - around whole neck of lobe
Linear stapler
Overlapping mattress suture
Electrocautery

Question 11

Where is the gall bladder located?

Answer 11

Between the right medial lobe and quadrate lobe

Question 12

What is the difference in the cystic duct in the biliary tract anatomy in the cat and dog?

Answer 12

The bile flows into the gallbladder via the cystic duct which is:
Shorter and straighter in the dog
More tortuous in the cat

Question 13

What is the difference in where the bile duct enters the GI tract in dogs and cats?

Answer 13

Canine bile duct - enters duodenum near the pancreatic duct, doesnt join
Feline bile duct - joins the pancreatic duct before entering duodenum

Question 14

What are the indications for biliary tract surgery?

Answer 14

Extrahepatic biliary tract obstruction
eg. Cholelithiasis, gall bladder mucocele, pancreatitis, neoplasia
Biliary tract rupture and bile peritonitis

Question 15

What are the two surgical strategies for biliary tract surgery?

Answer 15

Cholecystectomy - remove gall bladder
Cholecystoenterostomy - secure gall bladder to intestine

Question 16

What is the most important structure to conserve in biliary tract surgery?

Answer 16

The common bile duct - better to conserve than the gall bladder

Question 17

When do you perform a cholecystectomy?

Answer 17

For treatment of gall bladder disease or traumatic rupture

Question 18

When do you perform a cholecystotomy?

Answer 18

Removing choleliths and bile sludge
Flushing cystic and common bile ducts
(rarely indicated)

Question 19

When do you perform a cholecystoenterostomy?

Answer 19

When there is complete and irreversible obstruction/rupture of the common bile duct
But gall bladder still healthy

Question 20

What are the risks of cholecystoenterostomy?

Answer 20

Leakage
Stricture
Ascendign cholangiohepatitis

Question 21

What is an alternative to cholecystoenterostomy?

Answer 21

Common bile duct stenting

Question 22

What is the prognosis of extrahepatic biliary tract surgery/

Answer 22

Significant mortality
Require intensive post op care

Question 23

What are the goals of congenital portosystemic shunt surgery?

Answer 23

Attenuate (close) shunt
Restore normal portal blood flow
Resolve hepatic insufficiency and clinical signs

Question 24

What is the problem with acute attenuation of the portosystemic shunt?

Answer 24

Concern of portal hypertension - increased pressure in GI tract causing haemorrhagic diarrhoea, abdominal bloating, death

Question 25

What are the two surgical treatments for congenital portosystemic shunt?

Answer 25

Complete attenuation - ligation
Gradual attenuation devices -
Ameroid constrictor
Cellophane band
Intravascular coil

Question 26

What are the surgical complications of congenital portosystemic shunt surgery?

Answer 26

Portal hypertension
Haemorrhage/GI bleeding
Neuro complications
Hypoglycaemia
Death

Question 27

What is the outcome of congenital portosystemic shunt surgery?

Answer 27

Good long term outcome in majority of cases
More complications for intrahepatic shunt

Question 28

What are the pros and cons of gradual attenuation of congenital portosystemic shunt?

Answer 28

Might reduce chance of portal hypertension
May cause shorter lifespan, not work as well