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Surgery II > Liver > Flashcards

Liver Flashcards

(61 cards)

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1
Q

what is a hepatectomy?

A

removal of the entire liver

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2
Q

what is a partial hepatectomy?

A

removal of portion of the liver

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3
Q

what is a lobectomy?

A

removal of a single or multiple liver lobes

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4
Q

why is hypoalbuminemia a preop concern?

A

albumin levels <2 g/dL associated with delayed wound healing

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5
Q

why are coagulopathies a preop concern?

A

preop evaluation of clotting function, especially mucosal bleeding time. Fresh whole blood transfusions reduce intraoperative hemorrhage

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6
Q

why is anemia a preoperative concern?

A

Hct <20% and anemic animals that are hypoxic should be given blood transfusions

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7
Q

why is anorexia a preop concern?

A

require preop nutritional supplement

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8
Q

why is massive ascites a preop concern?

A

dsypneic due to pressure on diaphragm that restricts lung expansion -> remove fluid before inducing anesthesia

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9
Q

because high ventilator pressures reduce hepatic blood flow, what is important to do?

A

reduce pressure by removing some fluid (ascites)

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10
Q

what bacteria normally resides in liver?

A

aerobic and anaerobic bacteria

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11
Q

what may happen to bacteria with hepatic ischemia or hypoxia?

A

proliferate

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12
Q

when are prophylactic abx warranted?

A

in pt with severe hepatic dz undergoing hepatic sx

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13
Q

what are the two afferent blood supplies to liver?

A

portal system: low pressure
arterial system: high pressure

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14
Q

what does the portal vein drain

A

drains the stomach, intestines, pancreas, spleen

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15
Q

how much blood does the portal v supply to liver

A

4/5 of the blood that enters liver

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16
Q

what do the proper hepatic arteries do

A

provide remainder of the afferent blood supply

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17
Q

what are the proper hepatic arteries?

A

branches of common hepatic artery and may number between 2 and 5

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18
Q

why must we be cautious when dissecting around pylorus?

A

avoid damaging common bile duct

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19
Q

the cranial location of the liver may make hepatic biopsy difficult in deep-chested doggos. How should the incision be extended?

A

extend incision as far cranially to facilitate hepatic exposure

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20
Q

when is liver biopsy appropriate?

A

patients with clinical signs of hepatic dz, clinically normal animals with lab abnormalities

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21
Q

what are techniques to perform a liver biopsy?

A

percutaneous and fine needle, laparoscopic, guillotine method, guillotine by interlocking loops, punch, partial lobectomy

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22
Q

what are the two methods for a percutaneous and fine needle liver biopsy?

A

percutaneous blind, percutaneous US guided

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23
Q

how may tissue core biopsies be obtained?

A

tru-cut biopsy, large-bore needle, automated biopsy device

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24
Q

why should automated biopsy device not be used in cats

A

potential mortality associated with shock of wave caused by triggering the device

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25
where are percutaneous liver biopsies taken from?
only from L lateral lobe to minimize chance of lacerating bile ducts or gallbladder. significant limitation bc lesions may be in only a few lobes
26
which results are far more common with percutaneous liver biopsies?
false negs more common than false pos
27
what is needed to perform a punch biopsy of the liver
hemostatic foam precut, 6 mm minimum
28
what are portosystemic shunts also called?
portosystemic vascular anomalies
29
describe PSS
anomalous vessels pass directly into systemic circulation without first passing through the liver
30
what is a portocaval shunt
specific type of vascular anomaly
31
what are extrahepatic shunts?
vascular anomalies located outside the hepatic parenchyma
32
what are two types of extrahepatic shunts?
congenital extrahepatic portosystemic shunts, acquired
33
what are congenital intrahepatic portosystemic shunts?
located in the liver
34
what are hepatic microvascular dysplasia (portal vein hypoplasia)
small or absent intrahepatic portal vessel and portal arteriolar hyperplasia associated with microscopic shunting of blood through liver without macroscopic shunt
35
what are the broad general categories of hepatic shunts?
congenital or acquired and intrahepatic or extrahepatic
36
which shunts are typically single anomalous vessels that allow abnormal blood flow from portal v to systemic circulation?
CEPSS
37
CEPSS accounts for what percentage of single shunts in dogs?
63% in dogs, can also occur in cats
38
describe CEPPS in cats
most commonly have large single vessel that empties directly into pre-hepatic vena cava
39
atypical CEPPS connections in cats may flow into
renal vein, phrenicoabdominal vein, azygos vein, internal thoracic vein
40
intrahepatic portosystemic shunts occur in what percent of dogs and cats
usually congenital, 35% of single shunts in dogs, 10% in cats
41
why do intrahepatic portosystemic shunts arise?
singular shunts that occur because ductus venosus doesn't close after birth, arise when other portal to hepatic vein or caudal vena cava anastomoses exist
42
how is Hepatic microvascular dysplasia repaired?
non surgical, knowledge is being redefined
43
which dogs get which shunts?
small breed dogs: extrahepatic shunts (extra cute) large breed dogs: IHPSS
44
when should congenital PSS be considered in any young animal?
with a prolonged response to tranquilizers or anesthetic agents that require hepatic metabolism for clearance
45
what is a useful, noninvasive screening tool for dx congenital or acquired shunts and distinguish them from HMD?
nuclear scintigraphy
46
what is the tx of choice for PSS?
surgery. medical management -> 48% mortality rate
47
who are candidates for PSS surgery?
patients with congenital PSS
48
what is the goal of PSS sx?
ID and occlude or attenuate abnormal vessel
49
what are three methods of surgical occlusion or attenuation in PSS?
ameroid constrictor, cellophane banding, ligation
50
what does ligation do during PSS sx?
often leads to portal hypertension which may be fatal!
51
if you find mx shunts in an animal, what should you do?
biopsy the liver
52
why should you avoid using an ameroid that is too large?
the weight may cause the vessel to kink, obstructing flow prematurely
53
why should owners be warned that ligation of IHPSS is difficult?
shunts are hard to ID at surgery
54
what are cavitary hepatic lesions?
cysts or abscesses
55
what are hepatic abscesses?
localized collections of pus in the hepatic parenchyma
56
what are hepatic cysts?
closed, fluid-filled sac lined by secretory epithelium
57
how are cavitary hepatic lesions treated surgically?
partial hepatectomy. If it cannot be performed safely and cyst not completely removed, it may be omentalized
58
what is omentalization?
ID segment of omentum that will extend into cyst cavity, remove as much of the wall of the cyst, spread omentum over remaining cyst, tack it in place to remaining cyst capsule
59
when a liver lobe twists on its axis, what does it create?
venous obstruction, causing increased hydrostatic pressure, ascites, and thrombosis
60
what will happen to the liver lobe that has torsion?
necrosis - surgical resection warranted
61
why is histologic evaluation of the excised lobe after torsion warranted?
devitalized mass may appear similar to hepatic tumor

Surgery II (11 decks)

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