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100 terms

Hepatobiliary Sx - Karnik

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What are the common hepatobiliary tumors of dogs & cats?
Hepatocellular
Cholangiocelluar
Mesnechymal
Neuroendrocrine
Metastatic (most common)
What is the #1 hepatobiliary tumor in the dog?
Hepatocellular
What is the #1 hepatobiliary tumor in the cat?
Cholangiocellular adenoma (hepatoma)
What is the #2 hepatobiliary tumor in the dog?
Cholangiocellular
What vessels are compressed in the pringle maneuver?
portal V. & hepatic A.A.
What is the #2 hepatobiliary tumor in the cat?
adenoma (hepatoma)
T/F primary hepatic neoplasms are common in the cat & dog
F
What is the prognosis for a hepatocellular adenocarinomas in the dog
Massive - good (mst 1460d)
Nodular - not so good
Diffuse - bad
What are the common sites of met. for a diffuse hepatocellular adenocarcinoma in the dog?
lungs, ln.n. & peritoneum
T/F Most diffuse hepatocellular adenocarcinomas are metastatic.
T (93-100%)
What is another name for cholangiocellular carcinomas?
bile duct carcinomas
What is the m.c. location for a hepatocellular tumor?
lt. lat & med. lobes
What are cholangiocellular tumors?
bile duct tumors
What is #2 primary malignant tumor in the dog?
cholangiocellular
What is the incidence of mets. of of a cholangiocellular tumor in the dog?
up to 88%
Where do cholangiocellular tumors m.c. met. to in the dog?
l.n.n. & lungs
From where do cholangiocellular tumors arise in the cat?
intrahepatic bile duct epithelium
What is the m.c. hepatobiliary tumor in the cat?
cholangiocellular
What type of tumor comprises >50% of the hepatobiliary tumors in the cat?
Adenoma
What are the 2 different types of hepatobiliary adenomas in the cat?
cystadenoma
choecystadenoma
What is the #1 malignant cholangiocellular tumor in the cat?
carcinoma
What is the incidence of met. for a cholangiocellular carcinoma in the cat?
67-80%
What is carcinomatosis?
Seeding of neoplastic cells to other surrounding viscera.
Can cause all of the other organs to fibrose together into a "ball of guts."
What type of tumor does carcinomatosis occur with?
Cholangiocellular carcinoma in the cat.
What structures are involved w/regard to extra hepatic biliary dz?
hepatic, cystic & bile ducts, as well as the gb
What lobes in the liver is the gb located between?
quadrate medially & rt. medial lobe laterally
What are 6 forms/types of extra hepatic biliary dz?
Cholecystitis
Biliary mucocele
Obstruction
Trauma
Neoplasia
Choledocholiths
Where does the dog's bile duct terminate?
@ the duodenum near the opening of the minor pancreatic duct.
What comprises the major duodenal papilla?
combined opening of the minor pancreatic duct & the bile duct.
What does the feline bile duct join prior to entering the duodenum? What does this make them susceptible to?
major pancreatic duct
makes them susceptible to ascending infection
Rupture of cholecystitis/cholangiohepatitis may result in _________ _________.
septic peritonitis
What is the medical txt for cholecystitis/cholangiohepatitis if there is no rupture?
treat for enteric organisms
What are the 4 m.c. enteric organisms?
E. coli
Klebsiella
Enterobacter
Anaerobes
What is the sx txt for cholecysitis/cholangiohepatitis?
assess extrahepatic biliary tree
cholecystectomy
What is the etiopathogenesis of a biliary mucocele?
unclear but could be d/t:
hyperplasia of mucus-secreting cells & excessive mucus secretion OR
alterations in gb motility OR
accumulation of inspissated bile OR
overdistension of gb can result in rupture
may/may not have cholecystitis
Is overdistension of the gb grossly or histologically evident?
grossly ~50% of clinical cases
histologically present in >70%
How do you manage a biliary mucocele?
can try med. mgt w/fluids & cholorectics.
If a biliary mucocele isn't septic, how is it managed?
cholecystectomy &/or Abx.
During a cholecystectomy for a biliary mucocele, what do you need to confirm?
patentcy of bile duct.
How do you treat a biliary mucocele if the gb wall is viable?
cholecystoenterostomy
What is a laboratory result that may indicate rupture of a biliary mucocele?
increased venous lactate.
What are some biochemical abn. seen w/a biliary mucocele?
inreased: alk. phos.
ALT
GGT
total bilirubin
What are the diagnostic procedures to determine presence of a biliary mucocele?
survey rads & U/S
What would you expect to see on U/S of a biliary mucocele?
enlarged gb w/immobile echogenic bile
striated or stellate pattern ("Kiwi" sign)
What are the 5 possible causes of intraluminal biliary obstruction?
inflammatory dz
choleliths/choledocholiths
neoplasia
inspissated bile
parasites
What are the 2 possible causes of extraluminal biliary obstruction?
pancreatic dz
duodenal dz
What are 3 possible causes of bile peritonitis?
trauma
spontaneous rupture
iatrogenic
What is the more common cause of bile peritonitis?
bile duct trauma
Spontaneous rupture of the _________ can cause bile peritonitis
gallbladder
What are the tools used to diagnose bile peritonitis
abd. effusion --> pos. if abd. fl >/=2X serum
abdominocentesis: 4 quad tap
U/S guided aspirate
DPL
What is the most important prognostic factor in the mgmt of bile peritonitis?
Sterile bile vs. infected bile
What is sterile bile & what is the prog. for the pt. in this case?
sterile bile = chemical peritonitis
usu. well tolerated
prog. good if underlying cause eliminated
What is infected bile & what is the prog. for the pt. in this case?
infected bile = septic peritonitis
porg. fuarded/poor
morbidity & mortality are high
What are the 3 type of hepatic sx?
bx
partial lobectomy
complete lobectomy
What are the 3 biliary surgical methods?
cholecystotomy/cholecystectomy
bile duct exploration/reconstruction
biliary diversion
What are the 3 types of biliary diversion?
Cholecystoduodenostomy
Cholecystojejunostomy
Choledochoenterotomy
Which liver lobe should you bx if you suspect diffuse liver dz & why?
lt. lobe to avoid the main biliary structures
What are the 5 methods for harvesting a liver bx?
FNA
Tru-cut needles
Laparoscopic
Skin bx punch
Guillotine
What are the 3 surgical methods used when harvesting a liver bx w/a tru-cut needle?
U/S guided
Laparoscopy
Exploratory celiotomy
When would you use the FNA approach for harvesting a liver bx?
feline hepatic lipidosis
______ is an insensitive/unreliable method for harvesting a liver bx for diffuse dz & for those pts. th/may have congenital vascular shunts.
FNA
In what type of liver dz(s) is an FNA a useful diagnostic method?
diffuse hepatic neoplasia (lymphoscarcoma) & feline hepatic lipidosis
T/F There are substantial limitations of dx'ing hepatic dz in dogs & cats by percutaneous techniques
T
What must be determined before clinical illness d/t hepatic lipidosis can be dx'd?
th/there is sufficient fat in the hepatocytes to be causing hepatic dysfunction
Animals w/what c/s & clin. path. results shouldn't have a percutaneous bx d/t increased risk of uncontrollable hemorrhage?
clinical bleeding
severe thrombocytopenia
cavitary lesions
prolonged bleeding time
highly vascular lesions
What are the advantages to performing a laparoscopic bx?
can find lesions missed by U/S
better tissue samples taken
bx multiple liver lobes
can inspect entire abd.
quick (pt. dischgd within hours)
T/F If an animal has a coagulopathy, a laparoscopic bx is absolutely cx?
F
When would you use the guillotine technique to perform a liver bx?
when you are taking a bx of the hepatic margin
What add'l procedure should be routinely done during a laparoscopy in an animal known to have or suspected of having liver dz?
sx bx
Why should a sx bx be routinely done during a laparoscopy in an animal known to have or suspected of having liver dz?
it allows the entire liver to be thoroughly inspected & palpated & bx's taken of focal lesions
hemorrhage can be readily controlled
What are the 5 indications for a partial liver lobectomy?
bx
neoplasia
trauma
abscess
cysts
In what dz state could a partial liver lobectomy be indicated?
when the dz involves only a portion of a liver lobe such as a peripheral hepatic A-V fistulae, focal neoplasia, hepatic abscesses or trauma
What liver lobe bx technique generally results in the most blood loss?
parenchymal fx & ligation
What is an indication for a complete lobectomy?
some focal lesions involving 1 or 2 hepatic lobes
What 2 liver lobes maintain separation near the hilus more than other lobes?
Lt. lat & medial
What liver lobes can be removed using a single encircling ligature around the base of the lobe?
Lt. lat. & medial
What liver lobes require careful dissection around the hepatic caudal v.c.?
Rt. lat & caudate
How much of the liver can be removed & regeneration will still occur?
regen. possible even after 80% has been removed
T/F Liver lacerations must be sutured closed, even if the bleeding is minor
F (closed only when bleeding is profuse)
What artery in the liver can be ligated to control bleeding in an emergency.
proper hepatic A
How are complete fxs or sever contusions of the liver txtd?
hepatic lobectomy if ligation of hepatic A doesn't result in hemostatsis
What is the most common & serious complication regarding the stapling technique in the liver?
hemorrhage
What are the complications after major resection of the liver?
portal hyperT
ascites
fever
hemorrhage
persistent bile drainage
What is the m.c. indication for bile duct stenting?
most commonly done to relieve obstruction d/t extraluminal compression
What does bile duct stenting achieve?
obstruction d/t compression (most commonly)
temporarily diverts bile after suturing the bile duct
What are the 6 indications for a cholecystectomy?
necrotizing cholecystitis
chronic cholecystitis
biliary mucocele
cholelithiasis
neoplasia
trauma
What must be confirmed prior to performing a cholecystectomy?
patency of bile duct
How do you confirm patency of the bile duct?
squeeze the gb
What are the complications after a cholecystectomy?
bile peritonitis
bleeding
What are the causes of bile peritonitis following a cholecystectomy?
failure to adequately ligate the bile duct
failure to recognize & ligate small ducts entering cystic duct.
What is the cause of hemorrhage following a cholecystectomy
failure to ligate the cystic A
When is biliary diversion indicated?
Irreparable obstruction or trauma of the cbd w/o gb involvement
What are the options for biliary diversion?
Cholecystoduodenostomy
Cholecystojejunostomy
Choledochoenterotomy
Roux-en-Y (jejunal conduit betw. gb & duodenum or prox. jejunum)
What size does the stoma need to be for a cholecystoduodenostomy/cholecystojejunostomy? Why?
The initial size needs to be 2.5-3cm long to reduce the risk of the gb becoming impacted w/ingesta causing cholecystitis &/or cholangiohepatitis.
Due to the uncertainties regarding healing of the bile duct in the presence of infection, leakage or tension, what procedures are commonly performed rather than repair of the cbd?
draining procedures such as a cholecystojejunostomy
What are the common complications associated w/biliary diversion?
leakage
Cats: chronic vomiting
Dogs: ascending infections
bleeding @ stoma site
T/F Cats have a high mortality rate associated w/biliary diversion complications?
T (often assoc. w/underlying dz)
What are the potential complications associated w/a cholecystectomy?
generalized peritonitis
shock
sepsis
hypoglycemia
hypotproteinemic
hypokalemic
What are the potential complications associated w/sx of the cbd?
stricture
leakage
dehiscence
What are the potential complications associated w/biliary diversion?
ascending choangiohepatitis