Hepatobiliary Surgery Flashcards

1
Q

Fracture and penetrating wounds to the liver are usually due to?

A

Trauma

Fracture - blunt trauma (HBC)

Penetrating - gunshot, arrow, bite

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2
Q

How would you treat a trauma case with damage to the liver?

A

Conservative
Ligate severed vessels
Partial hepatectomy
Pringle maneuver

The closer the injury is to the hilus, the greater likelihood surgery will be necessary

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3
Q

What is the Pringle maneuver?

A

Clamp the hepatoduodenal ligament and interrupt flow though hepatic artery and portal vein to control bleeding in liver

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4
Q

What techniques are used for liver biopsy?

A

FNA
Tru-cut (image guided/ laparoscopically/ exploratory celiotomy)

Laparoscopic
Skin biopsy punch
Guillotine technique

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5
Q

In what animals might you required laraoscopy/ exploratory to get a tru-cut biopsy?

A

Smaller animals or in deep chested breeds —> liver lives farther under the rib cage

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6
Q

When is the guillotine technique appropriate for biopsy?

A

Lesions on the edge of liver or diffuse disease

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7
Q

What re the indications for a liver partial lobectomy?

A
Biopsy 
Neoplasia 
Trauma 
Abscess 
Cysts
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8
Q

T/F: when removing a portion of the liver, parenchymal fracture and ligation generally results in the most blood loss

A

True

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9
Q

What type of suturing is done with parenchymal fracture and ligation?

A

Overlapping sutures

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10
Q

What are alternatives to suture for partial liver lobectomies?

A

Stapling

Surgities

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11
Q

What are the extrahepatic biliary diseses?

A
Cholecysitis 
Biliary mucocele 
Obstrucion 
Trauma 
Neoplasia 
Choledocholiths
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12
Q

Rupture of a necrotizing cholecystitis can result in?

A

Septic peritonitis

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13
Q

How do you treat cholecytisitis?

A

Medically if not ruptured

Surgery

  • assess extraheptic biliary tree
  • cholecystectomy
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14
Q

What is the pathogenesis of biliary mucocele?

A

Hyperplasia of mucus-secreting cells and excessive mucus secretion

Alteration in gallbladder motility

Accumulation of inspissated boiled

Over-distention of gallbladder can result in rupture

+/- cholecystitis

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15
Q

Signalment associated with biliary mucocele ?

A

Small and medium size dogs - Shelties, cocker spaniel

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16
Q

Clinical signs with biliary mucocele ?

A

Vomiting
Anorexia
Lethargy

Pu/PD
Diarrhea
None

17
Q

Most common lab abnormalities with biliary mucocele ?

A

Increased ALP and ALT
Increased GGT
Increase Tbili

18
Q

What imaging can be done to identify biliary mucocele?

A

Survey rads

US
— enlarged gallbladder with echogenic bile
—striated or stellate patter “kiwi sign”

19
Q

Treatment for biliary mucocele ?

A

Medical — cholerectics (maybe works?)

Cholecystectomy
Confirm bile duct patency
Culture bile
Antibiotics

20
Q

What are indications for a cholecystectomy?

A
Necrotizing cholecystitis 
Chronic cholecystitis 
Biliary mucocele 
Cholelithisaisis 
Neoplasia 
Trauma
21
Q

Method of cholecystectomy?

A

MUST maintain hepatic ducts and common bile duct

Duodentomy with catheterizaiton of bile duct

Blunt dissection of gallbladder from hepatic fossa

Ligate cystic duct and cystic artery
Flush saline through bile duct - check for leakage

22
Q

Complications to cholecystectomy?

A

Bile peritonitis

  • failure to adequately ligate bile duct
  • failure to recognize and ligate small ducts entering cystic duct

Bleeding
-failure to ligate cystic artery

23
Q

What are causes of intralumenal biliary obstruction?

A
Inflammatory disease 
Choleliths and choledocholiths 
Neoplasia 
Inspissated bile 
Parasites
24
Q

What are extraluminal causes of biliary obstruction?

A

Pancreatic or duodenal disease

25
Q

What is a choledochotomy?

A

Incision into dilated common bile duct

26
Q

Indication for choledochotomy?

A

Choledocholithiasis

Biliary sludge

27
Q

What is the most common method to relieve obstruction due to extraluminal compression?

A

Bile duct stenting

Also done to temporarily divert bile after suturing the bile duct

28
Q

When is biliary diversion indicated?

A

Irreparable obstruction or trauma of common bile duct (eg tumor )

29
Q

What are methods of biliary diversion?

A

Choledochoenterostomy

Cholecystoduodenostomy

Cholecystojejunostomy

30
Q

When doing an cholecystoduodenostomy, the initial size of the stoma needs to be _________ cm long to reduced the risk of gallbladder becoming impacted with ingesta

A

2.5-3

31
Q

Complications of biliary diversion?

A

Leakage

Cats - high morbidity and morality and chronic vomiting

Dog - ascending infection and bleeding at stoma site

32
Q

What can cause bile peritonitis?

A

Trauma (more common to bile duct)

Spontaneous rupture (gallbladder)

Iatrogenic

33
Q

What is the appearce of bile peritonitis ?

A

Green, greenish-brown discolouration

Abdominal effusion

34
Q

How can you confirm bile peritonitis?

A

Abdominocentesis

  • 4-quadrant tap
  • US guided aspirate
  • DPL

Positive is fluid bilirubin is >2x serum

35
Q

T/f: Prognosis of sterile bile peritonitis is good if the underlying cause is eliminated

A

True

36
Q

T/f: Prognosis of infected bile peritonitis is good if the underlying cause is eliminated

A

False

Poor prognosis — septic peritonitis