What are the common hepatobiliary tumors of dogs & cats?
Metastatic (most common)
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
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 structures are involved w/regard to extra hepatic biliary dz?
hepatic, cystic & bile ducts, as well as the gb
What are 6 forms/types of extra hepatic biliary dz?
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
What is the medical txt for cholecystitis/cholangiohepatitis if there is no rupture?
treat for enteric organisms
What is the sx txt for cholecysitis/cholangiohepatitis?
assess extrahepatic biliary tree
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%
During a cholecystectomy for a biliary mucocele, what do you need to confirm?
patentcy of bile duct.
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.
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?
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
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
morbidity & mortality are high
What are the 3 biliary surgical methods?
bile duct exploration/reconstruction
What are the 3 types of biliary diversion?
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?
Skin bx punch
What are the 3 surgical methods used when harvesting a liver bx w/a tru-cut needle?
______ is an insensitive/unreliable method for harvesting a liver bx for diffuse dz & for those pts. th/may have congenital vascular shunts.
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
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?
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)
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?
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
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 lobes can be removed using a single encircling ligature around the base of the lobe?
Lt. lat. & medial
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)
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?
What are the complications after major resection of the liver?
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?
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.
When is biliary diversion indicated?
Irreparable obstruction or trauma of the cbd w/o gb involvement
What are the options for biliary diversion?
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?
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?