Surgery of the Liver and Biliary System Quiz

1. Surgery of the Liver and Biliary System Quiz Elaina Turner

2. List 3 types of neoplasm seen in the liver and biliary system of the dog and cat and give their prognosis. • Hepatocellular adenoma  good • Hepatocellular adenocarcinoma  single – can be good; diffuse – grave • Cholangiocellular carcinoma  grave

3. Which of these is most common in the dog? • Hepatocellular adenocarcinoma

4. Which is most common in the cat? • Both adenoma and adenocarcinoma are common

5. Which one of these tumors would you be least likely to feel during abdominal palpation? • Cholangiocellular adenocarcinoma

6. Which tumor can be cured by surgical excision? • Hepatic adenoma

7. Why is the liver more often damaged by blunt trauma than most other abdominal organs? • The liver can not slide out of the way because of its many attachments to the body wall. This is incontrast to the other abdominal organs which can move freely about the cavity.

8. Which part of the liver is most commonly damaged? Why? • Free caudal aspect of the liver because

9. What is the most useful diagnostic modality in detecting acute hemoperitoneum? • Paracentesis or diagnostic peritoneal lavage

10. What is the most common tx for hemoperitoneum secondary to hepatic trauma in dogs? • Stabilization not surgery

11. When is exploratory celiotomy indicated? (Be specific – what CS would lead you to sx?) • Evidence of continued hemorrhage • This animal will be in shock – tachycardia, tachypnea, pale mm

12. You are exploring a dog following abdominal trauma, and you find an area of tissue disruption on the caudate lobe. Several blood and bile vessels are ruptured and protruding from the parenchyma. How will you handle this situation? If the caudal margin of the caudate lobe is crushed, what will you do? • Superficial – leave alone if no significant leakage or hemorrhage present. Broad mattress sutures to align tissue and resection of crushed tissue. Use hemostatic clips on the blood and bile vessels.

13. Briefly describe the finger-fracture method of partial hepatic lobectomy. • Used for deep injuries • Incise capsule at margin of resection • Crush parenchyma w/ fingers or scalpel handle to separate the parenchyma from the vessels then… • Ligate isolated blood and bile vessels

14. What is the advantage of the previous technique? • Cutting through without doing the finger fracture method causes severe hemorrhage.

15. Total lobectomy is easiest in which liver lobes and in which patients? • Small dogs and the left and non-central divisions.

16. What is the major complication of hepatic lobectomy? • Hemorrhage

17. Why is it important to leave minimal amounts of suture material and Gelfoam in the hepatic parenchyma?

18. Is the previous a problem in cats as well as dogs?

19. Why is microhepatica a contraindication for percutaneous hepatic biopsy?

20. Describe the anatomical parts of the extrahepatic biliary system. • Cystic duct • Gall bladder • Common duct

21. Trace the flow of bile through the extrahepatic biliary system. • Gallbladder  cystic duct  common bile duct  duodenum

22. What steps must be taken to stabilize the patient with biliary obstruction before surgery? • Patient must be stabilized before sx • Fluids, electrolytes and acid-base correction • Antibiotics that concentrate in bile for prophylaxis: ampicillin, tetracycline • Vitamin K • Fresh whole blood or fresh (frozen) plasma

23. In dogs, obstruction is secondary to cholelithiasis, neoplasia or trauma. What is another cause, seen in cats, in Flordia and St. Kitts? • Bile duct fluke

24. What are the indications for cholecystectomy, cholecystotomy and cholecystoenterostomy? • Cholecystectomy = unresponsive cholelithiasis or cholecystitis, severe trauma or neoplasia • Cholecystotomy = cholelithiasis removal • Cholecystoenterostomy = neoplasia, calculi, etc.

25. Trace the flow of bile following cholecystectomy, cholecystotomy and cholecystoenterostomy. • Cholecystectomy • Cholecystotomy • Cholecystoenterostomy