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Exam 2
Dugat: Pancreas, Liver, & Biliary System
39
Veterinary Medicine
Professional
02/25/2017

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Cards

Term
Whee are the individual parts of the pancreas located in the body?
Definition
-body: assoc w/ descending duodenum
-left lobe: extends along greater curvature
-right lobe: closely assoc w/ duodenum
Term
Describe the blood supply of the pancreas.
Definition
-left limb: splenic artery
-body: cranial pancreaticoduodenal a
-right limb: cranial & caudal pancreaticoduodenal a
Term
Describe the duct system in the pancreas of the dog.
Definition
-accessory pancreatic duct exits at minor duodenal papilla (majority of secretions)
pancreatic duct exits at major duodenal pappilla
Term
Describe the duct system in the pancreas of a cat.
Definition
-80% have a single pancreatic duct that fuses with bile duct before entering duodenum at major duodenal papilla
Term
What are the methods of biopsy used on the pancrease?
Definition
-wedge
-blunt dissection
-guillotine: common for liver
-punch biopsy
Term
If the pancrease is diffusely affected, where do you take a biopsy?
Definition
-cuadal aspect of right limb is best
Term
What is a partial pancreatectomy? How much can you take?
Definition
-removal of tissue at distal aspect of pancreatic limbs
-can take 75-90%
Term
What are the indications for a partial pancreatectomy? Contraindication?
Definition
-Indications: abscess, neoplasia, biopsy
-Contraindication: removal of large portions of pancreatic body b/c risk damaging blood supply/ducts
Term
What is a total pancreatectomy? What adjunctive procedures usually coincide?
Definition
-removal fo the entire pancreas
-duodenectomy (shared blood supply), gastrojejunostomy, cholycystojejunostomy
Term
What do we risk w/ a total pancreatectomy?
Definition
-exocrine/endocrine function loss => requires insulin & pancreatic enzyme supplementation
Term
When do we see pnacreatic pseudocysts? How do we treat them?
Definition
-typically sterile cysts that may be assoc w/ pancreatitis
-Tx: partial pancreatectomy or open, drain, omentalize (preferred)
Term
What are the effects of a pancreatic insulinoma?
Definition
-severe hypoglycemia, often seizures
Term
How do we treat pancreatic insulinomas?
Definition
-partial pancreatectomy
-abdominal exploration for metastasis: 50% to liver & local LN, excise metastatic nodules if possible
Term
When do we usually see pancreatic abscesses? How do we treat them?
Definition
-can be assoc w/ pancreatitis
-tx: remove abscess, drain, omentalize, culture (abx therapy)
Term
What are the lobes of the liver?
Definition
-R lateral & medial
-L lateral and medial
-quadrate
-caudate
Term
What is the blood supply of the liver?
Definition
-hepatic a: 20%
-portal v: 80%
Term
What are the indications of liver biopsies?
Definition
-nonspecific liver pathology: inc bile acids, inc ALP/ALT, storage dz
-suspicion of specific dz: neoplasia
Term
What are the biopsy methods used on the liver?
Definition
-guillotine
-punch
-laparoscopic
Term
What is a guillotine biopsy?
Definition
-tie suture around end of lobe: excise distal to suture
-punch: only penetrate superficial surface, plug hole w/ gelfoam
Term
What is a laparoscopic biopsy?
Definition
-lessinvasive, quicker
-punch biopsy instrument
Term
When would we perform a partial lobectomy on the liver?
Definition
-focal dz: neoplasia, abscess, arteriovenous fistuly
Term
What is a total lobectomy of the liver? Technique?
Definition
-lobe resected at hilus
-technique: blunt dissection & suture, stapling device
Term
What is the common indication for liver total libectomy?
Definition
-large neoplastic
Term
What is the typical signalment of single congenital macroscopic liver shunts?
Definition
-young
-Extrahepatic: toy/minim breeds (yrokies), purevred cats (himalayan)
-Intrahepatic: large breeds (irish wolfhound)
Term
What is the typical signalment of acquired, multiple macroscopic liver shunts?
Definition
-middle-aged to older
-large breed dogs, cats
Term
How does the blood circulate w/ macroscopic liver shunts?
Definition
-blood bypasses the liver from portal circulation: toxins circulate systemically (ammonia)
Term
How do we diagnose macroscopic liver shunts?
Definition
-U/S
-CT/angiogram
Term
How do we treat macroscopic liver shunts?
Definition
-medical management
-sx: (PREFERRED) after medical management for 2w
Term
How do we surgically manage macroscopic liver shunts?
Definition
-acclusion of the anomalous vessel over 4-6w: ameroid ring, cellophane
Term
Where do we find macroscopic liver shunts?
Definition
-look for any vein entering into caudal cena cava cranial to phrenicoabdominal vv
Term
What are the risks of surgically manage macroscopic liver shunts?
Definition
-portal hypertension
-portal atresia
Term
What are common post-op complications w/ macroscopic liver shunts?
Definition
-seizures
-blindness
-ascites/portal hypertension
-multiple acquired shunts
Term
What is our major thing we check on follow-up w/ macroscopic liver shunts?
Definition
-recheck bile acids
Term
If we see persistent elevation w/ bile acids after surgery for macroscopic liver shunts?
Definition
-inadequate occlusion
-microscopic shunting (MVD)
-acquired multiple shunting
-indadequate liver regeneration
Term
What do multiple acquired liver shunts look like?
Definition
-manifest as multiple, weblike small vessels usually in omentum or near kidneys
-drains into vena cava
Term
What causes multiple acquried macrscopic liver shunts :
Definition
-portal hypertension
-chronic fibrosis
-cirrhosis
Term
What do microscopic liver shunts look like?
Definition
-microvascular dysplasia atthe level of the central lobule of the liver
Term
How do we diagnose microscopic liver shunts?
Definition
-biopsy
-rule out macroscopic shunts
Term
What are the implied causes of microscopic liver shunts?
Definition
-may be the result of persistent bile acid elevation
-may result in persistent clinical signs of HE
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