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 |
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Term
| Describe the blood supply of the pancreas. |
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Definition
-left limb: splenic artery
-body: cranial pancreaticoduodenal a
-right limb: cranial & caudal pancreaticoduodenal a |
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Term
| Describe the duct system in the pancreas of the dog. |
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Definition
-accessory pancreatic duct exits at minor duodenal papilla (majority of secretions)
pancreatic duct exits at major duodenal pappilla |
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Term
| Describe the duct system in the pancreas of a cat. |
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Definition
| -80% have a single pancreatic duct that fuses with bile duct before entering duodenum at major duodenal papilla |
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Term
| What are the methods of biopsy used on the pancrease? |
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Definition
-wedge
-blunt dissection
-guillotine: common for liver
-punch biopsy |
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Term
| If the pancrease is diffusely affected, where do you take a biopsy? |
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Definition
| -cuadal aspect of right limb is best |
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Term
| What is a partial pancreatectomy? How much can you take? |
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Definition
-removal of tissue at distal aspect of pancreatic limbs
-can take 75-90% |
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Term
| What are the indications for a partial pancreatectomy? Contraindication? |
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Definition
-Indications: abscess, neoplasia, biopsy
-Contraindication: removal of large portions of pancreatic body b/c risk damaging blood supply/ducts |
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Term
| What is a total pancreatectomy? What adjunctive procedures usually coincide? |
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Definition
-removal fo the entire pancreas
-duodenectomy (shared blood supply), gastrojejunostomy, cholycystojejunostomy |
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|
Term
| What do we risk w/ a total pancreatectomy? |
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Definition
| -exocrine/endocrine function loss => requires insulin & pancreatic enzyme supplementation |
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Term
| When do we see pnacreatic pseudocysts? How do we treat them? |
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Definition
-typically sterile cysts that may be assoc w/ pancreatitis
-Tx: partial pancreatectomy or open, drain, omentalize (preferred) |
|
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Term
| What are the effects of a pancreatic insulinoma? |
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Definition
| -severe hypoglycemia, often seizures |
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|
Term
| How do we treat pancreatic insulinomas? |
|
Definition
-partial pancreatectomy
-abdominal exploration for metastasis: 50% to liver & local LN, excise metastatic nodules if possible |
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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) |
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Term
| What are the lobes of the liver? |
|
Definition
-R lateral & medial
-L lateral and medial
-quadrate
-caudate |
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|
Term
| What is the blood supply of the liver? |
|
Definition
-hepatic a: 20%
-portal v: 80% |
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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 |
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|
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 |
|
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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
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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) |
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|
Term
| What is the typical signalment of acquired, multiple macroscopic liver shunts? |
|
Definition
-middle-aged to older
-large breed dogs, cats |
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|
Term
| How does the blood circulate w/ macroscopic liver shunts? |
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Definition
| -blood bypasses the liver from portal circulation: toxins circulate systemically (ammonia) |
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|
Term
| How do we diagnose macroscopic liver shunts? |
|
Definition
|
|
Term
| How do we treat macroscopic liver shunts? |
|
Definition
-medical management
-sx: (PREFERRED) after medical management for 2w |
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|
Term
| How do we surgically manage macroscopic liver shunts? |
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Definition
| -acclusion of the anomalous vessel over 4-6w: ameroid ring, cellophane |
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|
Term
| Where do we find macroscopic liver shunts? |
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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
|
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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 |
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|
Term
| What do microscopic liver shunts look like? |
|
Definition
| -microvascular dysplasia atthe level of the central lobule of the liver |
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|
Term
| How do we diagnose microscopic liver shunts? |
|
Definition
-biopsy
-rule out macroscopic shunts |
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|
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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