specific sx conditions of GIT 3 - liver, biliary, panc

Bact pop in liver (proliferate in avascular tissue)

Clost

Liver biopsy options

Guillotine method (peripheral)

Trucut/punch (central)

Liver lobectomy - when to do

Neo, abscess, trauma

Liver lobectomy - Methods of ligation

Single encircling

Finger fracture technique (score + lig)

Portosystemic shunt - which toxins can be not absorbed as liver bypassed → hep encephalopathy

Ammonia, methionine, mercaptans, short chain FA, GABA

Portosystemic shunt - Types

Congenital intra/extra hep (single)

Acquired extra hep (many from portal hypertension)

Portosystemic shunt - Animals with extra hep

Small - Yorkshire terrier, poodle, Lhasa apso, Pekingese, mini schnauzer

DSH

Portosystemic shunt - Animals with intrahep

Large - German shepherd, lab, golden, Doberman, Irish setter, Samoyed, wolfhound

DSH

Portosystemic shunt - Congenital age

<1yr

Portosystemic shunt - acquired age

1-7yrs

Portosystemic shunt - CS

Dec growth, anorexia, dep, V, PUPD, ptyalism, behaviour change, urate uroliths, hep enceph (ataxia, weak, head press, circling, dep, seizure, coma, worse after proteins)

Portosystemic shunt - Dx

Rx- Small liver, abnormal contrast

US

Hex

CS

Microcytosis, mild nonregen anaemia, poikilocytosis, low BUN, hypoalbuinaemia, inc enzymes, inc bile acids

Portosystemic shunt - Medical tx

Highly digestible soy protein diet (dec toxins)

AB (neomycin, metronidazole, ampicillin)

Lactulose

Portosystemic shunt - How to dec encephalopathy (bact digest proteins to make toxins)

Soy protein → dec toxins

AB → dec bact

Lactulose → dec ammonia, laxative

Portosystemic shunt - Why to give lactulose

Trap ammonia + dec ammonia production

Portosystemic shunt - Sx tx

Gradually attenuate/narrow shunt (metal band, cellophane band)

Portosystemic shunt - Why to not suddenly ligate shunts

Hypertension, microhepatia, can’t cope with inc blood

Portosystemic shunt - Prognosis

Dog Extra hep > intra hep

Dog > cat

Why do you think animals with shunts get urate urolithiasis?

Dec urea production → inc urate + inc ammonia in serum → urine

Ammonium urate crystals

Portosystemic shunt - Complications

Post attenuation neuro signs (seizures)

Hypoglycaemia

Hypothermia

Bile flow diversion - why to do

Obstruction to common bile duct (trauma, neo, liths)

Bile flow diversion - Options

Cholecystoduodenostomy (ideal)

Cholecystojejunostomy

Partial pancreatectomy - common issue with handling

Pancreatitis

Partial pancreatectomy - Methods of preventing H

Simple encircling

Blunt dissection lobules + individual ligation

Panc biopsy options

Trucut

FNA

Shave off with scalpel