1887

The liver and biliary tract

image of The liver and biliary tract
GBP
Online Access: GBP25.00 + VAT
BSAVA Library Pass Buy a pass

Abstract

Small animal patients commonly present with conditions of the liver and biliary tract that require surgical intervention. This chapter looks at anatomy, patient evaluation, diagnosis and management. Hepatic biopsy techniques and partial lobectomy; Complete hepatic lobectomy; Cholecystotomy; Cholecystectomy; Biliary diversion: cholecystoduodenostomy or cholecystojejunostomy.

Loading full text...

Full text loading...

/content/chapter/10.22233/9781910443248.chap9

Figures

Image of 9.1
9.1 (a) Anatomy of the liver. (b) The hepatorenal ligament extending from the caudate lobe to the right kidney. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Image of 9.2
9.2 The epiploic foramen bounded by the hepatic artery (black arrow), portal vein (white arrow) and caudal vena cava (yellow arrow).
Image of 9.3
9.3 Intrahepatic portal vein anatomy. (Illustration by T Vojt, courtesy of S Birchard)
Image of 9.5
9.5 Removal of the falciform ligament to improve visualization of the cranial abdomen.
Image of 9.6
9.6 Torsion of the left medial liver lobe in a 7-year-old Cocker Spaniel bitch.
Image of 9.7
9.7 (a) Large and (b) small biliary cystadenomas in the liver of a cat. (c) Multifocal hepatocellular carcinoma. (d) Diffuse form of hepatocellular carcinoma, which is not amenable to surgical resection.
Image of 9.8
9.8 Anatomy of the extrahepatic biliary tract. Hepatic ducts from the quadrate and right medial lobes (central division of the liver) enter the bile duct at its origin, along with the cystic duct from the gallbladder. Hepatic ducts from the right lateral and caudate lobes, left lateral and medial lobes and the papillary process of the caudate lobe enter the free portion of the bile duct more distally. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Image of 9.9
9.9 (a) Common bile duct (arrowed) entering the dudonenum. (b) The distal portion of the bile duct in the dog is intramural. It courses obliquely through the duodenal wall and terminates alongside but separate from the pancreatic duct at the major duodenal papilla. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Image of 9.11
9.11 Ultrasonogram showing a choledocholith with distension of the common bile duct proximal to it.
Image of 9.13
9.13 (a) Duodenotomy of the antimesenteric border of the proximal duodenum allowing visualization of the major duodenal papilla and cannulation of the common bile duct. (b) From the duodenal approach the tube may be ended within the lumen of the duodenum and held in place with absorbable sutures. This allows bile to flow into the duodenal lumen. The tube migrates into the duodenum postoperatively and passes from the body with the faeces. (c–d) Alternatively the tube can be placed through the abdominal wall on the right side, then tunnelled through the duodenum, similar to a jejunostomy tube. This has the advantage that cholangiography can be performed and the tube can be easily removed. (Photographs courtesy of S Birchard). Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Image of 9.14
9.14 (a) Tube cholecystotomy. (b–c) The Foley catheter should be connected to a closed connecting system and the amount of bile produced should be monitored. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Image of 9.15
9.15 Choledochotomy. (a) Fine stay sutures of polypropylene should be placed to allow traction on the duct and the area should be well packed off. A small incision should be made using a No. 15 scalpel blade. (b) Markedly dilated common (black arrow) and cystic (white arrow) ducts in a cat with a choledocholith. (c) Stay sutures are placed through the wall of the common bile duct. (d) An incision is made into the duct directly over the choledocholith. (e) The choledocholith. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Image of A loop of absorbable suture material is placed around the tip of a liver lobe.
A loop of absorbable suture material is placed around the tip of a liver lobe. A loop of absorbable suture material is placed around the tip of a liver lobe.
Image of The suture is tied tightly and an empty suture packet is placed below the tip of the liver to act as a ‘cutting board’. The hepatic tissue is cut approximately 5 mm from the ligature.
The suture is tied tightly and an empty suture packet is placed below the tip of the liver to act as a ‘cutting board’. The hepatic tissue is cut approximately 5 mm from the ligature. The suture is tied tightly and an empty suture packet is placed below the tip of the liver to act as a ‘cutting board’. The hepatic tissue is cut approximately 5 mm from the ligature.
Image of The biopsy site can be packed with a small piece of Gelfoam® or omentum following removal of the hepatic tissue to facilitate haemostasis.
The biopsy site can be packed with a small piece of Gelfoam® or omentum following removal of the hepatic tissue to facilitate haemostasis. The biopsy site can be packed with a small piece of Gelfoam or omentum following removal of the hepatic tissue to facilitate haemostasis.
Image of The focal lesion is identified.
The focal lesion is identified. The focal lesion is identified.
Image of The skin biopsy punch is pushed into the parenchyma to cut a core sample.
The skin biopsy punch is pushed into the parenchyma to cut a core sample. The skin biopsy punch is pushed into the parenchyma to cut a core sample.
Image of The biopsy sample and suture packet can then be handed to a non-sterile assistant to be put into formalin.
The biopsy sample and suture packet can then be handed to a non-sterile assistant to be put into formalin. The biopsy sample and suture packet can then be handed to a non-sterile assistant to be put into formalin.
Image of Overlapping guillotine suture technique.
Overlapping guillotine suture technique. Overlapping guillotine suture technique.
Image of Determine the line of separation between the normal parenchyma and that to be removed.
Determine the line of separation between the normal parenchyma and that to be removed. Determine the line of separation between the normal parenchyma and that to be removed.
Image of Bluntly fracture the liver with fingers (or the blunt end of a scalpel handle) to expose parenchymal vessels.
Bluntly fracture the liver with fingers (or the blunt end of a scalpel handle) to expose parenchymal vessels. Bluntly fracture the liver with fingers (or the blunt end of a scalpel handle) to expose parenchymal vessels.
Image of Large vessels encountered during the dissection are ligated.
Large vessels encountered during the dissection are ligated. Large vessels encountered during the dissection are ligated.
Image of A large crushing clamp can be placed across the lobe proximal to the lesion.
A large crushing clamp can be placed across the lobe proximal to the lesion. A large crushing clamp can be placed across the lobe proximal to the lesion.
Image of Large overlapping mattress sutures are placed through the parenchyma of the liver.
Large overlapping mattress sutures are placed through the parenchyma of the liver. Large overlapping mattress sutures are placed through the parenchyma of the liver.
Image of TA55 stapler being used to perform a partial hepatic lobectomy. The stapler is placed around the portion of the lobe to be resected, the appropriate lever is pulled and the staples are fired.
TA55 stapler being used to perform a partial hepatic lobectomy. The stapler is placed around the portion of the lobe to be resected, the appropriate lever is pulled and the staples are fired. TA55 stapler being used to perform a partial hepatic lobectomy. The stapler is placed around the portion of the lobe to be resected, the appropriate lever is pulled and the staples are fired.
Image of Once the staples have been fired, the lobe is amputated by cutting along the edge of the staple cartridge with a scalpel. The lobe is then released and the stump is checked for bleeding.
Once the staples have been fired, the lobe is amputated by cutting along the edge of the staple cartridge with a scalpel. The lobe is then released and the stump is checked for bleeding. Once the staples have been fired, the lobe is amputated by cutting along the edge of the staple cartridge with a scalpel. The lobe is then released and the stump is checked for bleeding.
Image of In small dogs and cats, either of the left liver lobes can be removed after placing encircling ligatures around the base of the lobe in an area that has been crushed by forceps.
In small dogs and cats, either of the left liver lobes can be removed after placing encircling ligatures around the base of the lobe in an area that has been crushed by forceps. In small dogs and cats, either of the left liver lobes can be removed after placing encircling ligatures around the base of the lobe in an area that has been crushed by forceps.
Image of Untitled
Image of Untitled
Image of Two stay sutures are placed: one in the fundus and one in the infundibulum. These help to immobilize the gallbladder during surgical manipulation.
Two stay sutures are placed: one in the fundus and one in the infundibulum. These help to immobilize the gallbladder during surgical manipulation. Two stay sutures are placed: one in the fundus and one in the infundibulum. These help to immobilize the gallbladder during surgical manipulation.
Image of A large incision is made in the gallbladder so that all contents may be easily removed. Additional stay sutures can be placed on either side of the incision to facilitate access to the gallbladder lumen. (Courtesy of S Birchard)
A large incision is made in the gallbladder so that all contents may be easily removed. Additional stay sutures can be placed on either side of the incision to facilitate access to the gallbladder lumen. (Courtesy of S Birchard) A large incision is made in the gallbladder so that all contents may be easily removed. Additional stay sutures can be placed on either side of the incision to facilitate access to the gallbladder lumen. (Courtesy of S Birchard)
Image of A stay suture is placed in the fundus of the gallbladder. The gallbladder is then bluntly dissected from the hepatic fossa using curved Halsted mosquito forceps.
A stay suture is placed in the fundus of the gallbladder. The gallbladder is then bluntly dissected from the hepatic fossa using curved Halsted mosquito forceps. A stay suture is placed in the fundus of the gallbladder. The gallbladder is then bluntly dissected from the hepatic fossa using curved Halsted mosquito forceps.
Image of The gallbladder is dissected away from the hepatic fossa using blunt and sharp dissection.
The gallbladder is dissected away from the hepatic fossa using blunt and sharp dissection. The gallbladder is dissected away from the hepatic fossa using blunt and sharp dissection.
Image of The cystic duct is dissected down to the junction with the common bile duct, clamped and severed.
The cystic duct is dissected down to the junction with the common bile duct, clamped and severed. The cystic duct is dissected down to the junction with the common bile duct, clamped and severed.
Image of The common bile duct is cannulated via the stump of the cystic duct and flushed to ensure patency.
The common bile duct is cannulated via the stump of the cystic duct and flushed to ensure patency. The common bile duct is cannulated via the stump of the cystic duct and flushed to ensure patency.
Image of Gallbladder mucocele.
Gallbladder mucocele. Gallbladder mucocele.
Image of Untitled
Image of Untitled
Image of Untitled
Image of Untitled
Image of Completed cholecystoenterostomy.
Completed cholecystoenterostomy. Completed cholecystoenterostomy.

More like this

/content/chapter/10.22233/9781910443248.chap9
dcterms_title,dcterms_description
5
5
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error