![]() 6,7 A single loop of absorbable suture material is placed around the tip of a lobe and tightened (Figure 21-2A and B). In cases of generalized disease or where a lesion exists at the apex of a lobe, the guillotine method is useful. 7 General anesthesia, specific equipment and expertise is required for the procedure.Ī variety of techniques have been described for obtaining a liver biopsy during celiotomy. 9 Laparoscopic biopsy allows direct visualization of the liver, especially when the disease is not generalized, and provides for a larger sized tissue sample. 8 Needle biopsy samples are not as accurate in yielding a diagnosis as larger wedge biopsies and laparoscopic liver biopsy is currently the best percutaneous technique. 6,7 This allows the clinician to obtain multiple samples for histopathological assessment with low risk of complications such as excessive hemorrhage. Ultrasound-guided needle biopsy is a commonly used technique for percutaneous liver biopsy (Tru-cut biopsy instrument). Care should be taken in the interpretation of such samples because the accuracy of liver cytology is markedly less than that of histopathological evaluation, especially in inflammatory hepatic disease. Biopsy TechniquesĬytological evaluation of samples obtained by fine needle aspiration can be useful in diagnosis of some diffuse diseases. Preoperative hemogram, serum chemistries, strict attention to intravenous fluid support (often with colloids to maintain osmotic pressure in a hypoalbuminemic patient) and careful attention to hemostasis are essential as is formulation of an appropriate anesthetic protocol. Patients with liver disease to be treated surgically are less than ideal anesthetic candidates, as hypotension, increased risk of hemorrhage, and more profound reaction to many anesthetic agents may be seen. Patients with liver disease may suffer from hypoproteinemia, hypoglycemia, and decreased levels of clotting factors. In addition to the production of bile the liver has other functions, including metabolism of protein, fat, carbohydrates, as well as many drugs. Hepatic ducts may vary in number and terminate in the bile duct (Figure 21-1B). Canaliculi drain into interlobular ducts which unite to form lobar ducts that exit from each liver lobe as extrahepatic bile passages termed hepatic ducts. 1,2īile is secreted by the hepatocytes into canaliculi within hepatic lobules. The normal liver does not usually extend caudal to the costal arch. The dorsal border extends more caudally than the ventral border, with the cranial pole of the right kidney located within a renal impression formed on the caudate process of the caudate lobe. The visceral surface consists of several visceral impressions the most prominent is to the left of midline, formed by the stomach. The right and left triangular ligaments extend from their respective crus of the diaphragm, attaching to the adjacent lateral lobes. The cranial surface of the liver follows the curve of the diaphragm, and the right and left coronary ligaments attach it to the diaphragm caudolateral to the vena cava. The quadrate lobe is situated between the right medial and left medial lobes, with the gallbladder located in a fossa formed between the quadrate and right medial lobes. The portal vein lies ventrally and the vena cava dorsally to the caudate lobe. The papillary process extends to the left where it lies in the lesser curvature of the stomach and the caudate process to the right where it contacts the cranial aspect of the right kidney. The caudate lobe is further divided into caudate and papillary processes and is positioned transversely across the abdomen. The organ is divided into 6 lobes: left lateral, left medial, quadrate, caudate, right medial and right lateral (Figure 21-1A). Positioned in the cranial abdomen, the canine liver is bound by the diaphragm cranially, and the stomach, intestines and spleen caudally, and lies transversely within the abdomen, with a slight majority of its mass located on the right of midline. Blood draining from the gastrointestinal tract passes through hepatic cells prior to returning to the general circulation of the body. The liver is the largest glandular organ in the body, consisting of between 3% and 5% of bodyweight in dogs and cats.
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