Page 131 - Clinical Manual of Small Animal Endosurgery

Diagnostic Laparoscopy 119

Fig. 4.10 Close-up view of a normal gallbladder. Photograph courtesy of
Mr P.J. Lhermette.

Fig. 4.11 Spinal needle introduced into the gallbladder for
cholecystocentesis. Photograph courtesy of Mr P.J. Lhermette.

patient, and the probe is used to move fat and omentum out of the view.
It is important to assess dilation and patency of the biliary system. The
normal gall bladder is soft and fluctuant on palpation and the biliary
tract is not distended. If obstruction is noted, its level and cause (mass,
stricture) should be determined. The portal vein and caudal vena cava
can be seen at the level of the insertion of the cystic duct into the common
bile duct. At this level it is also sometimes possible to find extrahepatic
portosystemic shunts.
Laparoscopy-guided cholecystocentesis (Fig. 4.11) can also be per-
formed, using a 20- or 22-gauge needle. The gall bladder is punctured