Page 2274 - Cote clinical veterinary advisor dogs and cats 4th

1128 Liver Biopsy, Laparoscopic

Equipment, Anesthesia • Pancreatitis (pp. 740 and 742) a large volume of distribution can redistribute
and cause clinical signs.
• 20% lipid emulsion • Hemolysis (oxidative damage) • Hemolysis: rare
VetBooks.ir • Fluid pump • Fat overload syndrome (hyperlipidemia, Alternatives and Their Relative
• Corneal lipidosis (rare, reversible)
• Peripheral catheter
fat embolism, hepatomegaly, splenomegaly,
Merits
Anticipated Time
About 60-90 minutes for initial setup and bolus thrombocytopenia, jaundice, coagulopathy, Symptomatic and supportive care relevant to
hemolysis) seen with excessive volumes or
plus constant-rate infusion (CRI) high administration rates the specific toxicant
Preparation: Important Procedure Pearls
Checkpoints • Place intravenous (IV) catheter • Lipids are relatively inexpensive and have
• Once opened, bag is good for only 24 hours. • 1.5 mL/kg bolus over 30 minutes (as fast as about a 2-year shelf life.
• Use aseptic technique because there are no possible if asystole) • Hyperlipemia can interfere with laboratory
preservatives in the lipid emulsion. • 0.25 mg/kg/min CRI for 30-60 minutes testing.
• If volume overload is a concern, stop other • Monitor for pyrogenic and allergic responses
fluids during administration of lipids. (especially first 20 minutes), and stop infu- SUGGESTED READING
sion immediately if this occurs. Robben JH, et al: Lipid therapy for intoxications. Vet
Possible Complications and • Check for lipemia in 4-6 hours. If no lipemia Clin North Am Small Anim Pract 47(2):435-450,
Common Errors to Avoid and animal is still symptomatic, repeat the 2017.
• ILE has not been shown to be consistently CRI; if still lipemic, wait and recheck in a AUTHOR: Tina Wismer, DVM, MS, DABVT, DABT
effective in all cases of lipophilic drug couple of hours. EDITORS: Leah A. Cohn, DVM, PhD, DACVIM; Mark S.
toxicosis. Thompson, DVM, DABVP
• Can antagonize/remove antidotal agents or Postprocedure
other supportive therapies • Lipemia: do not redose unless serum is clear.
• Volume overload • Recurrence of toxicosis: lipids may be more
• Lipemia quickly eliminated than the toxin; toxins with

Liver Biopsy, Laparoscopic Client Education
Sheet

Difficulty level: ♦♦♦ • Trocar cannulas (3) or single-site port ○ Use modified Hasson technique instead.
• Veress needle (optional) ○ Hemorrhage is usually self-limiting.
Overview and Goal • 5-mm oval cup biopsy forceps • Aggressive sampling with the biopsy forceps
• Visual inspection of all liver lobes to obtain • 14-16 gauge needle biopsy instrument can create excessive hemorrhage.
biopsy samples and safe access to the gallblad- • 18-20 gauge spinal needle ○ Use hemostatic material or apply compres-
der for aspiration • Blunt palpation probe sion with the blunt palpation probe.
• Samples are superior in size to ultrasound- • Hemostatic agent • Patients showing respiratory compromise
guided Tru-Cut samples • General anesthesia is recommended, although may require ventilatory support.
• Procedure time, with experience, should be sedation and local anesthesia may be used • Bile leakage after gallbladder aspiration is
less than that of an open laparotomy. in compromised patients. an uncommon complication.
Indications Anticipated Time Procedure
• Abnormal liver function Uncomplicated procedure can be accomplished Liver biopsy:
• Persistently elevated serum liver enzyme levels in less than 30 minutes with experience. • Establish pneumoperitoneum using a Veress
• Ascites of unknown origin (p. 79) needle or modified Hasson technique.
• Abnormal sonographic findings of the liver Preparation: Important • Insufflate the abdomen with CO 2 with a
• Monitoring results of specific therapy (e.g., Checkpoints maximum pressure of 15 mm Hg.
copper chelation) • Recent CBC with platelet count, coagulation • Telescope placement may be on ventral
• Suspected infectious or inflammatory biliary profile, and serum biochemical profile midline caudal to the umbilicus or a right-
tract disease (cholecystocentesis) • ± Thromboelastography and buccal mucosal sided midabdominal approach.
bleeding time ○ If the pancreas must be explored, the
Contraindications • Blood pressure right-sided approach is preferred to avoid
• Conditions necessitating full abdominal • List of samples to be obtained (e.g., liver the falciform ligament.
exploration tissue for histology, copper levels, and bacte- ○ For routine liver biopsies, a midline
• Abnormal clotting times rial culture; bile for culture) approach offers the most flexibility as
• Poor patient condition the Hasson technique may be used, and
• Patient size: very small Possible Complications and the left lateral lobe is better visualized.
Common Errors to Avoid • A single-site port may be used for access for
Equipment, Anesthesia • Proper room setup and portal placement the telescope and for instruments.
• Xenon light source and cable is paramount to a successful and seamless • If a single-site port is not used, the instru-
• Carbon dioxide insufflator and tubing procedure. ment portal is established using the scope
• Video camera and monitor • Splenic laceration on abdominal entry with to visualize placement in the right cranial
• 5-mm 0° or 30° telescope the Veress needle abdomen.

www.ExpertConsult.com