31 Liver ANATOMY AND PHYSIOLOGY
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Questions and Answers

What is the anatomic division of the liver into right and left halves by a line extending from the gallbladder fossa posteriorly to the inferior vena cava?

  • Falciform ligament
  • Hepatic artery variant
  • Cantlie’s line (correct)
  • Couinaud’s segmental anatomy
  • Which structure attaches the liver to the anterior abdominal wall and extends to the umbilicus?

  • Falciform ligament (correct)
  • Left hepatic artery
  • Line drawn from the middle of the gallbladder fossa to IVC
  • Hepatic artery variant
  • Which artery off the left gastric artery is found in the gastrohepatic ligament medially?

  • Left hepatic artery (correct)
  • Hepatic artery variant
  • Falciform ligament
  • Right hepatic artery
  • What structure carries the obliterated umbilical vein to the undersurface of the liver?

    <p>Ligamentum teres</p> Signup and view all the answers

    Which segments make up the left lobe according to Couinaud’s segmental anatomy of the liver?

    <p>Segments II, III, and IV</p> Signup and view all the answers

    Where does the right hepatic artery off superior mesenteric artery (#1 hepatic artery variant) course behind according to the text?

    <p>Pancreas</p> Signup and view all the answers

    What is the main component of bile responsible for emulsifying fats in the intestine?

    <p>Bile salts</p> Signup and view all the answers

    Which segment of the liver receives separate right and left portal and arterial blood flow?

    <p>Caudate lobe</p> Signup and view all the answers

    In which zone of the liver are hepatocytes most sensitive to ischemia?

    <p>Zone III</p> Signup and view all the answers

    What is the usual energy source for the liver?

    <p>Ketones</p> Signup and view all the answers

    Which condition leads to the dark color of urine, similar to cola?

    <p>Excess urobilinogen</p> Signup and view all the answers

    What is the main function of glucuronyl transferase in the liver?

    <p>Conjugation of bilirubin</p> Signup and view all the answers

    Which syndrome is characterized by a deficiency in storage ability and high conjugated bilirubin?

    <p>Rotor’s syndrome</p> Signup and view all the answers

    What is the primary component of bile responsible for solubilizing cholesterol?

    <p>Bile salts</p> Signup and view all the answers

    Which type of hepatitis agent has serious consequences that are uncommon?

    <p>Hepatitis A (RNA)</p> Signup and view all the answers

    What is the maximum total bilirubin level at which jaundice becomes evident under the tongue?

    <p>2.5</p> Signup and view all the answers

    Which virus is currently the most common cause of viral hepatitis leading to liver transplant?

    <p>Hepatitis C</p> Signup and view all the answers

    What is the best indicator of synthetic function in a patient with cirrhosis?

    <p>Prothrombin time (PT)</p> Signup and view all the answers

    What is the most common cause of liver failure?

    <p>Cirrhosis</p> Signup and view all the answers

    What is the mechanism behind cirrhosis?

    <p>Portal venous congestion</p> Signup and view all the answers

    What is the treatment for hepatic encephalopathy?

    <p>Lactulose</p> Signup and view all the answers

    What is the primary bacteria causing spontaneous bacterial peritonitis (SBP)?

    <p>Escherichia coli</p> Signup and view all the answers

    What is the initial management for esophageal variceal bleeding?

    <p>Band ligation and sclerotherapy</p> Signup and view all the answers

    Which condition leads to portal hypertension characterized by post-sinusoidal obstruction?

    <p>Budd-Chiari syndrome</p> Signup and view all the answers

    What is considered a significant portal vein pressure measurement?

    <p>&gt; 10 mm Hg</p> Signup and view all the answers

    "Caput medusae", a condition associated with portal hypertension, refers to visible veins around which area of the body?

    <p>Abdomen</p> Signup and view all the answers

    Which benign hepatic tumor is most likely to rupture and cause symptoms such as pain, elevated liver function tests, decreased blood pressure, and a palpable mass?

    <p>Adenoma</p> Signup and view all the answers

    Which benign hepatic tumor is characterized by having a central stellate scar on imaging and is more common in women?

    <p>Focal nodular hyperplasia</p> Signup and view all the answers

    Which test is the best for diagnosing hemangiomas?

    <p>Tagged RBC scan</p> Signup and view all the answers

    Which of the following is a rare complication of hemangioma characterized by consumptive coagulopathy and congestive heart failure?

    <p>Kasabach-Merritt syndrome</p> Signup and view all the answers

    What is the most common cancer worldwide and is most commonly associated with symptoms of right upper quadrant discomfort and weight loss?

    <p>Hepatocellular carcinoma</p> Signup and view all the answers

    Which type of hepatocellular carcinoma has the best prognosis and is usually found in adolescents and young adults, not in the setting of cirrhosis?

    <p>Fibrolamellar type</p> Signup and view all the answers

    What imaging test may show a mosaic pattern with non-homogenous necrotic areas mixed with hypervascular sections characteristic of hepatocellular carcinoma?

    <p>CT scan</p> Signup and view all the answers

    Which factor correlates with the size of hepatocellular carcinoma tumors?

    <p>AFP level</p> Signup and view all the answers

    What is the primary risk factor for hepatocellular carcinoma worldwide?

    <p>Hepatitis B</p> Signup and view all the answers

    What intervention is recommended if future liver remnant (FLR) does not look adequate for resection of liver cancer?

    <p>Preoperative liver transplantation evaluation</p> Signup and view all the answers

    What should be urgently repaired in the presence of perforation, infection, or bowel incarceration during umbilical hernia repair with ascites?

    <p>Bowel</p> Signup and view all the answers

    What should be removed and controlled preoperatively in the presence of ascites during umbilical hernia repair?

    <p>Ascites</p> Signup and view all the answers

    Which shunt option is considered selective and has a low rate of encephalopathy?

    <p>Splenorenal shunt</p> Signup and view all the answers

    In which condition is the use of splenorenal shunts contraindicated?

    <p>Refractory ascites</p> Signup and view all the answers

    What is used as an alternative if TIPS is not available and refractory ascites is the problem?

    <p>Partial portosystemic shunt</p> Signup and view all the answers

    Which scoring system correlates with mortality after open shunt placement?

    <p>Child-Pugh Score</p> Signup and view all the answers

    In which condition is TIPS contraindicated?

    <p>Refractory ascites</p> Signup and view all the answers

    What is the most common cause of massive hematemesis in children with portal hypertension?

    <p>Esophageal varices</p> Signup and view all the answers

    What is the most common organism responsible for pyogenic liver abscesses?

    <p>E. coli</p> Signup and view all the answers

    Which type of benign liver tumor has a risk of significant bleeding, especially as its size increases?

    <p>Hepatic adenoma</p> Signup and view all the answers

    Which condition can lead to isolated gastric varices without elevation of pressure in the rest of the portal system?

    <p>Splenic vein thrombosis</p> Signup and view all the answers

    What is the most appropriate initial treatment for acute portal vein thrombosis without upper gastrointestinal bleeding?

    <p>Heparin</p> Signup and view all the answers

    What is the most common cause of extrahepatic portal vein thrombosis in children?

    <p>Hypercoagulable states</p> Signup and view all the answers

    Which type of liver abscess can often be diagnosed based on CT characteristics and usually does not require drainage?

    <p>Amebic abscess</p> Signup and view all the answers

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