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

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

<p>Bile salts (A)</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 (C)</p> Signup and view all the answers

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

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

What is the usual energy source for the liver?

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

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

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

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

<p>Conjugation of bilirubin (D)</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 (A)</p> Signup and view all the answers

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

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

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

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

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

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

What is the most common cause of liver failure?

<p>Cirrhosis (C)</p> Signup and view all the answers

What is the mechanism behind cirrhosis?

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

What is the treatment for hepatic encephalopathy?

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

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

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

What is the initial management for esophageal variceal bleeding?

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

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

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

What is considered a significant portal vein pressure measurement?

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

Which test is the best for diagnosing hemangiomas?

<p>Tagged RBC scan (A)</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 (D)</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 (C)</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 (C)</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 (A)</p> Signup and view all the answers

Which factor correlates with the size of hepatocellular carcinoma tumors?

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

What is the primary risk factor for hepatocellular carcinoma worldwide?

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

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

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

In which condition is the use of splenorenal shunts contraindicated?

<p>Refractory ascites (D)</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 (A)</p> Signup and view all the answers

Which scoring system correlates with mortality after open shunt placement?

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

In which condition is TIPS contraindicated?

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

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

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

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

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

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

<p>Hypercoagulable states (C)</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 (B)</p> Signup and view all the answers

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