LVR ABST 10 Flashcards
With regard to hepatic anatomy, the falciform ligament
divides the _______ rom the _______.
A. Caudate lobe, quadrate lobe
B. Right lobe, le lobe
C. Left medial section, le lateral section
D. Left medial section, right lobe
C
The most common variant of normal hepatic artery
anatomy is
A. Replaced left hepatic artery rom the left gastric artery
B. Completely replaced common hepatic artery rom the
superior mesenteric artery (SMA)
C. Replaced right and left hepatic arteries
D. Replaced right hepatic artery rom the SMA
D
Which of the following correctly pairs the segments o the
liver and their associated systemic venous drainage?
A. Segments I, II, III: Right hepatic vein
B. Segment IV: Right hepatic vein
C. Segment I: IVC
D. Segment V, VI, VII, VIII: Lef hepatic vein
C
With respect to the enterohepatic circulation of bile, where
are the majority of bile salts reabsorbed?
A. Duodenum
B. Proximal jejunum
C. Terminal ileum
D. Colon
C
Which of the following compounds is not synthesized predominantly by the liver? A. Albumin B. Factor VIII C. Factor VII D. Factor II
B
The gold standard or identifying liver lesions by imaging
is
A. Intraoperative ultrasound
B. Computed tomography (C ) with triple-phase contrast
C. Magnetic resonance imaging (MRI) with gadoxetate based
contrast
D. Positron emission tomography (PE ) scan
A
The most common cause o acute liver failure (ALF) in the
United States is
A. Acute viral hepatitis
B. Cardiogenic shock
C. Autoimmune hepatitis
D. Drug/toxin-induced (including acetaminophen)
D
A patient presents with painless jaundice, and is found to
have cirrhosis. They have no history o alcohol abuse, but
do note a history o diabetes mellitus and pseudogout.
They also mention that multiple members o their family
have suffered rom cirrhosis. What is the most likely etiology
or their cirrhosis?
A. Alcohol abuse
B. Wilson disease
C. α1-antitrypsin deficiency
D. Hemochromatosis
D
Which of the following is not one of the physiologic
changes noted in patients with cirrhosis?
A. Reduced resting energy expenditure
B. Reduced muscle and at stores
C. Increased cardiac output
D. Decreased systemic vascular resistance
A
Clinically significant portal hypertension is evident when the \_\_\_\_\_\_\_ exceeds \_\_\_\_\_\_ mmHg. A. Wedged hepatic venous pressure, 10 B. Free hepatic venous pressure, 20 C. Hepatic venous pressure gradient, 10 D. Hepatic venous pressure gradient, 20
C
All of the ollowing therapies are considered appropriate
during the management of an acute variceal hemorrhage
EXCEPT ?
A. Endoscopy with variceal band ligation
B. Short-term antibiotic prophylaxis
C. Somatostatin analogues
D. Recombinant actor VIIa
D
A cirrhotic patient is admitted with variceal bleeding. The
bleeding is controlled with pharmacologic therapy, and the
patient recovers rom the acute episode. Assuming they
receive no other therapies to treat their varices or their
underlying cause, what is the likelihood that they will
experience a recurrent variceal bleed within 2 years
A. 20%
B. 40%
C. 70%
D. 100%
C
Which of the following INCORREC LY matches a grading
scale or patients with liver disease and one o its
components?
A. Model or End-Stage Liver Disease (MELD): Serum
creatinine
B. Child- Turcotte-Pugh (CTP): Bilirubin
C. CTP: INR
D. MELD: Albumin
D
Which of the following INCORRECTLY pairs the CTP
class with overall risk o mortality following an intraabdominal
operation?
A. Class A: 10%
B. Class B: 30%
C. Class C: 50%
D. Class C: 75%
C
What is the most common complication following TIPS? A. Encephalopathy B. Hepatic ischemia C. In ection D. Li e-threatening hemorrhage
A
Initial management of a pyogenic liver may include all of
the following EXCEPT ?
A. reatment o the underlying cause
B. Broad-spectrum intravenous antibiotics
C. Surgical drainage and/or resection
D. Percutaneous fine-needle aspiration and culture
A
The most common benign hepatic lesion is the A. Hemangioma B. Simple cyst C. Adenoma D. Bile duct hamartoma
B
Which of the following liver lesions carry a significant risk of spontaneous rupture? A. Hemangioma B. Hepatic cyst C. Adenoma D. Bile duct hamartoma
C
A patient presents with results from a contrast-enhanced
CT scan that describe a well-circumscribed lesion that
demonstrates homogenous enhancement during arterial
phase, isodensity on the venous phase, and a central scar.
In general, what would be the recommended treatment?
A. Reassurance and observation
B. Percutaneous radio frequency ablation
C. Resection
D. transarterial chemoembolization
A
What is the annual conversion rate to HCC or patients with cirrhosis? A. Less than 1% B. 1–2% C. 2–6% D. 6–10%
C
Patient’s eligible or the Mayo Clinical protocol to treat
hilar cholangiocarcinoma do NOT include
A. Patients with hilar cholangiocarcinoma and primary
sclerosing cholangitis (PSC).
B. Patients with unresectable cholangiocarcinoma.
C. Patients with tumors less than 3 cm.
D. Patients who have had prior radiotherapy.
D
A patient undergoes routine cholecystectomy and is incidentally
round to have gallbladder carcinoma that is
staged as 1. Further treatment should include
A. No further treatment.
B. External beam radiation with systemic chemotherapy.
C. Reoperation with central liver resection and hilar
lymphadenectomy.
D. Reoperation with ormal lobectomy and bile duct
resection.
D
Which of the following is considered a primary determinant
o suitability or resection when evaluating a patient
with hepatic colorectal metastases?
A. Number of metastatic tumors
B. Size of metastatic tumors
C. Predicted volume of hepatic remnant
D. Prior therapy
C
Based on the standard Milan criteria, which of the
following patients with HCC would be eligible or
transplantation?
A. One 4.5-cm lesion in segment VI with invasion of the
right portal vein.
B. T ree lesions conf ned to the right lobe, with the largest
being 2.5 cm.
C. A single, 5.5-cm lesion in segment II.
D. T ree lesions spread throughout the liver, with the
largest being 3.5 cm.
B
The only FDA-approved systemic chemotherapeutic agent or HCC is A. Epirubicin B. Cisplatin C. 5-Fluorouracil D. Sorafenib
D
Which of the following correctly pairs the Brisbane 2000
hepatic resection terminology with appropriate liver
segments?
A. Right posterior sectionectomy: Segments IV and IV
B. Left hepatectomy: Segments I, II, III, and IV
C. Right Hepatectomy: Segments VI, VII, and VIII
D. Left lateral sectionectomy: Segments II and III
D
Divides the right and left lobes of the liver
a. round ligament
b. falciform ligament
c. cantlie line
d. left triangular ligament
C
Ligaments that may be divided in a bloodless plane during liver resection(4)
Coronary ligaments
Falciform ligaments
Triangular ligaments
Round ligament
True about standard arterial anatomy of the liver
a. common hepatic artery arises from celiac trunk EXCEPT
b. gastroduodenal and proper hepatic artery are supplied by the hepatic artery
c. the proper hepatic artery becomes superior and inferior hepatic artery
d. standard arterial configuration is present in 76% of population
C
Common variants of hepatic arterial configuration are (4)
replaced R hepatic artery from SMA (10-15%)
replaced left hepatic artery from the left gastric artery (3-10%)
replaced right and left hepatic arteries (1-2%)
Completely replaced common hepatic artery from the SMA (1-2%)
What vein drains segments V-VIII
R hepatic vein
What vein drains segments II and III ?
L hepatic vein
What vein drains segment IV as well as segments V and VIII,
middle hepatic vein
The caudate lobe drains directly in to the
IVC
rate of albumin production by the liver
10 g/ day
T/F albumin measurement can surrogate for liver synthetic function
T
Half life of albumin
15-20 days
Markers for synthetic function EXCEPT
a. PTT
b. PT
c. INR
d. albumin
A
Conidtions that can prlong PT/INR EXCEPT
a. liver cirrhosis
b. vit K deficiency
c. warfarin use
d. oral contraceptive use
D
Definition of acute liver failure
development of hepatic encephalopathy within 26 weeks of severe liver injury in a patient with no history of liver disease or portal hypertension
Most common cause of chronic liver disease in the US
Chronic hep C infection
What is the most common metabolic cause of cirrhosis
Hemochromatosis
The following are intrahepatic causes of portal hypertension EXCEPT
a. schistosomiasis
b. myeloproliferative disorder
c. Budd-Chiari
d. NOTA
C
Budd Chiari is post-sinusoidal
T/F in evaluating patients with suspected portal hypertension, an enlarged portal vein on routine abdominal ultrasonography may suggest portal hypertension.
F
most accurate method for measuring portal hypertension is
hepatic venography
Leading cause of morbidity and mortality in those with portal venous hypertension
Variceal bleeding
During variceal bleeding, blood products
and crystalloid should be done with care. A target o hemoglobin
of _____is appropriate, and administration o platelets
and resh rozen plasma may be considered or patients with
thrombocytopenia or severe coagulopathy
8 g/dL
Over resuscitation with both blood products and crystalloid solution has been associated with ________
increased risk of re-bleeding and morbidity
Most common infectious complications in patients with liver cirrhosis who experience a variceal bleed
Bacterial peritonitis
Most potent vsoconstrictor used in management of variceal bleeding
Vasopressin
3 parameters in MELD scoring
BIC
Bilirubin, total
INR,
Creatinine, serum
Components of Child-Pugh scoring
Bilirubin Albumin ASCITIS INR ENCEPHALOPATHY
Estimated percent mortality with class A CTP
10%
Estimated percent mortality with class B CPT
30%
Estimated percent mortality with class C CPT
75-80%
MELD score considered appropriate for surgery
below 10
MELD score that should not be considered for elective procedures
above 15
Most common site of pyogenic liver abscess
right lobe of the liver
most cmmon pathogen of pyogenic liver abscess
E. coli
Duration of IV antibiotics in pyogenic liver abscess
8 weeks
Most common solid benign masses found in the liver
Hemangiomas
Treatment options for large hepatic cysts, proven effective in approximately 90% of patients.
Percutaneous cyst aspiration
Sclerotherapy
well-circumscribed mass
that demonstrates enhancement on the arterial phase and
isodensity on the venous phase with characteristic central scar.
Focal nodular hyperplasia
Not prone to malignant degeneration EXCEPT
a. hemangioma
b. FNH
c. adenoma
C
While
FNH and adenomas may appear similar on C or standard
MRI, new MRI contrast agents, such as _________, allow superior discrimination between
these two lesions
gadobenate dimeglumine (MultiHance)
Rank of HCC in terms of most common malignancy worldwide
5th
Cirrhosis is present in what percentage of patients who develop HCC?
70-90%
Second most common primary liver malignancy
Cholangiocarcinoma
Proximal cholangiocarcinoma a.k.a
a. hilar carcinoma
b. Klatskin tumor
c. both
d. neither
C
