Q1. Which of the following structures does not form the portal triad
a) Portal Vein
b) Hepatic vein
c) Hepatic Artery
d) Bile Duct
Q2. Which of the following has the weakest association with Hepatocellular Carcinoma (HCC)
a) Hepatitis B
b) Hepatitis C
c) oral contraceptives
d) Smoking
Q3. Which is not a paraneoplastic syndrome for Hepatocellular Carcinoma
a) Hypercalcemia
b) Hypoglycemia
c) Erythrocytosis
d) Hyperglycemia
Q4. Which is the most common cause of Hemobilia
a) Blunt Trauma Abdomen
b) Iatrogenic injury
c) Cholelithiasis
d) Hepatic artery aneyrysm
Q5. Which is not true regarding Haemangioendothelioma of liver?
a) It is a rare tumor
b) It is highly vascular
c) It involves both lobes of the liver
d)) In 50% cases it has extrahepatic spread.
Answers
1.b
Hepatic vein does not form part of the portal triad. It forms the central vein around which the hepatocytes are arranged and on the periphery is the portal triad consisting of Portal Vein Posteriorly, the bile duct on the right and Hepatic artery on the left.
2. c
Hepatitis B and Hepatitis C have known association with cirrhosis and Hepatocellular Carcinoma.
Other significant risk factors are
Chronic alcohol abuse
Smoking
Aflatoxins
Nitrates, NItrites
Haemochromatosis, Wilson, Aplpha 1 Antitrypsin deficiemcy
Throrotrast
Associations with hormonal manipulations such as the use of oral contraceptive agents and anabolic steroids have been suggested but are weak
Sabiston 17th
3. d
Less than 1% of cases of HCC present as a paraneoplastic syndrome, most commonly hypercalcemia, hypoglycemia, and erythrocytosis
4. b
Earlier Blunt Abdominal trauma was the most common cause of Hemobilia. But recently with the advent of more interventional procedures like PTBD (Percutaneous Transhepatic Biliary Drainage), hemobilia has become more common.
5.d
All the above are true except the fourth choice. In one fourth cases extrahepatic sprread occurs. Death is usually due to liver failure.
