Q6. Which of the following is not true about shunt encephalopathy?
a) TIPS is associated with 30% risk of encephalopathy in on year.
b) Neomycin and Lactulose have established role in treating chronic encepahlopathies
c) Flumazenil, a selective antagonist of benzodiazepine receptors has a definite role in management
d) Most of the TIPS encephalopathy can be reversed by Percutaneous techniques.
Q7. Which of the following has the weakest association with Hepatocellular Carcinoma (HCC)
a) Hepatitis B
b) Hepatitis C
c) oral contraceptives
d) Smoking
Q8. Which is of the following is not a differential diagnosis of simple cyst of the liver?
a) Hydatid cyst liver
b) Metastatic colorectal tumor
c) Cystadenoma
d) Metastatic neuroendocrine tumors
Q9. A 40 year old female comes with hepatocellular carcinoma 4 cm in size with child's B cirrhosis. Which of the following is the best treatment option for this patient?
a) Hepatic resection with 1 cm margin of normal liver
b) 5FUDR infusion in hepatic artery
c) Hepatic transplant
d) Radiofrequency abalation
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
6.c
Key to the management of encephalopathy is identifying and then eliminating whatever precipitating factors are responsible. Dietary protein should be restricted, infections should be treated, all sedatives should be discontinued, and intestinal catharsis should be accomplished.
Pharmacologic treatment of encephalopathy is indicated for patients with chronic, intermittent symptoms and for those with persistent, acute psychoneurologic disturbances despite elimination of precipitating factors. The only drugs with proven effectiveness are neomycin, a poorly absorbed antibiotic that suppresses ureasecontaining bacteria, and lactulose, a nonabsorbable disaccharide that acidifies colonic contents and also has a cathartic effect Unproven therapies for encephalopathy include the enteral or parenteral administration of branched-chain amino acids and the drug flumazenil, a selective antagonist of benzodiazepine receptors
7. 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
8. b
Simple cysts of the liver are mostly asymptomatic. they are seen as large cystic areas in the liver that do not communicate with the biliary tree. They have serous fluid and thin walled.
Differential diagnosis include hydatid cyst of the liver, cystadenomas and metastatic neuroendocrine tumors mostly gastrinomas, non functioning endocrine tumors, VIPOmas and somatostatinomas.
Metastatic colorectal tumors are mostly solid.
Sabiston 18th edition page 1511
9. c
In a patient with Child's B cirrhosis Hepatic transplant is the best option. Factors to be considered while hepatic resection are
Extent of the disease, functional liver reserve (FLR) and underlying cirrhosis. In a case with CHILD B and C cirrhosis, hepatic transplant is a better option if the size of a lesion is less than 5 cm or there are three different lesions each less than 3 cm in size.
Sabiston 18 page 1503-1504
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.
