Q16. In Bismuth Strasberg Classification cystic duct stump blow out is
A) Type A B) Type B
C) Type C D) Type D
Q17) All segments of liver drain into Right Hepatic Duct except?
A) I B) III
C) V D) VIII
Q18) Right Posterior segment duct drains into
a) VI VII b) V Viii
c) III d) IV
Q19) All surfaces of the liver are devoid of peritoneum except
b) Porta Hepatis
c) Anterior surface of caudate lobe
d) Bare area of liver
Q20) In liver transplantation false is
A. HLA-I is present on endothelium
B. HlA-II present on biliary epithelium
D).None
Q 21. False about Hepatocellular carcinoma?
a) In Japan HCV is a common cause
b) Hepatocellular Carcinoma (HCC) is multicentric with HCV
c) Interferon P is prognostic for HCV induced HCC
d) None
a) It is 20% of cardiac output
b) strenuous exercise increases hepatic artery flow
c) Major Oxygen supply to liver by hepatic artery
d) Hepatic artery mainly supplies biliary tree
Q23. False about liver functions
a) makes albumin and fibrinogen
b) endotoxin clearance
d) stores bile after cholecystectomy
e) Stores vit b12
Answers
16) a
TypeA - Bile leak from a minor duct still in continuity with CBD like cystic duct, liver bed
Type B - Occlusion of a part of biliary tree like injury to aberrant right hepatic duct.
Type C - Injury from bile duct not in communication with CBD
Type D - Lateral injury to extrahepatic ducts; CBD, CHD, right or left hepatic ducts
Type E - Circumferential injury to major bile ducts
Read more about biliary structures
here
17)b
The anterior
superior (VIII) and ant inferior (V) ducts join to form right anterior bile duct. The post superior (VII) and post inferior (VI) unite as right post duct. These two join medially to form the Right Hepatic duct
IN 28% cases these two dont merge and join the Left hepatic duct separately
On the left the superior lateral (II) and inferior Lateral (III) merge as lateral duct
Segment IV forms the medial duct. The lateral and medial unite to form the left hepatic duct
Segment I drains into both
18) A
see previous answer
19) C
The other three areas are all devoid of peritoneum.
20)d
The allograft rejection after transplantation is against a group of cell surface molecules known as human leukocyte antigen (HLA). HLAs display antigenic peptides to T- lymphocytes
HLA classs I present only intracellular antigens whereas HLA II present peptides derived from extracellular peptides.
HLA I is present on all nucleate cells
HLA II is present on dendritic cells, macrophages, B lymphocytes
chronic allograft rejection in liver is same vanishing bile duct syndrome
21.d
HCV is more common cause than HBV in Japan in causing Hepatocellular carcinoma. Harrsion 589
Recently, some papers have reported that interferon therapy decreased the incidence of hepatocellular carcinoma in a small number of patients with chronic active
hepatitis C with
cirrhosis. Mazzella and coworkers showed that interferon-alpha decreased the risk for hepatocellular carcinoma in patients with HCV-related cirrhosis. In contrast, Bruno and associates [30] found that interferon therapy was not an independent risk factor for hepatocellular carcinoma in anti-HCV-positive patients with cirrhosis. A European group also did not find a significant benefit of interferon-alpha in preventing hepatocellular carcinoma in patients with compensated type C cirrhosis. Thus, the effect of interferon treatment on the incidence of hepatocellular carcinoma in patients with HCV-related cirrhosis is controversial. (http://www.annals.org/cgi/content/full/129/2/94).
multicentric is more common in HCV infection (1: J Hepatol. 2005 Feb;42(2):225-9.
Multistep and multicentric development of hepatocellular carcinoma: histological analysis of 980 resected nodules)
22.b
Hepatic
blood flow 20% of cardiac output
Hepatic artery 20% of liver blood , 80% of oxygen
30% of hepatic blood flow
exercise decreases splanchnic and hepatic flow
23. d
CBD and not liver stores bile after cholecystectomy
