Q. All are true regarding hepatic blood flow except A. Liver has dual blood supply from portal vein and hepatic artery B. 70% of liver oxygen comes from the hepatic artery C. 70-80% of blood supply to the liver is from portal vein
Q) All are true for blunt hepatic trauma except A. Grade V liver injuries are associated with vascular avulsion B. Hepatic packing is an expeditious method to control bleeding in blunt hepatic trauma C. After damage control Surgery and hepatic packing, abdominal compartment syndrome can happen in immediate postoperative period D. Post conservative management, in the 3rd week anemia MC occurs due to subcapsular hematoma rupture
Q) The significance of MELD Scoring in Liver transplant is :
a) Less ill patients are given more priority in liver transplant
b) Set threshold for patients who are too ill to undergo transplant.
c) To access mortality in the waiting list.
d) To list patients in cadaveric deceased donor program
MELD score takes into account three factors. Bilirubin, INR and creatinine. Recently MELD Na is also included. Model for end stage Liver Disease (MELD) was initially developed to evaluate three months prognosis in patients undergoing TIPS. It ranges from 6 (3 months survival = 90%) to 40 (3 months survival =7%).
In countries where DDLT is more common MELD Score is used to allot grafts to people in the cadaveric list. More severe is the MELD, earlier is the allotment of cadaveric graft.
Q) Which of the following hemodynamic happens during pedicular clamping in liver transaction?
a) Systemic vascular resistance decreases by 20%
b) Mean arterial pressure decreases
c) Cardiac index decreases by 10%
d) Preload to the heart increases
c- Cardiac index decreases by 10%
Portal triad clamping is done to decrease blood loss during hepatic transaction. With the advancement in techniques in donor resection in living donor liver transplants, many centers are shifting away from this but in most centers this is still practiced. Read More ...
Previous history of breast cancer if completely treated is not an contraindication of liver transplant. Portal vein thrombosis was earlier considered a relative contraindication but almost all series have shown similar results in patients with PVT than patients without PVT.
IN portal vein thrombosis, inflow to the new liver can me taken in many ways
b) Jump grafts from Superior mesenteric vein
c) Anastomosis have been done from big collaterals
Active tuberculosis can be managed after transplant.
Modified ATT regimens without INH and Rifampicin are being used. Any kind of active substance abuse alcohol, drugs etc are absolute contraindications for liver transplant because the disease will recur.