Liver trauma in kids

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Q )Management of isolated liver injury in children commonly  is  a) Conservative b) Laparotomy c) Intervention and embolization of bleeding vessel d) Liver packing Answer for members only

HCC Cancer

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Q) Which of the following is true about screening in hepatocellular carcinoma (HCC Cancer)  a) Alpha feto protein should be done 6 monthly b) Ultrasound abdomen should be done 6 monthly c) Candidates for liver transplant should be screened every 3 months d) Nodules more than 2 cm should be followed up  more regularly Answer b Cirrhosis is prone for development of HCC. Screeing has to be stringrnt.  Earlier ultrasound of liver and alpha feto protein were both used for screening In 2009 Marrero et al demonstrated the suboptimal accuracy of AFP and after that it has been removed from the screening protocol and now only ultrasound is being done. The screening recommendation is not for those patients with severe associated conditions and with advanced liver disease who are already considered for  transplant. So there is no screening for those who are already listed. Nodules more than 1 cm are highly suspicious where as in nodules less than 1 cm only 40% will be malignant. Ref: blumgart 6th edition  

Fibrolamellar carcinoma of the liver

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Q) Fibrolamellar Carcinoma of the liver  a) Occurs in the setting of cirrhosis b) Has worse survival than Hepatocellular carcinoma c) Can be followed up for long time d) Seen in young females Answer

Hepatic Adenoma

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Q Which of the following statement about hepatic adenoma is CORRECT? a) More common in males b) Contains a central stellate scar c) Associated with cirrhotic liver d) Risk of rupture and fatal hemorrhage is present    Giving a clinical scenario of Hepatic Adenoma  A 37 year old lady presents with right upper quadrant pain and nausea. She is otherwise well and her only medical therapy is the oral contraceptive pill which she has taken for many years with no ill effects. Her liver function tests and serum alpha feto protein are normal. An ultrasound examination demonstrates a 4cm non encapsulated lesion in the right lobe of the liver which has a mixed echogenicity and heterogeneous texture.

Hydatid Cyst

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Q) All are true about hydatid cyst except? a) Liver is the commonest site followed by lung b) Most commonly presents as painless abdominal mass c) Anaphylaxis can occur if there is spillage during surgery d) Dog is the definitive host Answer for premium  

Contraindications for liver transplant

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Q )  Now a days contraindication for liver transplant is  a) HIV positive status of the recipient b) Active infection with SIRS c) Complete portal vein thrombosis  d) HCC with 3 lesions , one is segment II and other two in segment IV, maximum size is 2.8 cm Answer

Hemodynamic changes after pedicular clamping of Portal structures

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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.

Contraindication of liver transplantation

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Q)Contraindications of liver transplantation have changed over the years. Which is an absolute contraindication of  liver transplantation a) Previous breast cancer b) Portal vein thrombosis c) Active tuberculosis d) Active substance abuse Answer d 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 a) thrombectomy 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.

Hemangioma Liver

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Q) True about management of hemangioma liver a) All hemangioma more than 10 cm should be resected b) OCPs and pregnancy should be avoided in young females as there is risk of rupture c) Arterial embolization should be routinely done in large hemangiomas d) If surgery is decided  hemangioma located at the periphery should be enucleated