Q 61) Orthoptic Liver Transplant indicated in all except
A) HPS
B) Hyperbilirubinemia C) Severe hepatic encephalopathy
D) SBP
Q 62 ) Contraindication of major liver resection?
a) ICG retention of 13%
b) Child Pugh score B
c) Cirrhosis with FLR > 50%
d) Normal liver with FLR 30%
Q63) Regeneration of liver false is a) From 2 wk to 3 month b) Occur from epithelial cell fenestration. c) Kupffer cell DNA synthesis with in 48 hr d) Regeneration from periportal to pericentral direction
Ans False is b
Hepatocytes provide the mitogenic stimulus.
a is true
Liver regeneration is carried out by hepatocytes, biliary, fenestrated endothelial cells, Kupffer cells and Ito cells.
Induction of DNA synthesis at 48 hrs in Kupffer cells and biliary epithelial cells and 96 hrs for endothelial cells.
Q 64 : After hepatectomy for Non colorectal non neuroendocrine metastasis (false is :
1)Metastasis from non reproductive organ worse prognosis than reproductive tract tumor
2) Reproductive tract metastasis good prognosis
3) DFS is not a criteria for determining prognosis
4) Synchronous metastasis are those appearing with in 6 months
Ans - c
Genitourinary primaries to liver which are resected have the best prognosis followed by breast cancer ( both a and b are true) Blumgart page 1370
Disease free survival ( DFS) less than 24 mths is associated with worse prognosis
Ref blumgart page 1370
Q 65 Low CVP maintainace and hepatic resection all are associated with all except :
a) Reduced bleeding
b) Reduced transfusion
c) Increased renal injury
d) Reduced operative time
Ans 65) d
Low central venous pressure (CVP ≤5 mm Hg), through restrictive fluid administration, and administration of vasopressors and inotropes to attenuate splanchnic hyperemia and support organ perfusion pressure, is associated with reduced bleeding and transfusion requirements in OLT
There is increased mortality and renal failure associated with low-CVP management. Whereas the low-CVP strategy may be possible in select patients with normal kidney function and good cardiovascular reserve, targeting one specific low CVP (i.e., 5 mm Hg) may not be physiologically advantageous in patients with poor ventricular compliance or dynamic LV outflow obstruction
Ref Blumgart 6th edition page 1758
Q66 Caudate anatomy, false is :
a) Bile duct supply is by both right and left hepatic duct
b) Paracaval portion is segment IX
c) Mainly venous drainage to middle and left hepatic vein
4)
Ans 66 ) c Caudate venous outflow is to IVC
The vascular inflow and biliary drainage to the caudate lobe come from both the right and left pedicles
The hepatic venous drainage of the caudate is unique because a number of posterior small veins drain directly into the IVC.
Ref sabiston 21 page 1428
Q 67 ) ALPSS all are true except?
a) ALPPS should not be considered in every patient in whom PVE has failed.
b) CT scan and volumetric assessment is done after POD 7 and proceeded to stage 2 if sFLR greater than 30% (BWR > 0.5%) or 40% (BWR > 0.8%) depending on parenchymal quality
c) Indicated for Large CRLM
d) Is a relative contraindication for patients with hilar cholangiocarcinoma
Ans 67 a) ALPPS should be considered in every patient in whom PVE or the classic two-stage approach is not feasible or has failed
The limits for safe hepatic resections are usually considered from 20% to 40%, depending on the quality of liver parenchyma (fibrosis, steatosis,
chemotherapy-related liver injury). The lower limit for FLRV is set at 20% in patients with normal livers, 30% to 35% in patients with chemotherapy-related liver injury, and 40% in patients with chronic liver disease
Cut-off values for proceeding to stage 2, usually after 7 to 14 days, are sFLR greater than 30% (BWR > 0.5%) or 40% (BWR > 0.8%) depending on parenchymal quality. ( Ref BG page 1665)
Currently, CRLM is the most promising indication, especially for bilobar involvement
In hilar cholangiocarcinoma its a relative contraindication as the mortality and morbidity are high