Liver MCQs

  1.b

3. d

 4. b

 5.d

All other options are correct

a

Cryotherapy is a good ablation for unresectable liver cancer.

It has a 2 year survival of 60% in unresectable group.

Big sized blood vessels are relatively not affected much because of the rapid blood flow which prevents injury

but larger bile ducts are at risk of injury.

Cryotherapy is generally avoided at sites near major bile ducts.

Bleeding from the probe tract is never a major problem as it can easily be embolized

a

Hepatic ischemia (Shock liver) is a condition where not enough blood or oxygen gets to the liver. This shortage causes injury to liver cells.

Blood levels of liver enzymes such as AST and ALT typically rise 1-3 days after the episode of low blood pressure. Levels of another enzyme in the blood, LDH, are also usually quite high.

Patients generally recover if the underlying illness can be treated. Death from liver failure as a result of hepatic ischemia is very rare.

 d

Contrast Enhanced Ultrasound is a new modality which consists of injecting contrast bubbles in the circulatuion and as these contrast get adherent to the Kupffer cells of liver, they emit acoustic signals which are then picked up by the USG probe.

Now 2nd generation contrast bubbles are available that emit acoustic signals as they contract and expand. These bubbles remian in circulation and detection of arterial and portal phase becomes easier

Advantages over CT scan are

1 the microbubble contrast agents are real blood-pool agents not leaving the intravascular space

2 A continuous imaging over the whole enhancement period with high temporal resolution is possible, not limited to distinct, pre-defined time points

Other advantages are no exposure to radiation, absence of nephrotoxic contrast agents and large availability of machines.

In comparison with CT and/or dynamic MRI, SonoVue®-enhanced sonography applied for characterization of focal liver lesions was 30.2% more sensitive in the recognition of malignancy and 16.1% more specific in the exclusion of malignancy and overall 22.9% more accurate.

(Ref)Hervé Trillaud Characterization of focal liver lesions with SonoVue®-enhanced sonography: International multicenter-study in comparison to CT and MRI . World J Gastroenterol. 2009 August 14; 15(30): 3748–3756.

Ans ) a

Despite a long list of functional, biochemical tests and imaging studies, the clinical examination by an experienced hepatic surgeon remains the most important issue in major hepatic resections.

With improvements in surgical technique, anesthesia and ICU care liver resection now has a mortality of less than 3%

Child Pugh System was initially developed for patients of Postal Hypertension who underwent a shunt procedure. It has three objective (Bilirubin, Ascites, INR) and two subjective (Ascites, Encephalopathy) criteria