Questions in Liver Diseases
Q41) 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
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Whatever the size there is no role of resection for asymptomatic hemangioma. Risk of rupture is very small and therefore there is no rationale for stopping OCPS, pregnancy or physical activities.
Arterial embolization, which may be considered for temporary control of hemorrhage has limited success and is occasionally associated with morbidity
In symptomatic hemangioma liver resection is the treatment of choice, in peripheral tumors enucleation and in centrally placed tumors, formal resection should be done
REf Blumgart Surgery of liver 6th edition
Q42 ) Which of the following is a total shunt?
a) Interposition porto caval shunt (8mm)
b) Distal splenorenal shunt
c) Side to side portocaval shunt
d) Splenocaval shunt
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Shunt surgery is done for portal hypertension to bypass the blocked portal vein and decompress the splnachnic venous system.
There are selective (partial) and non selective (complete) shunts.
Non selective or complete shunts divert the whole splnachnic flow to the systemic flow ie to the IVC.
Non Selective shunts are end to side portocaval shunt and side to side portocaval shunt. They cause complete diversion of blood from the portal vein to the IVC. As a result of this, liver does not get portal flow.
The disadvantage of these non selective shunts is
- Earlier predisposition for liver failure
- Higher chances of encephalopathy
Selective shunts do not completely divert the portal flow to the liver but divert just one arm. This one arm can be either splenic or superior mesenteric
Distal splenorenal shunt (Warren shunt) just diverts the splenic flow and preserves the SMV flow to the liver where as interposition shunt does not completely divert the portal flow.
Q43) 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
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Hepatic adenoma are benign epithelial tumors that appear in a normal liver.
Most commonly seen in young females (20-40 years) in right lobe and are mostly single.
Central stellate scar is seen in Focal Nodular Hyperplasia (FHN) and not adenoma. Hepatic adenomas are composed of large hepatocytes (adenoma cells) with glycogen and lipid.
They are non functional and do not take up Technitium sulphur colloid.
The development of sudden, severe pain associated with hypotension reflects rupture into the peritoneum and bleeding an event associated with a mortality of up to 20 percent if not identified and appropriately treated.
Q44) True about presentation of amoebic liver abscess?
a) 60-70% patients with amoebic liver abscess have diarrhoea
b) Jaundice is seen in 50% of these patients
c) Rupture of liver abscess in the peritoneum is seen in 10% cases
d) More complications of amoebic liver abscess occurs in acute presentation
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Acute presentation of amoebic liver abscess ie symptoms of less than 10 days duration differ from those who have chronic presentation ie more than 2 weeks. Acute presentation presents in the form of pain abdomen, fever, chills and rigors. When there is acute presentation more than 50% lesions are bilateral and in chronic presentation 80% lesions are solitary.
Only 25% of patients have diarrhea. Jaundice is seen in 22& of cases in which there is a large lesion compressing the intrahepatic bile ducts. Rupture in the pleural cavity and peritoneal cavity is less than 1%.
Q45) Which of the following happens during pedicular clamping?
a) Systemic vascular resistance decreases by 20%
b) Mean arterial pressure decreases
c) Cardiac index decreases by 10%
d) Preload to the heart increases
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45 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.
When ever the portal vein is clamped many hemodynamic changes are expected. These include
- Systemic Vascular Resistance (SVR) increase by 40%. This means there is vasoconstriction
- Preload to the heart decrease by 10%
- Cardiac index (cardiac output from left ventricle to the body in one min/BSA) decreases
- Mean arterial BP increases
Normally with the decrease in preload one would expect MAP to fall but MAP increases.