Q51) Which of the following liver resections have the least chances of bleeding?
a) Previous history of TACE
b) A patient with splenomegaly
c) The patient with Platelet count 25000
d) Patient with grade III esophageal varices
51 a
Prior history of TACE means no portal hypertension. All other choices are indirect evidences of portal hypertension.
52). Absolute contraindication for left lobe LDLT is A. Trifurcation of the portal vein B. Bifurcation of portal vein in the right lobe of the liver C. Aberrant right hepatic artery D. Right Posterior duct draining into left hepatic duct
52) d
Trifurcation of portal vein is not a contraindication of left lobe liver transplant as we will get a single portal vein on the left side
Portal vein
Bifurcation of portal vein in right lobe does not matter because we are leaving the right lobe behind
Again right aberrant artery does not matter because that segment is left behind
Right post duct draining into left duct gives rise to two ducts on the left or a single duct which is quite high.
Right posterior duct to left
53) Which of the following does not cause hepatic adenoma? (AIIMS 2018, NOV)
c) Mesocaval graft thrombosis precludes liver transplant
d) In IVC stenosis, splenorenal shunt can be used
54) c
Hepatic venography is often not needed for establishing a diagnosis but may be useful for direct measurement of a pressure gradient - Ref SKF 1521
The diagnosis of Budd-Chiari syndrome should be considered in any patient with hepatomegaly and ascites. Pain is seen in acute and not chronic BCS
Vein angioplasty with or without stent placement also has been tried in selected cases. It is indicated for short-segment stenoses of a hepatic vein or veins, hepatic venous outflow tract stenosis following liver transplantation, or IVC webs. Angioplasty with stenting of the retrohepatic IVC has been performed in conjunction with surgical portosystemic shunting when a pressure gradient exists across this segment of the IVC from caudate lobe compression.
If the IVC is widely patent, either a mesocaval shunt, a central splenorenal shunt, or a side-to-side portacaval shunt
Mesocaval and splenorenal shunts are used most commonly. If the mesocaval graft thromboses, the superior mesenteric vein will probably not be available should liver transplant eventually become warranted.
A direct, sideto-side splenorenal shunt preserves the hepatic hilum and does not require a vein graft. Although side-to-side portacaval shunts have a reported high-patency rate, hypertrophy of the caudate lobe can make direct shunting impossible. In addition, dissection of the hepatic hilum can make subsequent liver transplantation difficult. Finally, portal vein thrombosis is an obvious contraindication for the procedure.
IN IVC stenosis, mesoatrial shunt is used
Ref SKF page 1522
Q55) Which is not true in terms of biliary fistula in hydatid cyst liver
a) Cyst diameter more than 10 cm is a predictor of intrabiliary rupture
b) Minor communications are revealed by post op bile leak
c) Major biliary communication is fistula more than 5 mm or communication in the bile duct
d) Major biliary communication is seen in 15-20%
Answer
Q56) In Budd Chiari Syndrome best management for patients when all three hepatic veins are blocked with deranged LFT
a) Liver transplant
b) Side to side porto caval shunt
c) MEso atrial Shunt
d) TIPS
Q57 ) True about 5 cm haemangioma of the liver
a) 50% of symptomatic haemangiomas of the liver will still have some other intra abdominal cause
b) They should be operated because of high risk of rupture
Q58) Which finding best describes post hepatectomy liver failure A) INR and Billi raises on or after day 5 B) Refractory INR even after FFP C) Hyperbilirubinemia D) Hepatic encephalopathy
