Liver 11-15

Online MCQs in Liver

Liver Secondaries

Hydatid disease

Hepatocellular carcinoma

Radiofrequency embolisation

Questions on Liver Anatomy 

Questions on Portal hypertension


Q11. Which of the following is not true about shunt encephalopathy?
a) TIPS is associated with 30% risk of encephalopathy in one year.
b) Neomycin and Lactulose have an established role in treating chronic encepahlopathy
c) Flumazenil, a selective antagonist of benzodiazepine receptors has a definite role in management
d) Most of the TIPS encephalopathy can be reversed by Percutaneous techniques.

Key to the management of encephalopathy is identifying and then eliminating whatever precipitating factors are responsible.
All infections should be treated
all sedatives should be discontinued, and intestinal catharsis should be accomplished.
Pharmacologic treatment of encephalopathy is indicated for patients with chronic, intermittent symptoms and for those with persistent, acute psychoneurologic disturbances despite elimination of precipitating factors.
The only drugs with proven effectiveness are neomycin, a poorly absorbed antibiotic that suppresses urease containing bacteria, and lactulose, a nonabsorbable disaccharide that acidifies colonic contents and also has a cathartic effect                                                      
Unproven therapies for encephalopathy include the enteral or parenteral administration of branched-chain amino acids and the drug flumazenil, a selective antagonist of benzodiazepine receptors

Q12. Which of the following has the weakest association with Hepatocellular Carcinoma (HCC)
a) Hepatitis B
b) Hepatitis C
c) oral contraceptives
d) Smoking

12. c
Hepatitis B and Hepatitis C have known association with cirrhosis and Hepatocellular Carcinoma.
Other significant risk factors are
Chronic alcohol abuse
Nitrates, NItrites
Haemochromatosis, Wilson, Aplpha 1 Antitrypsin deficiemcy
Associations with hormonal manipulations such as the use of oral contraceptive agents and anabolic steroids have been suggested but are weak
Sabiston 20th


Q13. Which is not a paraneoplastic syndrome for Hepatocellular Carcinoma
a) Hypercalcemia
b) Hypoglycemia
c) Erythrocytosis
d) Hyperglycemia

13. d
Less than 1% of cases of HCC present as a paraneoplastic syndrome, most commonly hypercalcemia, hypoglycemia, and erythrocytosis

Q14.  Which is the most common cause of Hemobilia
a) Blunt Trauma Abdomen
b) Iatrogenic injury
c) Cholelithiasis
d) Hepatic artery aneyrysm

14. b
Earlier Blunt Abdominal trauma was the most common cause of Hemobilia. But recently with the advent of more interventional procedures like PTBD  (Percutaneous Transhepatic Biliary Drainage), hemobilia has become more common.

Q15. Which is not true regarding Haemangioendothelioma of liver?
a) It is a rare tumor
b) It is highly vascular
c) It involves both lobes of the liver
d)) In 50% cases it has extrahepatic spread.

All the above are true except the fourth choice. In one fourth of the cases extrahepatic spread occurs. Death is usually due to liver failure

         Surgery Notes

King's college criteria of Liver Transplantation in Acute Liver Failure
Acetaminophen-induced disease
Arterial pH <7.3 (irrespective of the grade of encephalopathy)
 Grade III or IV encephalopathy, and
Prothrombin time >100 seconds, and
Serum creatinine >3.4mg/dl (301 ?mol/L)
All other causes of fulminant hepatic failure
Prothrombin time >100 seconds (irrespective of the grade of encephalopathy)
Any three of the following variables (irrespective of the grade of encephalopathy)
Age <10 years or >40 years
Etiology: non-A, non-B hepatitis, halothane hepatitis, idiosyncratic drug reactions
Duration of jaundice before onset of encephalopathy >7 days
Prothrombin time >50 seconds

Serum bilirrubin >18 mg/dl (308 ?mol/L)


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