Liver, Biliary System, and Spleen

Question 1

Liver is derived from

Answer 1

Ventral (endodermal) outgrowth of the foregut

Question 2

Kupffer cells, hepatic stroma, and hepatic vessels arise from

Answer 2

Septum transversum (mesoderm)

Question 3

Line that divides the liver into 2 lobes

Answer 3

Cantlie’s line

runs from the left side of the gallbladder fossa to the inferior vena cava (IVC).

Question 4

The functional unit of the liver.

Answer 4

acinar unit

Question 5

Zone of the liver that is located closest to the portal triad

Answer 5

Zone 1

Question 6

Zone of the liver that is least susceptible to ischemic insult, but most susceptible to toxic or chemical injury

Answer 6

Zone 1

Question 7

Zone of the liver that is adjacent to the terminal hepatic vein

Answer 7

Zone 3

Question 8

Zone of the liver that is most susceptible to ischemic injury

Answer 8

Zone 3

Question 9

Segments drained by right hepatic duct

Answer 9

V, VI, VII, VIII

left drains I, II, III, IV

Question 10

Normal gallbladder wall thickness

Question 11

Accessory bile ducts

Answer 11

Ducts of luschka

Question 12

Implicated as a common source of postcholecystectomy biliary leaks that are not caused by injury to the major ducts or by failure to close the cystic duct stump.

Answer 12

Ducts of Luschka

Question 13

Epithelial lining of the biliary system

Answer 13

Columnar

Question 14

Form from the invagination of the epithelium through the fibromuscular layer as a result of inflammation and ↑ intraluminal pressure in the gallbladder (eg, cholangitis, acute cholecystitis).

Answer 14

Rokitansky–Aschoff sinuses

Question 15

Most liver tumors are supplied primarily by what vessel

Answer 15

Hepatic artery

Question 16

Vein that drains the II, III, IVa

Answer 16

Left hepatic vein

Question 17

Vein that drains the V, and IVb segments

Answer 17

Middle hepatic vein

Question 18

Vein that drains VI, VII, VIII

Answer 18

Right hepatic vein

Question 19

Segment of the liver that is drained directly into the IVC

Answer 19

Caudate (I)

Question 20

Makes up 85% of the spleen

Answer 20

Red pulp

White pulp - 15%

Question 21

3 arteries that supply the spleen

Answer 21

Splenic artery
Left gastroepiploic artery
Short gastric artery

Question 22

Bile salts are absorbed in what part of the GIT

Answer 22

Terminal ileum

Question 23

Consumption thrombocytopenia related to hepatic hemangiomata.

Answer 23

Kasabach–Merritt syndrome

Canlead to disseminated intravascular coagulation (DIC).

Question 24

Lobar predilection of hydatid cyst

Answer 24

Right lobe of the liver

Question 25

Most common benign liver tumor

Answer 25

Hemangioma

Question 26

Benign hepatic tumor related to OCP use

Answer 26

Hepatic adenoma

Question 27

CT shows hypervascular mass with hypodense stellate scar; "Hot" on Tc-macroaggregated albumin scan. Biopsy shows hepatocyte and bile ducts

Answer 27

Focal nodular hyperplasia

Question 28

CT Scan shows mass that lacks central scarring; "cold" on Tc-macroaggregated albumin scan; biopsy shows hepatocytes

Answer 28

Hepatic adenoma

Question 29

Management of asymptomatic hemangioma

Answer 29

Observe

Question 30

Management of symptomatic hepatic hemangioma

Answer 30

Enucleation or lobectomy

Question 31

Management of asymptomatic focal nodular hyperplasia

Answer 31

Observe with serial CT scan

Question 32

Management of symptomatic focal nodular hyperplasia

Answer 32

Resection

Question 33

Includes cholestasis and fibrotic strictures of the intrahepatic and extrahepatic biliary tree that is in association with ulcerative colitis and other autoimmune disease

Answer 33

Primary Sclerosing Cholangitis

Question 34

Most common cause of liver abscess worldwide

Answer 34

Amebic abscess

Question 35

The content of this abscess is described as anchovy paste

Answer 35

Amebic abscess

Question 36

Intermittent jaundice, weight loss, fatigue, pruritus and abdominal pain are symptoms of

Answer 36

Primary sclerosing cholangitis

Question 37

Endoscopic retrograde cholangiopancreatography (ERCP) demonstrate multiple dilatations and strictures of both the intra- and extra-hepatic biliary tree.

Answer 37

Primary sclerosing cholangitis

Question 38

Treatment option for patients with PSC and advanced liver disease.

Answer 38

Liver transplantation

Question 39

Most common cause of cirrhosis worldwide

Answer 39

Hepatitis C

Question 40

Classification that helps determine the extent of cirrhosis and predict operative mortality

Answer 40

Child-Pugh classification

Question 41

Operative mortality for Child-Pugh Class A cirrhosis

Answer 41

10%

Question 42

Operative mortality for Child-Pugh Class B cirrhosis

Answer 42

30%

Question 43

Operative mortality for Child-Pugh Class C cirrhosis

Answer 43

70%

Question 44

Diagnostic tests that confirm diagnosis of PSC

Answer 44

ERCP and liver biopsy

Question 45

AST and ALT > 3 times normal

Answer 45

Chronic liver disease

Question 46

ALT/AST > 2

Answer 46

Alcoholic cirrhosis

Question 47

Synthetic function of the liver is best assessed by

Answer 47

PT

Question 48

5 Parameters used in Child-Pugh classification of cirrhosis

Answer 48

ProBAAN ``` PROthrombin time Bilirubin Ascites Albumin Neurologic disorder ```

Question 49

Most common cause of SBP

Answer 49

E. Coli

Question 50

Treatment of SBP

Answer 50

Third gen cephalosporin (cefotaxime)

Question 51

Involves occlusion of the major hepatic veins resulting in postsinusoidal portal HTN.

Answer 51

Budd–Chiari syndrome Caudate lobe is spared In women; with hypercoagulable state

Question 52

Caused by splenic vein thrombosis, typically resultant from pancreatitis. Results in gastroesophageal varices without main PV HTN.

Answer 52

Sinistral portal HTN Typically patients have preserved liver function, but bleeding may occur. Treatment includes splenectomy.

Question 53

Used by the transplant community to prioritize patients for liver transplantation.

Answer 53

Model for End-stage Liver Disease (MELD) score

Question 54

Most common cancer worldwide

Answer 54

Hepatocellular carcinoma

Question 55

Most common liver mass

Answer 55

Metastatic

Question 56

Most common cause of hepatocellular carcinoma

Answer 56

HBV

Question 57

Preferred treatment for hepatocellular carcinoma with Child-Pugh class A and B patients

Answer 57

Partial hepatectomy

Question 58

5-year survival rate for hepatocellular carcinoma

Question 59

Cancer of the intra- or extra-hepatic bile ducts.

Answer 59

Cholangiocarcinoma

Question 60

Most common location of cholangiocarcinoma

Answer 60

Upper 1/3 Unresectable

Question 61

Procedure for cholangiocarcinoma in the middle 1/3 of the bile duct

Answer 61

Heoaticojejunostomy

Question 62

Procedure for cholangiocarcinoma in the lower 1/3 of the bile duct

Answer 62

Whipple procedure

Question 63

Black gallstones

Answer 63

Calcium bilirubinate

Question 64

Pain caused by transient obstruction of the cystic duct by gallstone

Answer 64

Biliary colic

Question 65

Charcot's triad

Answer 65

Fever RUQ pain Jaundice Acute cholangitis

Question 66

Reynold's pentad

Answer 66

``` Fever RUQ pain Jaundice Hypotension Altered mental status ```

Question 67

Diffuse deposition of Ca in the gallbladder

Answer 67

Porcelain gallbladder (carcinoma)

Question 68

5 year survival rate of gallbladder carcinoma

Answer 68

5%

Question 69

Under which segments of the liver do you expect to find the gallbladder?

Answer 69

Segments IV and V

Question 70

A 40-year-old man UGI bleed from esophageal varices. What medications may be used?

Answer 70

Vasopressin, octreotide.

Question 71

The falciform ligament divides A. Segments I and II B. Segments III and IV C. Segments V and VI D. Segments VII and VIII

Answer 71

B