Liver

Hemodynamic changes after pedicular clamping of Portal structures

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Q) 33 year old male is undergoing resection of right lobe of liver Which of the following hemodynamic  happens during pedicular clamping in liver transaction? 

a) Systemic vascular resistance decreases by 20%

b) Mean arterial pressure decreases

c) Cardiac index decreases by 10%

d) Preload to the heart increases

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.

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Contraindication of liver transplantation

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Q)Contraindications of liver transplantation have changed over the years. Which is an absolute contraindication of  liver transplantation

a) Previous breast cancer

b) Portal vein thrombosis

c) Active tuberculosis

d) Active substance abuse

d

Previous history of breast cancer if completely treated is not an contraindication of liver transplant. Portal vein thrombosis was earlier considered a relative contraindication but almost all series have shown similar results in patients with PVT than patients without PVT.

IN portal vein thrombosis, inflow to the new liver can me taken in many ways

a) thrombectomy

b) Jump grafts from Superior mesenteric vein 

c) Anastomosis have been done from big collaterals

Active tuberculosis can be managed after transplant.

Modified ATT regimens without INH and Rifampicin are being  used.  Any kind of active substance abuse alcohol,  drugs etc are absolute contraindications for liver transplant because the disease will recur.

Hydatid liver

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Q) Not an indication of surgery in hydatid cyst liver

a) CE2 cyst with multiple daughter cysts

b) Large 10 cm cyst situated peripherally

c) Infected cyst

d) 6 cm asymptomatic cyst

Hemangioma Liver

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Hepatic Hemangioma Management MCQ for NEET SS | mcqsurgery.com

A 38-year-old woman is found to have a 12-cm hepatic hemangioma. Which statement regarding management is true?

Correct Answer

d) If surgery is planned, peripherally located hemangiomas should be enucleated

Explanation

Hepatic hemangiomas are the most common benign tumors of the liver and are usually detected incidentally. Management depends on symptoms, complications, and diagnostic certainty, not size alone.

  • Size and surgery:
    Lesion size alone, even when greater than 10 cm (giant hemangioma), is not an indication for surgery if the patient is asymptomatic.
  • Oral contraceptives and pregnancy:
    Although estrogen exposure may cause hemangioma enlargement, there is no strong evidence that oral contraceptive pills or pregnancy significantly increase the risk of rupture. Routine avoidance is not recommended.
  • Role of arterial embolization:
    Arterial embolization is not performed routinely. It is reserved for:
    • Symptomatic patients unfit for surgery
    • Acute bleeding
    • Preoperative reduction of tumor vascularity
  • Surgical technique:
    When surgery is indicated (symptoms, complications, or diagnostic uncertainty), enucleation is preferred for peripherally located hemangiomas because it:
    • Preserves maximum liver parenchyma
    • Results in less blood loss
    • Has lower morbidity compared to formal hepatic resection

Teaching Points

  • Hepatic hemangioma is the most common benign liver tumor
  • Size alone is not an indication for surgery
  • Most asymptomatic hemangiomas require only observation
  • Enucleation is preferred over resection when surgery is needed
  • Embolization is reserved for selected symptomatic or high-risk cases
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HCC Cancer

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Q) Which of the following is true about screening in hepatocellular carcinoma (HCC Cancer) 

a) Alpha feto protein should be done 6 monthly

b) Ultrasound abdomen should be done 6 monthly

c) Candidates for liver transplant should be screened every 3 months

d) Nodules more than 2 cm should be followed up  more regularly

Answer b

Cirrhosis is prone for development of HCC. Screening has to be stringent.  Earlier ultrasound of liver and alpha feto protein were both used for screening

In 2009 Marrero et al demonstrated the suboptimal accuracy of AFP and after that it has been removed from the screening protocol and now only ultrasound is being done.

The screening recommendation is not for those patients with severe associated conditions and with advanced liver disease who are already considered for  transplant. So there is no screening for those who are already listed. Nodules more than 1 cm are highly suspicious where as in nodules less than 1 cm only 40% will be malignant.

Ref: blumgart 6th edition