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.
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.
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
High-Yield Liver MCQ for NEET SS, MCh and GI Surgery
LIVER • HEPATOCELLULAR CARCINOMA
Which of the following is true regarding surveillance for hepatocellular carcinoma (HCC)?
A.
Serum alpha-fetoprotein (AFP) alone should be performed every 6 months
B.
Abdominal ultrasound should be performed every 6 months
C.
All candidates awaiting liver transplantation should undergo HCC surveillance every 3 months
D.
Hepatic nodules larger than 2 cm should simply be followed up more frequently
✓ Correct Answer: B. Abdominal ultrasound should be performed every 6 months
Explanation
Surveillance for hepatocellular carcinoma is performed in patients at increased
risk of developing HCC, particularly those with cirrhosis and selected patients
with chronic hepatitis B infection.
Ultrasound-based surveillance at approximately 6-month intervals is the
standard approach. Serum AFP may be used as an adjunct depending on the
guideline and clinical setting, but AFP alone is not considered an adequate
surveillance strategy.
Why are the other options wrong?
A. AFP alone every 6 months – Incorrect.
AFP has limited sensitivity and specificity. It should not be relied upon as the
sole surveillance modality for HCC.
C. All transplant candidates every 3 months – Incorrect.
More frequent surveillance is not routinely required for every patient awaiting
liver transplantation. The surveillance interval may vary according to individual
clinical circumstances and the presence of known lesions.
D. Nodules larger than 2 cm should simply be followed more frequently – Incorrect.
A liver lesion larger than 2 cm requires appropriate diagnostic evaluation,
usually with multiphasic contrast-enhanced imaging, rather than merely more
frequent surveillance.
Teaching Point:
The key interval to remember for HCC surveillance is 6 months.
Ultrasound is the cornerstone of surveillance, while AFP may be used as an
additional tool depending on the clinical protocol.