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Chapter 24: Liver & Portal Venous System

Chapter 24. Liver & Portal Venous System

All of the following are true about the blood supply to the liver, except

A. The portal vein is formed by the confluence of the splenic and superior mesenteric veins at the level of the second lumbar vertebra behind the head of the pancreas.

B. The common hepatic artery arises from the celiac axis, ascends in the hepatoduodenal ligament, and gives rise to the right gastric, gastroduodenal, and proper hepatic arteries.

C. In the hepatoduodenal ligament, the portal vein lies dorsal and slightly medial to the common bile duct.

D. A replaced right hepatic artery typically arises from the inferior mesenteric artery and courses posteriorly and to the right of the common bile duct within the porta hepatis.

E. A replaced left hepatic artery typically arises from the left gastric artery.

D. A replaced right hepatic artery typically arises from the inferior mesenteric artery and courses posteriorly and to the right of the common bile duct within the porta hepatis

The Child–Pugh classification of functional status in liver disease does not include

A. Prothrombin time

B. Serum albumin

C. Encephalopathy

D. Serum sodium

E. Serum bilirubin

D. Serum sodium

Blunt trauma to the liver

A. Requires operative management in 85% of patients

B. With a laceration 4-cm deep but not affecting the major vasculature is a Grade III lesion

C. Is involved in approximately 20% of all trauma admissions

D. Is more common in the left liver than the right

E. Is best evaluated acutely by MRI to define the ductal anatomy

B. With a laceration 4-cm deep but not affecting the major vasculature is a Grade III lesion

Portal hypertension

A. In the United States, is most often caused by cirrhosis

B. Is defined as a hepatic venous pressure gradient (the difference between portal-vein pressure and hepatic-vein pressure) greater than 25 mm Hg

C. Is caused by Budd-Chiari syndrome in about 25% of cases in the United States

D. Due to hepatic venous thrombosis causes isolated splenic venous hypertension (sinistral or left-sided portal hypertension)

E. Requires operative management in most patients

A. In the United States, is most often caused by cirrhosis

Management of acute bleeding from esophageal varices

A. Can include transecting and anastomosing the mid-esophagus with an end-to-end stapler

B. Should include urgent operation in most patients

C. Should include controlling hemorrhage as expediently and simply as possible

D. Is commonly required in the management of chronic pancreatitis

E. Should reserve invasive procedures for patients who have required more than 15 units blood transfusion

C. Should include controlling hemorrhage as expediently and simply as possible

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Chapter 24: Liver & Portal Venous System

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Chapter 24. Liver & Portal Venous System

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