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Question 1
Correct
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Question 2
Correct
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What are the three main structures in the portal triad (portal space)?
Your Answer: Branch of hepatic artery, branch of portal vein, bile ductules
Explanation:A portal triad (also known as portal field, portal area, or portal tract) is a distinctive arrangement in the liver. It is a component of the hepatic lobule. It consists of the following five structures:
- Proper hepatic artery
- Hepatic portal vein
- Common bile duct
- Lymphatic vessels
- Branch of the vagus nerve
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This question is part of the following fields:
- Hepatobiliary
- Medicine
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Question 3
Correct
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Select the CORRECT statement regarding bile salts…
Your Answer: Are necessary for any bile acid secretion by hepatocytes.
Explanation:Bile salts stimulate bile secretion by the liver. Bile salts do not have an enzymatic action on digestion of fat but rather emulsify fat for the action of enzymes secreted mainly by the pancreas. Bile salts are polar cholesterol derivatives and are not derived from amino acids.
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This question is part of the following fields:
- Hepatobiliary
- Medicine
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Question 4
Correct
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In liver failure there is likely to be?
Your Answer: Bleeding disorders
Explanation:Liver failure can lead to several significant changes in the body’s physiology, but let’s review each option in the context of liver failure:
- Raised blood urea: This is not typical of liver failure. In liver failure, blood urea nitrogen (BUN) levels are often low because the liver is not effectively converting ammonia to urea.
- Increase in the albumin/globulin ratio in the blood: This is incorrect. In liver failure, albumin production decreases, leading to a lower albumin/globulin ratio.
- Bleeding disorders: This is possible, but it often fluctuates. Liver failure can lead to both bleeding tendencies due to decreased production of clotting factors and a hypercoagulable state due to the reduced synthesis of anticoagulant proteins like Protein C and S.
- Stable blood glucose level: This is incorrect. Liver failure often causes hypoglycemia because the liver’s ability to produce glucose via gluconeogenesis and glycogenolysis is impaired.
- Increased absorption of fat: This is incorrect. Liver failure can lead to decreased bile production, which is necessary for fat emulsification and absorption, resulting in decreased fat absorption.
Given these points, the most likely option related to liver failure would actually be issues related to bleeding complications.
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This question is part of the following fields:
- Hepatobiliary
- Medicine
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Question 5
Correct
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Concerning the functional unit of the liver, which segment is most susceptible to hypoxic damage?
Your Answer: Zone 3
Explanation:From a metabolic perspective, the functional unit is the hepatic acinus (terminal acinus), each of which is centred on the line connecting two portal triads and extends outwards to the two adjacent central veins. The periportal zone I is nearest to the entering vascular supply and receives the most oxygenated blood, making it least sensitive to ischemic injury while making it very susceptible to viral hepatitis. Conversely, the centrilobular zone III has the poorest oxygenation, and will be most affected during a time of ischemia.
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This question is part of the following fields:
- Hepatobiliary
- Medicine
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Question 6
Correct
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The conversion of haem to bilirubin is catalysed by which of these enzymes?
Your Answer: Biliverdin reductase
Explanation:Bilirubin is created by the activity of biliverdin reductase on biliverdin, a green tetrapyrrolic bile pigment that is also a product of haem catabolism.
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This question is part of the following fields:
- Hepatobiliary
- Medicine
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Question 7
Correct
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What is the blood supply to the liver?
Your Answer: Hepatic artery and hepatic portal vein
Explanation:The liver receives a dual blood supply from the hepatic portal vein and hepatic arteries. The hepatic portal vein delivers approximately 75% of the liver’s blood supply, and carries venous blood drained from the spleen, gastrointestinal tract, and its associated organs. The hepatic arteries supply arterial blood to the liver, accounting for the remaining quarter of its blood flow. Oxygen is provided from both sources; approximately half of the liver’s oxygen demand is met by the hepatic portal vein, and half is met by the hepatic arteries
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This question is part of the following fields:
- Hepatobiliary
- Medicine
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Question 8
Correct
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Which of the following portocaval anastomoses can cause problems in preterm infants?
Your Answer: Patent ductus venosus.
Explanation:The ductus venosus is open at the time of the birth and closes during the first week of life in most full-term neonates; however, it may take much longer to close in pre-term neonates. After it closes, the remnant is known as ligamentum venosum. If the ductus venosus fails to occlude after birth, it remains patent (open), and the individual is said to have a patent ductus venosus and thus an intrahepatic portosystemic shunt (PSS).
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This question is part of the following fields:
- Hepatobiliary
- Medicine
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Question 9
Correct
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Which is true of the composition of bile in the human hepatic duct?
Your Answer: Contains only actively secreted substances
Explanation:Hepatic bile is an isotonic fluid and its electrolyte composition resembles that of plasma. 97% of water is found in the gallbladder bile, not hepatic duct. Hepatic bile is alkaline. The ratio of bile acids: phosphatidylcholine: cholesterol is 20:1:3. Hepatic bile contai9ns only actively secreted substances.
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This question is part of the following fields:
- Hepatobiliary
- Medicine
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Question 10
Incorrect
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Question 11
Correct
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Where is the normal upper border of the liver situated?
Your Answer: 6th rib midclavicular line on right
Explanation:Assessment of liver margins is important clinically to determine the size of the liver and is done via percussion during the physical examination. The liver typically extends from the fifth intercostal space or 6th rib to the right costal margin in the midclavicular line and the 10th rib on anterior axillary line.
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This question is part of the following fields:
- Hepatobiliary
- Medicine
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Question 12
Correct
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The main source of nutrients in the liver is via the
Your Answer: Portal vein
Explanation:The portal vein or hepatic portal vein is a blood vessel that carries blood from the gastrointestinal tract and spleen to the liver. This blood is rich in nutrients that have been extracted from food, and the liver processes these nutrients; it also filters toxins that may have been ingested with the food. 75% of total liver blood flow is through the portal vein, with the remainder coming from the hepatic artery proper.
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This question is part of the following fields:
- Hepatobiliary
- Medicine
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Question 13
Correct
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Question 14
Correct
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Bile salts are responsible for:
Your Answer: The emulsification of fats
Explanation:The main function of bile acids is to allow digestion of dietary fats and oils by acting as a surfactant that emulsifies them into micelles, allowing them to be colloidally suspended in the chyme before further processing.
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This question is part of the following fields:
- Hepatobiliary
- Medicine
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Question 15
Correct
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The percentage of blood supplied to the liver by the hepatic artery is?
Your Answer: 25%
Explanation:The liver receives a dual blood supply from the hepatic portal vein and hepatic arteries. The hepatic portal vein delivers approximately 75% of the liver’s blood supply, and carries venous blood drained from the spleen, gastrointestinal tract, and its associated organs. The hepatic arteries supply arterial blood to the liver, accounting for the remaining quarter of its blood flow. Oxygen is provided from both sources; approximately half of the liver’s oxygen demand is met by the hepatic portal vein, and half is met by the hepatic arteries
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This question is part of the following fields:
- Hepatobiliary
- Medicine
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Question 16
Incorrect
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The liver is the principal site for?
Your Answer: Synthesis of Vit B12
Correct Answer: Storage of iron
Explanation:The liver mainly synthesizes proteins including albumin, globulins and coalgulative factors. Vitamin B12 is taken in via the diet and stored by the liver. Vitamin C is not stored and excessive vitamin C is excreted via urine. Liver is the main site of iron storage, where it is stored in the form of ferritin.
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This question is part of the following fields:
- Hepatobiliary
- Medicine
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Question 17
Correct
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Question 18
Incorrect
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Cytochrome p450 enzymes expressed in hepatocytes serve to?
Your Answer: Facilitate phase 2 of liver drug metabolism.
Correct Answer: Facilitate oxidations or hydrolysis of drugs.
Explanation:Cytochrome p 450 are a family of proteins involved in drug metabolism which accounts for about 75% of the total metabolism. Most drugs are deactivated directly or by facilitated excretion from the body.
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This question is part of the following fields:
- Hepatobiliary
- Medicine
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Question 19
Correct
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Where is the lower border of the liver usually found?
Your Answer: 10th rib anterior axillary line on right
Explanation:Assessment of liver margins is important clinically to determine the size of the liver and is done via percussion during the physical examination. The liver typically extends from the fifth intercostal space or 6th rib to the right costal margin in the midclavicular line and the 10th rib on anterior axillary line.
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This question is part of the following fields:
- Hepatobiliary
- Medicine
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Question 20
Incorrect
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The production of bile is increased by: Stimulation of the ____ nerve and the hormone ____.
Your Answer:
Correct Answer: Vagus, CCK
Explanation:Cholecystokinin is synthesized and secreted by enteroendocrine cells in the duodenum, the first segment of the small intestine, and causes the release of digestive enzymes and bile from the pancreas and gallbladder, respectively. It also acts as a hunger suppressant. Release of CCK is stimulated by monitor peptide released by pancreatic acinar cells as well as CCK-releasing protein, a paracrine factor secreted by enterocytes in the gastrointestinal mucosa. In addition, release of acetylcholine by the parasympathetic nerve fibers of the vagus nerve also stimulate its secretion.
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This question is part of the following fields:
- Hepatobiliary
- Medicine
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