Hepatobiliary Surgery: Master Liver, Gallbladder, and Bile Duct Conditions

Question 1

Discuss the surgical options for localized liver cancer, including hepatectomy, liver transplantation, and ablation techniques. Analyze the advantages and disadvantages of each approach.

Accepted Answer

The choice of surgical approach depends on factors such as the size, location, and stage of the tumor, as well as the patient's overall health and liver function.

Answer

Hepatectomy is the only potentially curative option for liver cancer and is suitable for all patients.

Answer

Liver transplantation is typically considered for patients with early-stage liver cancer.

Answer

Ablation techniques are less invasive than hepatectomy but have a higher success rate.

Question 2

Which type of liver resection involves removal of the right lobe of the liver?

Accepted Answer

Right hepatectomy

Answer

Left hepatectomy

Answer

Extended right hepatectomy

Answer

Central hepatectomy

Question 3

What is the most common type of liver cirrhosis in the United Kingdom?

Accepted Answer

Alcoholic cirrhosis

Answer

Viral cirrhosis

Answer

Non-alcoholic fatty liver disease (NAFLD)

Answer

Autoimmune cirrhosis

Question 4

Which of the following is the most common type of cholangiocarcinoma?

Accepted Answer

Perihilar

Answer

Intrahepatic

Answer

Distal

Answer

Mass-forming

Question 5

What is the name of the surgical procedure used to resect a segment of the liver?

Accepted Answer

Hepatectomy

Answer

Liver transplantation

Answer

Ablation

Answer

Embolization

Question 6

Which among the given options is the most prevalent cause of biliary obstruction in elderly individuals?

Accepted Answer

Choledocholithiasis

Answer

Pancreatic head tumor

Answer

Biliary stricture secondary to cirrhosis

Answer

Bile duct cancer

Question 7

For a patient suspected of sustaining a bile duct injury during laparoscopic cholecystectomy, which surgical approach is generally considered optimal?

Accepted Answer

Exploratory laparotomy with direct repair

Answer

Laparoscopic exploration and repair

Answer

Endoscopic retrograde cholangiopancreatography (ERCP) with stenting

Answer

Conservative management with observation

Question 8

What is the primary indication for performing a laparoscopic Roux-en-Y hepaticojejunostomy?

Accepted Answer

Bile duct stricture

Answer

Choledocholithiasis

Answer

Liver abscess

Answer

Gallbladder cancer

Question 9

Which type of primary liver cancer is most commonly encountered?

Accepted Answer

Hepatocellular carcinoma

Answer

Cholangiocarcinoma

Answer

Neuroendocrine tumor

Answer

Sarcoma

Question 10

Which of the following is NOT a surgical approach to cholecystectomy?

Accepted Answer

Endoscopic retrograde cholangiopancreatography (ERCP)

Answer

Robotic-assisted cholecystectomy

Answer

Open cholecystectomy

Answer

Laparoscopic cholecystectomy

Question 11

What is the primary indication for liver transplantation?

Accepted Answer

End-stage liver disease

Answer

Acute liver failure

Answer

Biliary atresia

Answer

Hepatocellular carcinoma

Question 12

Which imaging modality is considered the gold standard for diagnosing liver tumors?

Accepted Answer

Magnetic resonance imaging (MRI) with gadolinium contrast

Answer

Ultrasound

Answer

Positron emission tomography (PET) with fluorodeoxyglucose (FDG)

Answer

Computed tomography (CT) with contrast

Question 13

What is the primary indication for surgical resection in patients with chronic pancreatitis?

Accepted Answer

Intractable pain unresponsive to medical management

Answer

Weight loss and malnutrition

Answer

Pseudocyst formation

Answer

Jaundice and cholangitis

Question 14

What is the most common complication following laparoscopic cholecystectomy?

Accepted Answer

Bile leak

Answer

Wound dehiscence

Answer

Hemorrhage

Answer

Infection

Question 15

For a patient with a distal common bile duct stone not amenable to endoscopic retrograde cholangiopancreatography (ERCP), which surgical approach is typically preferred?

Accepted Answer

Choledochotomy

Answer

Laparoscopic cholecystectomy

Answer

Percutaneous transhepatic cholangioscopy

Question 16

Which imaging modality is generally most effective for visualizing gallstones?

Accepted Answer

Ultrasound

Answer

Magnetic resonance imaging (MRI) scan

Answer

Computed tomography (CT) scan

Question 17

In liver resection, the primary indication is typically:

Accepted Answer

Liver cancer

Answer

Liver cyst

Answer

Liver cirrhosis

Answer

Liver abscess

Question 18

In liver transplantation, the surgical technique commonly used to restore bile flow is:

Accepted Answer

Bile duct anastomosis

Answer

Roux-en-Y choledochojejunostomy

Answer

Hepaticojejunostomy

Answer

Choledochojejunostomy

Question 19

For a 65-year-old patient with recurrent episodes of biliary colic, the most suitable initial surgical intervention is generally:

Accepted Answer

Laparoscopic cholecystectomy

Answer

Endoscopic retrograde cholangiopancreatography (ERCP)

Answer

Open cholecystectomy

Answer

Percutaneous transhepatic cholangiography (PTC)

Question 20

During a laparoscopic cholecystectomy, if the cystic duct is accidentally injured, the most appropriate immediate action is to:

Accepted Answer

Control the bleeding and perform a cholangiogram

Answer

Immediately refer for ERCP

Answer

Convert to an open cholecystectomy

Answer

Proceed with cholecystectomy and close the abdomen

Question 21

Which of the following is known to be a risk factor for developing cholangiocarcinoma?

Accepted Answer

Primary sclerosing cholangitis

Answer

Hepatitis B infection

Answer

Chronic pancreatitis

Answer

Obesity

Question 22

In a patient with Crohn's disease who presents with recurrent episodes of cholangitis, the most likely underlying cause is:

Accepted Answer

Bile duct stricture

Answer

Hepatitis B infection

Answer

Acute cholecystitis

Answer

Choledocholithiasis

Question 23

For a 70-year-old patient with a history of alcohol abuse who presents with right upper quadrant pain and fever, and a CT scan reveals a large liver abscess, the most appropriate management is:

Accepted Answer

Percutaneous drainage and antibiotic therapy

Answer

Observation and supportive care

Answer

Antibiotic therapy alone

Answer

Surgical resection of the abscess

Question 24

In liver transplantation, a common post-operative complication is:

Accepted Answer

Rejection

Answer

Choledocholithiasis

Answer

Gastric ulcer disease

Answer

Acute cholecystitis

Question 25

A patient with a history of cirrhosis undergoes a liver biopsy.  Which of the following histological findings is most consistent with cirrhosis?

Accepted Answer

Bridging fibrosis and regenerative nodules

Answer

Acute hepatitis

Answer

Fatty infiltration

Answer

Hepatocellular carcinoma