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Self-Assessment Questions

General Surgery

Liver and Gallbladder: Review Questions

N. Joseph Espat, MD

Dr. Espat is an Assistant Professor of Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, IL, and a member of the Hospital Physician Editorial Board.

Choose the single best answer for each question.

1. A 25-year-old Hispanic woman who is 4 months postpartum has pain in the right upper quadrant. Her laboratory values are as follows: leukocyte count, 9.0 × 103/mm3; total serum bilirubin, 0.9 mg/dL; serum alkaline phosphatase, 100 U/L; and serum amylase, 300 U/L. Which of the following statements regarding her condition is INCORRECT?
  1. If she undergoes a laparoscopic cholecystectomy, there is an approximately 5% chance that conversion to an open cholecystectomy will be necessary
  2. If she undergoes laparoscopic cholecystectomy, she will have a 1.0% to 1.5% chance of having a surgically attributable injury to the common bile duct
  3. She is likely to have gallstones, which are common in Hispanic women and frequently discovered during or following pregnancy
  4. She most likely has experienced biliary colic and has passed a gallstone that resulted in mild pancreatitis, rather than having biliary obstruction at this time
  5. Unless she has cholecystitis, cholelithiasis with symptomatic biliary colic is unlikely
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2. Which of the following statements regarding hepatic infections is INCORRECT?

  1. Cholangitis always results from biliary manipulation or bile contamination from an extrahepatic source
  2. Cholangitis, which can result from the use of surgical instruments on the bile duct or from benign or malignant obstruction, requires immediate medical treatment
  3. After the resection of a hydatid cyst, the preferred treatment is systemic albendazole
  4. Hydatid cysts are caused by infection with Echinococcus species, usually transmitted by a canine vector or by consumption of contaminated food containing the parasite
  5. Percutaneous drainage and use of intravenous antibiotics are appropriate to treat a parenchymal bacterial hepatic abscess
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  3. Which of the following statements regarding hepatic mass lesions is INCORRECT?
  1. Adenomas are benign liver tumors associated with oral contraceptive use in young women and should always be resected because of their high frequency of malignant transformation into hepatocellular cancere
  2. Focal nodular hyperplasia, which is characterized on imaging studies by the finding of a central scar, rarely requires surgical resection
  3. Resection of a hemangioma is indicated in patients who have pain or demonstrated platelet dysfunction
  4. Simple cysts are a common finding, and surgical intervention is unnecessary in most patients
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4. Following a motor vehicle accident, a patient has an abdominal CT scan, which shows a subcapsular hematoma and a partial fracture of the right lobe of the liver; there also is free air under the diaphragm. The patient’s temperature is 34°C, and he is hemodynamically stable. Which of the following statements regarding his condition is correct?

  1. A diagnostic peritoneal lavage also may be useful in determining the presence of hepatic injury
  2. The CT scan should be repeated to ascertain if the subcapsular hematoma is still contained prior to surgery
  3. The patient requires an urgent laparotomy, with packing of the liver if further hemorrhaging occurs
  4. The patient should be taken immediately to the operating room for a right hepatic resection
  5. Serial hematocrit levels should be obtained in order to identify possible ongoing hemorrhaging prior to surgery
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