Liver 1 (Tests)

• Briefly mention the blood supply and venous drainage of the liver to explain the functional division of the liver

  • Functionally liver has two independent right and left lobes or parts
  • Each lobe has own primary branch of hepatic artery
  • and portal vein
  • and hepatic vein
  • Caudate lobe receives vessels independently from the left and right portal veins
  • left and right hepatic arteries
  • and it drains independently into the inferior vena cava by multiple small branches
  • (Some of the sections in the midline also drain into the middle vein
• Briefly list the important and typical pathological features of

  cirrhosis and give a classification based on macroscopic findings.

  1. Cirrhosis is a diffuse and irreversible condition, characterized by fibrosis and nodular regeneration.
  2. Macroscopic classification:
  3. Macro nodular (larger than 3mm)
  4. Micro nodular (smaller than 3mm)
  5. Mixed – both small and large modules
• Discuss the important points of pre-endoscopy emergency management of a patient with an upper gastrointestinal bleed due to oesophageal varices.

  • Group and cross-match blood.

  • Support of circulating blood volume with adequate resuscitation – IV fluids.

  • Maintenance of Hb at approximately 8 g/dL.

  • Antibiotic prophylaxis - norfloxacin

  • Somatostatin or its analogues

  Also accepted following:

  Sengstaken-Blakemore tube.

  Check coagulation status.
• Discuss pre-exposure and post-exposure prophylaxis for hepatitis B virus.

  Pre-exposure prophylaxis

  • HBV vaccination

  – part of EPI (expanded programme on immunization)

  – indicated in cases of high risk exposure to HBV, e.g. health care workers

  Post-exposure prophylaxis (administered to those who are exposed to HBV and have no immunity)

  • HBV vaccine plus HBV immunoglobulins

  – Needle stick injury and other exposures – administer both within 72 hours

  – Infants of HBsAg-positive mothers – administer vaccine and HBV immunoglobulins within 12 hours after birth
• List the factors that promote progression in chronic hepatitis C virus infection

  Males

  Co-infection with HIV

  Older than 40years of age

  Co-infection with Hepatitis B virus

  Alcohol abuse