High-Yield Image Based Questions On Liver

Diagnosis: CT scan of Pyogenic Liver Abscess 

Diagnosis is highly suggested by USG and CT confirmed by aspiration and culture.

Diagnosis: Amoebic Liver Abscess 

Organism Responsible: Entamoeba Histolytica · This organism causes histolysis of hepatocytes and necrosis of WBCs leading to collection of reddish-brown fluid which looks like Anchovy sauce so Anchovy sauce appearance. · Diagnosis is confirmed by Amoebic serology.

Diagnosis: Autosomal Dominant Polycystic Kidney Disease (ADPKD) 

Most common extra-renal manifestation of ADPKD is Polycystic liver disease.

Diagnosis: Hemangioma of Liver 

Shows peripheral nodular enhancement typical to hemangioma of liver · M/C benign tumor of liver is Hemangioma.

Diagnosis – Gross tumor image of Focal Nodular Hyperplasia 

There is central stellate scarring · Its having a central feeding arterial and multiple peripheral branches · On CT we can see Central stellate scar · Cart wheel or Spoke wheel appearance on angiography.

Other tumors with central stellate scarring: · Focal Nodular Hyperplasia · Fibrolamellar variant of HCC · Serous Cystadenoma of Pancreas · Renal Oncocytoma

Diagnosis: Given CT is suggestive of HCC [Hepatocellular Carcinoma] 

IOC – Triple phase CT · On Triple phase CT we can see Arterial Hypervascularization and Venous washout.

Endoscopic Appearance of Esophageal Varices 

Varices are because of venous collateral between systemic and portal circulation · Esophageal variceal starts forming at > 10 mmHg pressure · Esophageal variceal bleeding starts at > 12 mmHg pressure.

Proximal Splenorenal Shunt (PSRS) aka Linton's shunt

Type of non-selective shunt because almost whole blood of portal circulation is entering systemic circulation.

Distal Splenorenal Shunt (DSRS) aka Warren Shunt 

Type of Selective shunt. · By this shunt, blood is going into IVC and only Splenic circulation is getting decompressed.

Diagnosis: Budd-Chiari Syndrome 

There is Hepatic venous outflow obstruction mainly due to Hepatic vein thrombosis, but it can be also due to IVC obstruction.

Due to obstruction there is foramen of collaterals around liver · On venography → Spiderweb collaterals are seen in Budd Chiari syndrome  On Angiography – Corkscrew collaterals are seen in Buerger's disease.

Also read: High-Yield GIT, Hepatobiliary and Pancreatic Surgery Questions

Hope you found this blog helpful for your GIT, Hepatobiliary and Pancreatic Surgery preparation. For more informative and interesting posts like these, keep reading PrepLadder’s blogs.