MCQs on Hepato-Biliary System

MCQ Bank General Surgery Module

Written by Dr. Andrew McAllister
(MBBS, FRACS) – Surgeon

Question 1

A 35-year-old woman presents to the emergency department with acute onset right upper quadrant pain which started one hour ago. When visited by the emergency physician, she mentions that the pain has gone away. An ultrasound scan of the liver and biliary tree reveals a simple cyst in the liver. Which one of the following is the most appropriate next step in management?

A) Reassure her.
B) Aspiration of the cyst.
C) Abdominal CT scan.
D) Laparoscopic removal of the cyst.
E) MRI of the liver

Correct Answer: C) Abdominal CT scan.

Explanation:
Simple liver cysts are often congenital, thought to arise from intrahepatic biliary ducts due to their similar lining. They generally cause no symptoms but may produce dull right-upper-quadrant pain if large. Other symptoms include abdominal bloating, early satiety, or a palpable abdominal mass. Rare complications include jaundice from bile duct obstruction, rupture, or torsion of a mobile cyst, which can present as an acute abdomen.

When a cystic lesion is detected on ultrasound, a contrast-enhanced CT scan is recommended to better characterize the lesion and exclude malignant hepatic lesions or tumors with central necrosis that can mimic simple cysts.

(Option A) Simply reassuring the patient without further investigation is inappropriate because symptomatic cysts require evaluation and management.

(Option B) Percutaneous aspiration is generally avoided because it has a nearly 100% recurrence rate and risks contamination leading to hepatic abscess.

(Option D) Laparoscopic unroofing is the treatment of choice for symptomatic cysts but should only be done after further investigations confirm the diagnosis.

(Option E) MRI has a limited role and is often unnecessary in evaluating simple cysts.

Question 2

A 35-year-old woman presents to the emergency department with acute onset right upper quadrant pain which started one hour ago. When visited by the emergency physician, she mentions that the pain has gone away. An ultrasound scan of the liver and biliary tree reveals a simple cyst in the liver. Which one of the following is the most appropriate next step in management?

A) Reassure her.
B) Aspiration of the cyst.
C) Abdominal CT scan.
D) Laparoscopic removal of the cyst.
E) MRI of the liver.

Correct Answer: C) Abdominal CT scan.

Explanation:
Simple liver cysts are often congenital, thought to arise from intrahepatic biliary ducts due to their similar lining. They generally cause no symptoms but may produce dull right-upper-quadrant pain if large. Other symptoms include abdominal bloating, early satiety, or a palpable abdominal mass. Rare complications include jaundice from bile duct obstruction, rupture, or torsion of a mobile cyst, which can present as an acute abdomen.

When a cystic lesion is detected on ultrasound, a contrast-enhanced CT scan is recommended to better characterize the lesion and exclude malignant hepatic lesions or tumors with central necrosis that can mimic simple cysts.

(Option A) Simply reassuring the patient without further investigation is inappropriate because symptomatic cysts require evaluation and management.

(Option B) Percutaneous aspiration is generally avoided because it has a nearly 100% recurrence rate and risks contamination leading to hepatic abscess.

(Option D) Laparoscopic unroofing is the treatment of choice for symptomatic cysts but should only be done after further investigations confirm the diagnosis.

(Option E) MRI has a limited role and is often unnecessary in evaluating simple cysts.

Question 3

After evaluation of a 67-year-old woman with right upper quadrant abdominal pain, dyspepsia and weight loss, she is found to have a solitary tumor in the right lobe of her liver. CT scanning of the liver suggests the tumor to be malignant. Which one of the following could be the most likely diagnosis?

A) Hepatoma.
B) Metastasis from colon cancer.
C) Metastasis from stomach cancer.
D) Metastasis from breast cancer.
E) Metastasis from ovarian cancer.

Correct Answer: A) Hepatoma.

Explanation:
Approximately 90% of malignant liver tumors are metastases from other primary cancers elsewhere in the body. However, these metastases are usually multiple, not solitary.

A solitary malignant liver tumor is more characteristic of a primary liver cancer, such as hepatocellular carcinoma (HCC), also known as hepatoma, which accounts for about 10% of malignant liver lesions.

Given this patient’s presentation with right upper quadrant pain, dyspepsia, weight loss, and imaging showing a single liver lesion, the most likely diagnosis is hepatoma.

(Options B–E) While the colon, stomach, breast, and ovaries are all common sources of liver metastases, such secondary tumors typically appear as multiple lesions, making them less likely in this clinical scenario.

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8. General Surgery Module

8.1 Acute Abdomen

8.2 Upper GI Tract

8.3 Hepatobiliary System

8.4 Lower GI Tract

8.5 Lumps

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