Liver Anatomy Quiz: Test Your Knowledge

Understanding liver anatomy and anatomic hilar vascular variants is important for the practicing surgeon. This knowledge is essential for cholecystectomy, hepatobiliary, pancreatic, and upper GI surgery. The attached quiz is intended to provide a liver anatomy teaching guide for surgical oncology, transplant, and HPB fellows; general surgery residents; and medical students, as well as a refresher for general and GI surgeons. It is hoped that dissemination will serve as a valuable teaching tool for surgeons at all levels of training.

11. For hepatic lobar anatomy, which of the following is correct?
A. The falciform ligament separates the right and left lobes of the liver. B. The plane from the gallbladder bed to the IVC (Cantlie's line) separates the right and left lobes. 14. The left medial hepatic segment is also known as: A. Segment IV B. Quadrate lobe C. Caudate lobe D. Both A and C E. Both A and B

A replaced right hepatic artery typically courses:
A. Posterior to the portal vein B. Anterior to the portal vein C. In the gastrohepatic ligament D. Both A and C are correct E. Both B and C are correct 16. Conventional or normal hepatic artery blood flow is which of the following: A. Aorta to celiac axis to hepatic artery proper to common hepatic artery to R/L hepatic arteries B. Aorta to celiac axis to common hepatic artery to hepatic artery proper to R/L hepatic arteries C. Aorta to common hepatic artery to celiac axis to hepatic artery proper to R/L hepatic arteries D. None of the above 17. A central liver resection for gallbladder cancer typically involves removing all or a portion of which hepatic segments?
A. 5 and 4B B. 5 and 4A C. 5 and 6 D. 5   A. 20-25% future liver remnant is usually adequate for normal liver. B. > 30% future liver remnant is preferred in fatty liver. C. > 40% future liver remnant is recommended for severe fibrosis or cirrhotic liver. D. ICG clearance is helpful for cirrhotic livers. E. All of the above.

Gilbert's disease:
A. Is a hyperbilirubinemia with serum T bili usually > 5 B. Is a progressive disease that usually leads to liver failure C. Requires treatment with plasmapheresis D. Is an autosomal recessive disease with mildly elevated levels of unconjugated bilirubin and normally no serious consequences E. All of the above 1. Liver segmental anatomy is named after which physician that defined the hepatic segments in the 1950s: Arantius was an Italian anatomist who made many contributions to human anatomy, fetal circulation, and science. James Cantlie was a Scottish surgeon who described the midline of the liver between the right and left lobes based on autopsy findings in 1887. This line passes from the gallbladder fossa down to the inferior vena cava. Thomas Starzl was a pioneer in the field of organ transplantation and performed the world's first liver transplant in 1963 in Denver, CO. Henri Bismuth is a French pioneer in hepatobiliary surgery and is credited with developing the split-liver technique for liver transplantation that allows two patients to be transplanted from only one liver donor.
2. Current liver resection terminology was coined at which IHPBA meeting/consensus?   Normal blood flow is from the portal vein through the liver (hepatopetal flow). In the setting of cirrhosis and portal hypertension, blood flow reverses away from the liver (hepatofugal flow) and often passes through the dilated coronary vein and/or re-canalized umbilical vein.
14. The left medial hepatic segment is also known as: A. Segment IV B. Quadrate lobe C. Caudate lobe D. Both A and C E. Both A and B The left medial segment of the liver is also known as segment IVor the quadrate lobe of the liver. Hence, it has 3 names that refer to the same segment.

A replaced right hepatic artery typically courses;
A. Posterior to the portal vein B. Anterior to the portal vein C. In the gastrohepatic ligament D. Both A and C are correct E. Both B and C are correct 16. Conventional or normal hepatic artery blood flow is which of the following: A. Aorta to celiac axis to hepatic artery proper to common hepatic artery to R/L hepatic arteries B. Aorta to celiac axis to common hepatic artery to hepatic artery proper to R/L hepatic arteries C. Aorta to common hepatic artery to celiac axis to hepatic artery proper to R/L hepatic arteries D. None of the above 17. A central liver resection for gallbladder cancer typically involves removing all or a portion of which hepatic segments?

The fissure of Gans:
A. Is embryologically present 70% of time B. Contains the right posterior sectoral pedicle C. Is also referred to as Rouviere's sulcus D. All of the above E. None of the above 24. The right hepatic artery crosses: A. Posterior to the common hepatic duct 88% of time and anterior to common hepatic duct 12% of time B. Posterior to the common hepatic duct 12% of time and anterior to common hepatic duct 88% of time C. Posterior to the common hepatic duct 50% of the time D. Posterior to the common hepatic duct 100% of the time E. None of the above 25. The left and middle hepatic veins form a common trunk before inserting into the supra-hepatic IVC in what % of time? A. 20-25% future liver remnant is usually adequate for normal liver.
B. > 30% future liver remnant is preferred in fatty liver. C. > 40% future liver remnant is recommended for severe fibrosis or cirrhotic liver. D. ICG clearance is helpful for cirrhotic livers. E. All of the above.

Gilbert's disease:
A. Is a hyperbilirubinemia with serum T bili usually > 5 B. Is a progressive disease that usually leads to liver failure C. Requires treatment with plasmapheresis D. Is an autosomal recessive disease with mildly elevated levels of unconjugated bilirubin and normally no serious consequences E. All of the above 61-75. Match the letter to the correct liver segment: 1, 2, 3, 4A, 4B, 5, 6, 7, 8.
(A segment may be used more than once) Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.