The fissure of gans: Referred to as Rouviere’s sulcus Is embryologically present 70% of time Contains the right posterior sectoral pedicle All of the above. In the following enzymes enlisted, which is larger than its substrate? Alkaline phosphatase Alanine transferase Amylase Enolase. Which of the following is not an appropriate step to prevent mother to the child transmission of hepatitis B virus (HBV) Stop breastfeeding Early umbilical cord clamping Hepatitis B immunoglobulin and vaccination to newborn Antiviral treatment to mother. Out of the following, who is related to the discovery of Australian antigen? Hippocrates Baruch Blumberg Michael Houghton Md. S Khuroo. DANE particle is the name given to? Hepatitis A virion Hepatitis B virion Hepatitis C virion Hepatitis D virion. When placing a hepatic artery infusion (HAI) pump, the tip of the catheter tubing should be in the Right hepatic artery Hepatic artery proper Common hepatic artery Gastroduodenal artery. Assertion (A): Serum Aspartate Aminotransferase (AST) level is elevated almost in 2:1 ratio than serum alanine aminotransferase (ALT) in acute alcoholic hepatitis. Reason (R): Mitochondrial damage releases mitochondrial AST (mAST) due to alcohol Both A and R are true and R is correct explanation of A Both are incorrect A and R are true but R is not the correct explanation of A A is incorrect but R is true. A person is tested HBsAg positive twice at the interval of 6 months. However, Anti-HBsAb negative. What should be not be the next step of action? Check HBV DNA load Liver function test Family screening and vaccination Start anti-viral therapy. All of the following are used for the treatment of chronic hepatitis B except? Entecavir Sofosbuvir Tenofovir Lamivudine. Which of the following is the most effective definitive therapy for both prevention of recurrent variceal hemorrhage and control of ascites? Side-to-side portocaval shunt End-to-side portocaval shunt Esophagogastric devascularization (Sugiura procedure) Endoscopic sclerotherapy. Answer Keys (D) All of the aboveExplanation: Fissure of Gans is one of the three minor fissures found, the other two being umbilical and venous fissures. The fissure of Gans lies on the undersurface of the right lobe of the liver behind the gallbladder fossa. It often contains the portal pedicle to the right posterior sector. It is thought to correspond to the right fissure as it relates to the separation of the sectors of the liver.[1] This can be used as a signpost to avoid bile duct injury during laparoscopic cholecystectomy.(C) AmylaseExplanation: All enzymes are larger than their substrates except for proteases, nucleases, and amylases.[2](A) Stop breastfeedingExplanation: Stopping of breastfeeding is not an appropriate measure to stop vertical transmission of hepatitis B from mother to baby. In fact, immunoglobulins present in breast milk offer protection to baby against infections. Early umbilical cord clamping prevents exchange between fetal and maternal blood. Hepatitis B immunoglobulin and vaccination at birth provide active and passive immunity. Antiviral treatment to mother reduces the viral load and the infectivity.[3](B) Blumberg et al.[4]Explanation: Hippocrates gave an account of hepatitis A.[5] Michael Houghton discovered hepatitis C along with Harvey Alter, and Charles Rice.[6] Dr. Mohammed S Khuroo brought Hepatitis E into limelight and studied its epidemiology in Kashmir, India.[7](B) Hepatitis B[8]Explanation: The Dane particle is the infectious component of HBV has a diameter of ≈ 44 nm and consists of a double-layered capsid particle enclosing a circular, incomplete double-stranded DNA genome [Figure 1].(B) Hepatic arteryExplanation: HAI pump is used in case of liver metastasis in colorectal cancers. It is an implantable device where the chemotherapy pump is fixed subcutaneously in the abdomen. Since the healthy liver tissue receives its blood supply through portal vein, hepatic artery is utilized to receive the chemotherapy. This process has the benefit of increasing bioavailability of chemotherapy to the malignant tissue and obviates any other device use for delivering the same and has better results. The catheter is inserted through gastroduodenal artery to perfuse the hepatic artery, and simultaneously, a cholecystectomy is done to avoid chemotherapy-induced cholecystitis.[9](A) Both are correct, and R is the correct explanation of AExplanation: Both A and R are true and R is correct explanation of A. This is explained by De Ritis ratio. In acute alcoholic hepatitis the ratio might go up to 2.5:1 to as high as 5.09. This is due to decreased ALT activity due to Vitamin B6 depletion in alcoholics and mitochondrial damage leading to mAST release to serum. However, in chronic alcoholics, due to fibrosis and cirrhosis the ratio may be >1 but if serum AST is elevated, it can be due to recent exposure of alcohol. Toxic drugs may also elevate serum AST by damaging mitochondria.[10](D) Start anti-viral therapyExplanation: In this case HbSAg is positive, but antibody against this viral antigen is negative for a period of 6 months implies that the hepatitis is still in the icteric phase, where antibodies have not developed against the surface antigen. As soon as the antibody appears, the surface antigen disappears.[11]In this case, anti-viral therapy must be started, with a nucleoside analogue. Treatment should continue until 3 months after sero-conversion or 6 months after HBeAg seroconversion.[12](B) Sofosbuvir is not used in the treatment of chronic Hep B infectionExplanation: Drugs approved for the treatment of chronic Hep B infection include pegylated Interferon (IFN), lamivudine, adefovir, entecavir, telbivudine, and tenofovir.[12] Sofosbuvir is a nucleotide polymerase inhibitor and is used for hepatitis C infection.[13](A) Side-to-side portocaval shuntPortal-systemic shunts, such as the side-to-side portacaval shunt, reliably decompress both the liver and splanchnic viscera, thus preventing ascites formation.[14] Figure 1: Dane particle, rc DNA=recombinant DNA, pol=HBV polymerase, core=core protein (HBc), M,S,L are surface proteins(HBs). black arrow depicts HBeAgWith endoscopic sclerotherapy, rebleeding rates are 40%–60%. Hepatic sinusoidal pressure may be unchanged or even increased after an end-to-side portacaval shunt. Only side-to-side portal-systemic shunts, such as the side-to-side portacaval shunt, reliably decompress both the liver and splanchnic viscera, thus preventing ascites formation.[14] Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.