QUIZ: Structure and function of the liver

 

This five-question quiz helps medical students review key concepts in liver structure, dual blood supply, bile flow, and complications of liver dysfunction such as jaundice, coagulopathy, and encephalopathy.

 

1. A 50-year-old man with liver cirrhosis presents with increasing fatigue and abdominal distension. Liver cirrhosis can have a significant impact on hepatic circulation.

Which statement correctly describes how blood reaches the liver?

A. The hepatic artery supplies most of the liver’s blood
B. The portal vein carries oxygen-rich blood from the gut
C. The liver receives blood from two sources: the hepatic artery and portal vein
D. The hepatic veins carry oxygenated blood to the liver
E. The portal vein drains blood directly into the hepatic artery

2. A 55-year-old woman is diagnosed with a bile duct obstruction. She presents with jaundice, pale stools, and dark urine.

Which of the following correctly describes the direction of blood and bile flow in the liver?

A. Blood and bile both flow toward the central vein
B. Blood flows inward, while bile flows outward
C. Bile travels directly into the portal vein
D. Sinusoids transport bile toward the central vein
E. Bile moves into blood vessels for processing

3. A 65-year-old man with chronic liver disease is found to have confusion and a flapping tremor (asterixis). His blood tests show high ammonia levels.

Which liver function is most responsible for preventing ammonia toxicity?

A. Production of albumin
B. Urea cycle
C. Clotting factor synthesis
D. Bile acid production
E. Gluconeogenesis

4. A 60-year-old man with cirrhosis presents with easy bruising and prolonged bleeding after minor cuts. His blood tests show that his blood takes longer to clot than normal.

Which function of the liver is directly responsible for clot formation?

A. Vitamin D metabolism
B. Bile production
C. Clotting factor synthesis
D. Iron storage
E. Drug metabolism

5. A 48-year-old woman with chronic liver disease develops night blindness and frequent bruising. Blood tests show low vitamin A and vitamin K levels.

Which liver function is required for fat-soluble vitamin absorption?

A. Bile acid secretion
B. Albumin synthesis
C. Hepatic artery circulation
D. Kupffer cell activity
E. Portal vein filtration

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Answer Explanations

1. Correct answer: C. The liver receives blood from two sources: the hepatic artery and portal vein
The liver has a dual blood supply—about 75% from the portal vein (nutrient-rich, oxygen-poor) and 25% from the hepatic artery (oxygen-rich). Cirrhosis can obstruct portal flow, increasing pressure and contributing to ascites, varices, and splenomegaly.

2. Correct answer: B. Blood flows inward, while bile flows outward
Blood flows from the portal triads through sinusoids toward the central vein. Bile is produced by hepatocytes and flows in the opposite direction—toward the bile ducts. Obstruction prevents bilirubin excretion, causing jaundice, pale stools, and dark urine.

3. Correct answer: B. Urea cycle
The liver detoxifies ammonia through the urea cycle, producing urea for renal excretion. In liver failure, this process is impaired, leading to hyperammonaemia and neurological symptoms (hepatic encephalopathy).

4. Correct answer: C. Clotting factor synthesis
The liver synthesises most clotting factors, including fibrinogen, prothrombin, and factors V, VII, IX, X, and XI. In cirrhosis, their production falls, increasing bleeding risk. Easy bruising and prolonged clotting times are common findings.

5. Correct answer: A. Bile acid secretion
Bile acids emulsify dietary fats and enable absorption of fat-soluble vitamins (A, D, E, K). Without adequate bile flow, these vitamins are poorly absorbed, leading to deficiencies. Vitamin A deficiency causes night blindness; vitamin K deficiency leads to bleeding.

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