Stanford University SURG 203 Anatomy
(Macroscopic, Embryology and Histology) –
Stanford Medical School Anatomy Study Guide,
Original Practice Questions & Answers, SURG 203
Exam Preparation, Comprehensive Clinical
Anatomy Review, Gross Anatomy, Macroscopic
Anatomy, Embryology, Histology, Developmental
Anatomy, Medical Imaging, Dissection, Thorax,
Abdomen, Pelvis, Back, Upper & Lower Limbs, Head
& Neck & Clinical Applications
Question 1: Which of the following embryonic structures is the direct
precursor to the adult liver and the intrahepatic biliary tree?
A. Septum transversum
B. Hepatic diverticulum
C. Sinus venosus
D. Foregut endoderm
CORRECT ANSWER: B. Hepatic diverticulum
Rationale: The hepatic diverticulum is an outgrowth of the foregut endoderm that
appears in the fourth week of development. Its cranial part gives rise to the liver and
intrahepatic biliary apparatus, while its caudal part forms the gallbladder and
extrahepatic bile ducts. The septum transversum provides mesenchymal cells that
contribute to the stroma and Kupffer cells.
Question 2: A 45-year-old male presents with jaundice, pruritus, and right
upper quadrant pain. Imaging reveals a dilated intrahepatic biliary tree. Which
congenital anomaly, resulting from failure of the hepatic diverticulum to
divide, could predispose to this presentation?
A. Biliary atresia
B. Choledochal cyst
C. Double gallbladder
D. Agenesis of the gallbladder
CORRECT ANSWER: C. Double gallbladder
Rationale: Failure of the hepatic diverticulum to divide completely during embryonic
development can lead to a double gallbladder, a congenital anomaly. This can be
associated with an increased risk of cholelithiasis and biliary obstruction, which may
present with jaundice, pruritus, and pain. Biliary atresia is due to failed recanalization of
the bile ducts.
,Question 3: The adult gallbladder is derived from which specific part of the
embryonic hepatic diverticulum?
A. Cranial bud
B. Caudal bud
C. Ventral bud
D. Dorsal bud
CORRECT ANSWER: B. Caudal bud
Rationale: The hepatic diverticulum divides into a cranial (larger) bud, which forms the
liver and intrahepatic bile ducts, and a caudal (smaller) bud, which forms the gallbladder
and the cystic duct. The ventral and dorsal buds refer to the primordia of the pancreas.
Question 4: A histology slide of the liver shows a portal triad. Which of the
following structures is NOT a typical component of a portal triad?
A. Branch of the hepatic artery
B. Branch of the portal vein
C. Bile duct
D. Central vein
CORRECT ANSWER: D. Central vein
Rationale: The portal triad is composed of a branch of the hepatic artery, a branch of the
portal vein, and a bile duct, all surrounded by a connective tissue sheath. The central
vein is located in the center of the hepatic lobule and drains blood from the sinusoids
into the hepatic veins. It is not part of the portal triad.
Question 5: The hepatic sinusoids are lined by a unique population of
fenestrated endothelial cells. Which of the following cells is found within the
sinusoid lumen, is derived from the monocyte lineage, and functions as a
resident macrophage?
A. Hepatic stellate cell (Ito cell)
B. Kupffer cell
C. Hepatocyte
D. Pit cell
CORRECT ANSWER: B. Kupffer cell
Rationale: Kupffer cells are the resident tissue macrophages of the liver. They are
located within the lumen of the hepatic sinusoids, attached to the endothelial lining.
They are derived from circulating monocytes and play a crucial role in phagocytosing
pathogens, old erythrocytes, and particulate matter from the portal blood.
,Question 6: A 55-year-old with a history of alcohol abuse has cirrhosis. Which
perisinusoidal cell type is primarily responsible for the excessive deposition of
collagen and extracellular matrix seen in this condition?
A. Kupffer cell
B. Hepatocyte
C. Hepatic stellate cell (Ito cell)
D. Endothelial cell
CORRECT ANSWER: C. Hepatic stellate cell (Ito cell)
Rationale: Hepatic stellate cells (Ito cells) are located in the space of Disse, between the
sinusoid endothelium and the hepatocytes. In their quiescent state, they store vitamin A.
In response to liver injury (e.g., from alcohol), they become activated (transdifferentiate
into myofibroblasts) and produce large amounts of collagen type I, leading to fibrosis
and ultimately cirrhosis.
Question 7: During the fourth week of development, the liver receives its blood
supply primarily from which of the following?
A. Umbilical arteries
B. Vitelline veins
C. Cardinal veins
D. Aorta
CORRECT ANSWER: B. Vitelline veins
Rationale: The vitelline veins return blood from the yolk sac to the embryo. During the
development of the liver, these veins break up into a sinusoidal network within the
hepatic primordium, providing the major blood supply to the developing organ. The
umbilical veins also contribute after the placenta forms.
Question 8: The portal vein is formed by the union of which of the following
veins?
A. Superior mesenteric and inferior mesenteric veins
B. Splenic and superior mesenteric veins
C. Splenic, superior mesenteric, and inferior mesenteric veins
D. Gastric and splenic veins
CORRECT ANSWER: B. Splenic and superior mesenteric veins
Rationale: The portal vein is formed posterior to the neck of the pancreas by the
confluence of the splenic vein and the superior mesenteric vein. The inferior mesenteric
vein typically drains into the splenic vein, but its contribution is not the primary union
forming the main portal vein.
, Question 9: In the classic liver lobule, blood flows from the portal triads
towards the central vein. In which direction does bile flow?
A. From the central vein towards the portal triads
B. From the portal triads towards the central vein
C. From the portal triads to the portal triads
D. From the central vein to the central vein
CORRECT ANSWER: A. From the central vein towards the portal triads
Rationale: Bile is secreted by hepatocytes into the bile canaliculi, which are small
intercellular channels. The bile flows in the canaliculi in a direction opposite to the blood
flow, i.e., from the center of the lobule (where central veins are located) towards the
periphery (portal triads), where it enters the bile ducts (canals of Hering).
Question 10: A histology section of the gallbladder reveals a mucosa with deep
invaginations. What is the functional significance of these invaginations?
A. To increase surface area for absorption
B. To provide structural support to the wall
C. To act as a reservoir for bile between meals
D. To secrete mucus for lubrication
CORRECT ANSWER: A. To increase surface area for absorption
Rationale: The mucosal surface of the gallbladder is lined by a tall columnar epithelium
with prominent microvilli, and it has multiple deep invaginations or folds that extend
into the lamina propria. This greatly increases the surface area of the mucosa, which is
essential for the gallbladder's primary function of concentrating bile by actively
absorbing water and electrolytes.
Question 11: The cystic artery is most commonly a branch of which artery?
A. Common hepatic artery
B. Proper hepatic artery
C. Right hepatic artery
D. Gastroduodenal artery
CORRECT ANSWER: C. Right hepatic artery
Rationale: In approximately 70-80% of individuals, the cystic artery arises from the right
hepatic artery within the hepatoduodenal ligament, posterior to the common hepatic
duct. It then courses to the neck of the gallbladder to supply it.
(Macroscopic, Embryology and Histology) –
Stanford Medical School Anatomy Study Guide,
Original Practice Questions & Answers, SURG 203
Exam Preparation, Comprehensive Clinical
Anatomy Review, Gross Anatomy, Macroscopic
Anatomy, Embryology, Histology, Developmental
Anatomy, Medical Imaging, Dissection, Thorax,
Abdomen, Pelvis, Back, Upper & Lower Limbs, Head
& Neck & Clinical Applications
Question 1: Which of the following embryonic structures is the direct
precursor to the adult liver and the intrahepatic biliary tree?
A. Septum transversum
B. Hepatic diverticulum
C. Sinus venosus
D. Foregut endoderm
CORRECT ANSWER: B. Hepatic diverticulum
Rationale: The hepatic diverticulum is an outgrowth of the foregut endoderm that
appears in the fourth week of development. Its cranial part gives rise to the liver and
intrahepatic biliary apparatus, while its caudal part forms the gallbladder and
extrahepatic bile ducts. The septum transversum provides mesenchymal cells that
contribute to the stroma and Kupffer cells.
Question 2: A 45-year-old male presents with jaundice, pruritus, and right
upper quadrant pain. Imaging reveals a dilated intrahepatic biliary tree. Which
congenital anomaly, resulting from failure of the hepatic diverticulum to
divide, could predispose to this presentation?
A. Biliary atresia
B. Choledochal cyst
C. Double gallbladder
D. Agenesis of the gallbladder
CORRECT ANSWER: C. Double gallbladder
Rationale: Failure of the hepatic diverticulum to divide completely during embryonic
development can lead to a double gallbladder, a congenital anomaly. This can be
associated with an increased risk of cholelithiasis and biliary obstruction, which may
present with jaundice, pruritus, and pain. Biliary atresia is due to failed recanalization of
the bile ducts.
,Question 3: The adult gallbladder is derived from which specific part of the
embryonic hepatic diverticulum?
A. Cranial bud
B. Caudal bud
C. Ventral bud
D. Dorsal bud
CORRECT ANSWER: B. Caudal bud
Rationale: The hepatic diverticulum divides into a cranial (larger) bud, which forms the
liver and intrahepatic bile ducts, and a caudal (smaller) bud, which forms the gallbladder
and the cystic duct. The ventral and dorsal buds refer to the primordia of the pancreas.
Question 4: A histology slide of the liver shows a portal triad. Which of the
following structures is NOT a typical component of a portal triad?
A. Branch of the hepatic artery
B. Branch of the portal vein
C. Bile duct
D. Central vein
CORRECT ANSWER: D. Central vein
Rationale: The portal triad is composed of a branch of the hepatic artery, a branch of the
portal vein, and a bile duct, all surrounded by a connective tissue sheath. The central
vein is located in the center of the hepatic lobule and drains blood from the sinusoids
into the hepatic veins. It is not part of the portal triad.
Question 5: The hepatic sinusoids are lined by a unique population of
fenestrated endothelial cells. Which of the following cells is found within the
sinusoid lumen, is derived from the monocyte lineage, and functions as a
resident macrophage?
A. Hepatic stellate cell (Ito cell)
B. Kupffer cell
C. Hepatocyte
D. Pit cell
CORRECT ANSWER: B. Kupffer cell
Rationale: Kupffer cells are the resident tissue macrophages of the liver. They are
located within the lumen of the hepatic sinusoids, attached to the endothelial lining.
They are derived from circulating monocytes and play a crucial role in phagocytosing
pathogens, old erythrocytes, and particulate matter from the portal blood.
,Question 6: A 55-year-old with a history of alcohol abuse has cirrhosis. Which
perisinusoidal cell type is primarily responsible for the excessive deposition of
collagen and extracellular matrix seen in this condition?
A. Kupffer cell
B. Hepatocyte
C. Hepatic stellate cell (Ito cell)
D. Endothelial cell
CORRECT ANSWER: C. Hepatic stellate cell (Ito cell)
Rationale: Hepatic stellate cells (Ito cells) are located in the space of Disse, between the
sinusoid endothelium and the hepatocytes. In their quiescent state, they store vitamin A.
In response to liver injury (e.g., from alcohol), they become activated (transdifferentiate
into myofibroblasts) and produce large amounts of collagen type I, leading to fibrosis
and ultimately cirrhosis.
Question 7: During the fourth week of development, the liver receives its blood
supply primarily from which of the following?
A. Umbilical arteries
B. Vitelline veins
C. Cardinal veins
D. Aorta
CORRECT ANSWER: B. Vitelline veins
Rationale: The vitelline veins return blood from the yolk sac to the embryo. During the
development of the liver, these veins break up into a sinusoidal network within the
hepatic primordium, providing the major blood supply to the developing organ. The
umbilical veins also contribute after the placenta forms.
Question 8: The portal vein is formed by the union of which of the following
veins?
A. Superior mesenteric and inferior mesenteric veins
B. Splenic and superior mesenteric veins
C. Splenic, superior mesenteric, and inferior mesenteric veins
D. Gastric and splenic veins
CORRECT ANSWER: B. Splenic and superior mesenteric veins
Rationale: The portal vein is formed posterior to the neck of the pancreas by the
confluence of the splenic vein and the superior mesenteric vein. The inferior mesenteric
vein typically drains into the splenic vein, but its contribution is not the primary union
forming the main portal vein.
, Question 9: In the classic liver lobule, blood flows from the portal triads
towards the central vein. In which direction does bile flow?
A. From the central vein towards the portal triads
B. From the portal triads towards the central vein
C. From the portal triads to the portal triads
D. From the central vein to the central vein
CORRECT ANSWER: A. From the central vein towards the portal triads
Rationale: Bile is secreted by hepatocytes into the bile canaliculi, which are small
intercellular channels. The bile flows in the canaliculi in a direction opposite to the blood
flow, i.e., from the center of the lobule (where central veins are located) towards the
periphery (portal triads), where it enters the bile ducts (canals of Hering).
Question 10: A histology section of the gallbladder reveals a mucosa with deep
invaginations. What is the functional significance of these invaginations?
A. To increase surface area for absorption
B. To provide structural support to the wall
C. To act as a reservoir for bile between meals
D. To secrete mucus for lubrication
CORRECT ANSWER: A. To increase surface area for absorption
Rationale: The mucosal surface of the gallbladder is lined by a tall columnar epithelium
with prominent microvilli, and it has multiple deep invaginations or folds that extend
into the lamina propria. This greatly increases the surface area of the mucosa, which is
essential for the gallbladder's primary function of concentrating bile by actively
absorbing water and electrolytes.
Question 11: The cystic artery is most commonly a branch of which artery?
A. Common hepatic artery
B. Proper hepatic artery
C. Right hepatic artery
D. Gastroduodenal artery
CORRECT ANSWER: C. Right hepatic artery
Rationale: In approximately 70-80% of individuals, the cystic artery arises from the right
hepatic artery within the hepatoduodenal ligament, posterior to the common hepatic
duct. It then courses to the neck of the gallbladder to supply it.
