A 23-Year-Old-Man Is Brought to the Emergency Department After He

question 167

Multiple Choice

A 23-year-old-man is brought to the emergency department after he was stabbed in the right upper quadrant of the abdomen.  His blood pressure is 70/42 mm Hg, pulse is 135/min, and respirations are 26/min; pulse oximetry shows oxygen saturation of 95% on room air.  Physical examination shows a stab wound 2 cm inferior to the right costal margin.  The patient's abdomen is firm and distended.  Focused assessment with sonography for trauma (FAST) is positive for blood in the right upper quadrant.  He is taken for immediate laparotomy, and approximately 1 liter of blood is evacuated from the peritoneal cavity.  Brisk, nonpulsatile bleeding is seen emanating from behind the liver.  The surgeon occludes the hepatoduodenal ligament, but the patient continues to hemorrhage.  Which of the following structures is the most likely source of this patient's bleeding?

• A)Common bile duct
• B)Cystic artery
• C)Hepatic artery
• D)Inferior vena cava
• E)Portal vein

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