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Complications of duodenal diverticulum

Q) True statement regarding complications of duodenal diverticulum is

a) Perforation is the commonest complication

b) Obstruction is caused by extra luminal duodenal diverticulum

c) Bleeding is the most common complication of duodenal diverticulum.

d) Diverticulitis is common and easily diagnosed.

Answer

c

Complications of duodenal diverticulum are rare with a reported incidence of 5-10% in those with duodenal  diverticulum. Operative intervention is required in about 1% cases

Perforation is the rarest but the most severe complication of duodenum diverticulum. The most common cause of perforated duodenal diverticulum is diverticulitis. They perforate in the retroperitoneum, adding to diagnostic uncertainty. Ct Scans are most diagnostic to help in this diagnosis.

Obstruction is commonly caused by intraluminal  duodenal diverticulum. It can also become obstructed by gall stones or undigested foreign particles.

Bleeding is the commonest complication of duodenal diverticulum and present as haematemesis or melena. Diagnosis and treatment is by endoscopy.

Duodenal diverticulitis is uncommonly diagnosed because of its site and diagnostic confusion with cholecystitis, pancreatitis and other upper GI causes.

Bowel preparation before colon surgery

Q) What is true about bowel preparation before colon surgery in an elective case?

a) Bowel preparation should be done in every case

b) Bowel preparation should be done in all emergency situations like perforation and obstruction to attempt primary repair.

c) Mechanical purging one day before surgery and at leat 3 days of administration of non absorbable oral antibiotic should be given in all patients before elective colon resection

d) Bowel preparation at most centers is based on surgeons's discretion but reports have not shown any proven benefits.

Answer  for premium members 

 

 

Blood Supply of Stomach

Q) True about blood supply of stomach

a) Right gastric artery is the largest artery to the stomach

b) At least three out of four arteries of the stomach can be ligated and blood supply to the stomach may remain preserved.

c) Right gastric artery originates from splenic artery

d) Aberrant left hepatic artery arises from splenic artery

Answer

b

Blood supply of stomach is mostly consistent and there are four named arteries.

Left gastric artery is the largest artery to the stomach and in 15-20% cases, there is an aberrant left hepatic artery which arises from it. 

At least three arteries of the stomach can be safely ligated if the arcades on the greater and lesser curvatures are preserved and vascularity of whole of stomach may be preserved.

Right gastric artery is the branch of common hepatic artery or Gastro duodenal artery

Aberrant left hepatic artery is the branch of Left gastric artery. It is seen in 15-20% cases.

Right gastro epiploic artery is the branch of Gastro duodenal artery and left gastro epiploic from splenic artery

Blood supply of stomach

 

GI Bleed

Q )  A 59 year old male alcoholic male presents with history of upper GI bleed of 1 day duration. During the day he has had three episodes of bleeding each time about 150 ml. Blood is fresh and not associated with retching. He has a history of long standing alcohol intake. What will be the most likely cause of GI bleed

a) Mallory weiss tear

b) Esophageal varices

c) Gastric ulcer

d) Esophagitis

Answer for premium

Median arcuate syndrome

Q) Median arcuate syndrome is due to compression of 

a) Coeliac artery

b) Superior mesenteric artery

c) Phrenic artery

d) Inferior mesenteric artery

Free Answer for MCH GI Surgery Questions

A) a

Median arcuate syndrome is also known as coeliac artery compression syndrome. Median arcuate

ligament connects the diaphragm with the spine. In some individuals this median arcuate compresses the coeliac artery and produes abdominal pain. Read More ...

Mass in Right lower quadrant

Q) A 55 year old lady presents with vague pain in right lower abdomen. Physical examination reveals a well defined mass there which is non tender and freely mobile. It is non pulsatile as well. What is the most likely possibility?

a) Appendicular mass

b) Mesenteric cyst

c) Perforated tubo ovarian mass

d) Meckel's diverticulum

Answer

b

Mesenteric cysts are uncommon lesions found in this age group. It typically presents as a freely mobile mass  which moves perpendicular to small blwel axis. It is painless as well.

Appendicular mass will have a preceding history of pain abdomen

Similarly perforated  tubo ovarian mass will also have a history of pain 

Meckel's diverticulum does not present as this kind of mass

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