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Surgery Questions

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Hepatic Adenoma

Q) A 37 year old lady with history of oral contraceptives undergoes a CT scan for pain lower abdomen which also revealed a solitary 6 cm lesion in segment VI of liver.  Triple phase  Ct scan shows a lesion which  enhances in the arterial phase more at the margins and in the venous phase it moves towards the center. This lesion is :

a) Focal Nodular Hyperplasia

b) Haemangioma

c) Hepatic Adenoma

d) Hepatocellular carcinoma

Answer is C

Hepatic Adenoma is benign neoplasms of the liver. They are associated with 

  1. OCP use

  2. Androgen containing steroids

  3. Type I and III glycogen storage diseases

They are diagnosed on the basis of CT scans. Diagnostic features of CT Scan for hepatic adenoma are

  1. Non contrast- Heterogenous hypodense mass with areas of hemorrhage and necrosis

  2. Arterial phase shows rapid filling at the periphery then progressing to the center

Hepatocellular carccinoma shows - Rapid arterial filling with wash off in the portal venous phase

Hemangioma- Peripheral nodular enhancement

FNH- Central scar

Rf: Shackelford page 1564

 

Recurrent Pyogenic Cholangitis

Q) Not true about  recurrent pyogenic cholangitis :

a) Mostly there are intrahepatic strictures with involvement of the left side duct

b) It can present as choledochoduodenal fistula

c) In it there is complete biliary obstruction which  leads to marked jaundice and pruritis

d) MRCP and other other cholangiography can be diagnostic

Answer c

In recurrent pyogenic cholangitis (RPC)  complete obstruction does not occur and jaundice and pruritis is not marked. RPC is a disease commonly seen in young Asians (also known as oriental cholangiohepatitis) which leads to multiple strictures in extra or intrahepatic ducts.

Association with Ascaris lumbricoides and Clonorchis sinensis has been noted.

It can present as choledocholithiasis  with stricture, choledochoduodenal fistula, acute pancreatitis, secondary biliary cirrhosis and can lead to cholangiocarcinoma.

MRCP can be diagnostic and is preferred because of its non invasive nature.

 

Q) What is type III Paraesophageal hernia

a) Paraesophageal hiatus hernia

b) Sliding hiatus hernia

c) Both sliding and paraesophageal hernia

d) Large part of stomach in the mediastinum with pylorus near the esophageal hiatus

Answer  c

Hiatal hernias are protrusion of stomach through a defect in the esophageal hiatus into the mediastinum.

They are of two types

  1. Sliding - GE junction migrates to the mediastinum and rests superior to the diaphragm.
  2. Paraesophgaeal - Part of stomach migrates through the esophageal hiatus into the mediastinum with GE junction remaining at its normal position.

paraesophgeal hiatus hernia

  1. There are IV types of hiatal hernia

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