Beger Procedure for Chronic Pancreatitis

Q) True about Beger procedure for chronic pancreatitis

a) Posterior branch of gastro duodenal artery is preserved.

b) Beger procedure is  a pancreatic head mass resection that can be done for small pancreatic tumors.

c) Intra pancreatic, choledochal and ampullary structures are removed.

d) Neck of the pancreas is not  transacted

 

Answer a) Posterior branch of GDA is preserved

Beger procedure for chronic pancreatitis is mostly done in Europe. Hans Beger in 1972 in Germany introduced this  for chronic pancreatitis with inflammatory head mass. This is a complex procedure which removes head of the pancreas but leaves duodenum, a thin rim of pancreas around the medial aspect of duodenum and intrapancreatic bile duct intact.

The difference from  similar Frey's procedure is that in Beger procedure neck of the pancreas is transacted where as in Frey, neck of the pancreas is not cut.

This procedure is not recommended if there is suspicion of carcinoma  head of pancreas and Whipple is the procedure for that.

Posterior branch of GDA is preserved in Beger Procedure.

Reconstruction is at two places: Distal pancreas and rim of the pancreas at medial side of duodenum.

Free Questions on Pancreas

Relation of malignancy with ulcerative colitis

Q) A patient has ulcerative colitis with pan colitis. He is on medications and screening endoscopy 10 years later show high grade dysplasia. What is the management now?

a) Nothing for now and repeat colonscopy after 1 year

b) Total proctocolectomy

c) Resect the segment with high grade dysplasia

d) Increase the steroid dose

Answer and explanations  is for premium members

gastricbypass.surgery

USMLE Liver

Q) A 50 year old lady with right renal cell carcinoma presents with acute pain in right upper abdomen. She has acute tenderness in right upper abdomen with palpable edge of liver.
She is afebrile and has normal liver functions and normal TLC. CECT Abdomen shows extensive web of collterals in the liver. What is the next step in management.
Portal Cavernoma
                          Portal Cavernoma
 
a) Cholecystectomy
b) Beta blockers
c) Tissue plasminogen activator followed with anticoagulation
d) ERCP and stenting
Answer for premium only

Heel reconstruction in Plastic Surgery

Q) For a 3 X 4 cm defect on weight bearing heel, the ideal flap would be 

a) Gracilis and skin

b) Radial forearm

c) Dorsalis Pedis

d) Medial Plantar Island flap

Answer d

Sensate pedicled medial plantar island

This area of the heel is a sensitive area and would be under tremendous gravitational and shearing force. It will require a resilient flap in the form of choice d. This island flap is sensate, hairless and tough.

All other are muscle flaps which do not provide enough strength and are unstable. They also do not have a sensory supply.

Early esophagus cancer

Q) Which one of the following is not a management option in early esophageal cancer?

a) Photodynamic therapy

b) Endoscopic Mucosal resection

c) Argon plasma coagulation

d) Esophagectomy

Answer  d Esophagectomy

There is a recent term Endoscopically suspected Esophageal metaplasia (ESEM) seen with white light high resolution endoscopy. Management is PPI and repeat evaluation after 6-12 months

Once Barrett's esophagus is diagnosed, the further management depends on weather its a low grade or high grade dysplasia.

No dysplasia and barrett's segment < 3 cm - Endoscopic surveillance 5 years Read More ...