Q1 Treatment of Choice for gastric varices is
a) Sclerotherapy
b) Band Ligation
c) Transjugular Intrahepatic Portosystemic Shunt
d) Application of cyanoacrylate glue
Q2. Best Investigation for diagnosing gastrojejunocolic fistula is
a) Barium Meal
b) Barium swallow
c) Barium Enema
d) Colonoscopy
Q3. False about gastric bypass surgery is
a) In gastric bypass surgery there is progressive weight loss upto 3 yrs
b) Horizontal gastroplasty with the application of single
horizontal stapler has a failure rate of 40-70%
c) Gastric bypasssurgery has a failure rate of about 15%
d) With three superimposed applications of a stapling device,
gastric bypass staple line dehiscence occurs in less than 2%
Q4. Jejunoileal bypass surgery has now been abandoned.
Which of the following is true following jejunoileal bypass?
a) Kidney stones occur with increased frequency due to
increased absorption of pyruvate from the colon
b) The most serious complication of jejunoileal bypass is development
of cirrhosis due to protein calorie malnutrition
c) Bacterial overgrowth in the bypassed segment can be treated with oral vancomycin
d)
Q5. Which of the following statements is correct with
regard to gastric bypass for obesity?
a) Rapid weight loss following successful gastric bypass
for obesity is associated with an increased risk of developing cholelithiasis
b) Marginal ulcer develops in 25% of gastric bypass patients
c) Vitamin B12 deficiency is a potential complication of
gastric bypass due to gastric mucosal atrophy
d) Anastamotic leak after gastric bypass is often heralded by bradycardia
Answers
1. d
Controlled studies evaluating pharmacologic therapy for gastric variceal bleeding are lacking, the agents used are based on extension of the data relating to esophageal varices. Medical management with vasoactive agents should be started as early as possible, preferably at least 30 minutes before endoscopic therapy is carried out. The preferred endoscopic therapy for fundal gastric variceal bleeding is injection of polymers of cyanoacrylate, usually N-butyl-2-cyanoacrylate,. Obliteration of the varices occurs when the injected cyanoacrylate adhesive hardens on contact with blood. The mucosa overlying the varix eventually sloughs, and the hardened polymer is extruded. Fortunately, the resulting ulcers occur late, and the risk of bleeding is lower than that associated with sclerotherapy-related ulcers. Cyanoacrylate injection has been found to be superior to both variceal band ligation and sclerotherapy using alcohol.Complications of cyanoacrylate injection include bacteremia and variceal ulceration. Pulmonary and cerebral emboli have been reported on occasion, usually in patients with spontaneous large portosystemic or intrapulmonary shunts. The endoscope may be damaged by the glue, but the risk is minimized if silicone gel is used and suction is avoided for 15 to 20 seconds following injection
Ref:Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 9th ed.
Read about esophageal varices here
2) c
Gastrojejunocolic fistula (GJF) is associated with previous gastroenterostomy. It is thought to be the late complication of a stomal ulcer, which develops as a result of inadequate gastric resection or incomplete vagotomy, for peptic ulcer disease. Most patients with GJF present with a
symptom triad of faecal vomiting/breath, chronic diarrhoea, and weight loss. The diagnostic investigation of choice to date has been barium
enema, which has a sensitivity of 95% for this condition
Ref: http://www.hkmj.org/article_pdfs/hkm0112p439.pdf
Full text article discussing management of gastrojejunocolic fistula
3)a
Horizontal gastroplasties include a single application of a 90-mm
stapling device without suture reinforcement of the “stoma’’ between
upper and lower gastric pouches or a double application of staples with
either a central or lateral prolene-reinforced stoma. The failure rates
for horizontal gastroplasty procedures ranges from 40% to 70%.
The vertical banded gastroplasty (VBGP) is a procedure in which
a stapled opening is made in the stomach with the stapling device
5 cm from the cardioesophageal junction. Two applications of a
90-mm stapling device are made between this opening and the angle of His,
and a 1.5 5 cm strip of polypropylene mesh is wrapped around the stoma on the
lesser curvature and sutured to itself.
Gastric bypass can be performed with placement of staples in a vertical
or horizontal direction; the vertical direction is preferred because there is less
risk of gastric pouch devascularization or splenic injury. With three superimposed
applications of a 90-mm stapler, the incidence of staple line disruption has been
less than 2%.
Roux-en-Y gastric bypass has significantly better weight loss than VBGP.
Although 10% to 15% of patients fail gastric bypass, weight loss seems to remain
stable in most patients over 5 years or more after surgery.
Weight loss after GBP(Gastric Bypass Procedure) occurs over 1-3 years
Ref. Schakelford stomach 197.
4) c
Malabsorption of bile salts, coupled with rapid weight loss
significantly increases risk of gallstone development. Multiple kidney stones
result from excessive absorption of oxylate from the colon where oxylate
is ordinarily chelated with calcium. Malabsorption results in severe
diarrhea, electrolyte abnormalities, metabolic acidosis and anemia.
Bacterial overgrowth in the bypassed intestinal segment coupled with
protein malabsorption is postulated to be responsible for development
of cirrhosis, the most serious complication of jejunoileal bypass.
Bacterial overgrowth can be temporarily suppressed by metronidazole.
Development of hepatic dysfunction is an indication for reversal of the bypass.
Ref. Schakelford stomach 197.
5)a
Anastomotic leak is accompanied with tachycardia not bradycardia.
Signs of peritonitis following anastomotic leak are subtle.Marginal Ulcer
develops in 10%. Vit B12 deficiency occurs due to decreased acid digestion of B12 with
food
