Q) Late dumping syndrome is due to
a) Insulin overshoot
b) Food bolus in jejunum
c) Release of serotonin
d) Local enteric reflexes
a, Excessive release of Insulin
Dumping syndrome are most common after billroth II gastrectomy followed by BI and Truncal vagotomy and gastro jejunostomy.
Dumping can occur 30 mins after food, (early dumping) or 2 hours after eating (late dumping). Early dumping has GI symptoms such as nausea, vomiting, epigastric fullness, diarrhea and abdominal pain.
Early dumping occurs due to rapid emptying of chyme in jejunum. This hyperosmolar fluid draws water from extracellular compartment to the lumen of small intestine causing intestinal distension and autonomic changes.Serotonin, bradykinin-like substances, neurotensin, and enteroglucagon are involved in early dumping.
Late dumping syndrome has more cardiovascular symptoms such as palpitations, light headedness, dizziness, tachycardia, diaphoresis, flushing and blurred vision.
It occurs due to delivery of carbohydrates into jejunum, their absorption causes hyperglycemia and insulin release. Excessive insulin release leads to development of symptoms.
Treatment of Dumping syndrome
- Diet - Avoid carbohydrates, frequent small meals of protein and fat and separate liquids from solids
- Octreotide agonists
- surgery Conversion to Roux en Y
Ref Sabiston 1212
Q) Starburst appearance is seen in
a) Mucinous cystic neoplasm
b) Serous cystic neoplasm
d) Pseudocyst of pancreas
Q) Which of the following is true about giant gastric ulcer?
a) 70-80% of these ulcers are malignant
b) By definition giant gastric ulcer is more than 1.5 cm in size
c) Medical therapy can heal 80% of such ulcers
d) They are more common on the greater curvature and invade surrounding organs like spleen, liver etc
Answer for premium members
Q) A 68-year-old woman complains of Intestinal obstruction. Xrays reveal fluid levels and air in the biliary tree. What is the likely cause?
(A) Choledochal cyst
(B) Gallstone ileus
(C) Obstructed hernia
(D) Previous choledochoduodenostomy
Q) In LYMPHEDEMA STOCKING class A pressure is ?
a. 20 -30mmHg
b. 30-40 mmHg
c. 40-50 mmHg
Use of compression stockings in lymphedema
Q) According to Siewert classification tumors at GE junction are
a) Type I
b) Type II
c) Type III
d) Type IV
Answer (free for all)
Type I Lower (centre located within between 1-5cm above the anatomic OGJ)
Type II Real GE junction (within 1cm above and 2cm below the OGJ)
Type III (2-5cm below OGJ)
This classification has only 3 subtypes
According to the Siewert-Stein classification,
Type I tumour 25% approx
Type II - Most common 49%
Type III was present in 25%
This classification helps in deciding the operative management and unified pre op classificationT
Types of Surgery
Type I cancer--depending of the size of the tumour--distal 2/3 oesophagectomy with the resection of the proximal lesser curve of the stomach or total gastrectomy or THE
In patients with types II and III cancers total gastrectomy
Q) Most common pathological finding on defecography studies is
Discuss what is defecography? Diseases diagnosed by it
Q) How should you transport amputated finger?
a) Plastic bag with wet ice inside
b) Plastic bag with wet ice outside
c) Plastic bag with dry ice outside
d) Over sterile gauge
Discuss Proper method for transportation of an amputated body part to maximize replantation success.
Q) False about choledochal cyst is
a) Type IV is also known as Caroli's disease
b) Type I choledochal cyst is the most common type
c) Type III is also called as choledochocele
d) Type II choledochal cyst is diverticular disease
This question was asked in NEET this year and a similar question on choledochal cyst is already on the website for some time.
Q. Carbon monoxide poisoning true is
a. It is having 10 times more affinity than oxigen
b. 60 percent is not deadly.
c. Concentration above 10% are dangerous and need observation
d. Concentration above 10% are dangerous and need treatment with pure oxigen
for more than 24 hours
Option A: Affinity of CO for Hb is 200-250 times that of oxygen. It causes a conformational change in Hb molecule and reduces affinity of Hb for O2, shifting the oxyhemoglobin dissociation curve to the left.
Option B: Concentrations less than 10% are usually asymptomatic. Concentrations >60% are fatal. Arterial carboxyhemoglobin level must be obtained because pulse oximetry can be falsely elevated.
Option C: Concentrations above 10 per cent are dangerous and need treatment with pure oxygen for more than 24 hours. Administration of 100% O2 reduces the half-life of CO from 250 minutes in room air to 40 to 60 minutes on 100% oxygen.
Q) Recurrence rate in lap repair of recurrent inguinal hernias is
a. 5 %
b. 8 %
c. 10 %
d. 14 %
Discuss Recurrence rates in open and laparoscopic repairs in primary hernia
Recurrence rate of lap repair in recurrent hernia