Isotonic fluid

Q) Isotonic fluid  solution is
A. Half normal saline
B. 1/5
th normal saline
C. Ringer lactate
D. Dextrose in Normal saline

Answer is free

Ringer lactate and Normal saline are isotonic fluid. they are useful in replacing GI losses. Ringer lactate has a bit of potassium as well.

Body actually requires bicarbonate and not lactate. Lactate is the more stable form in IV solutions and is used, it is converted by liver into bicarbonates.

Half NS is used in replacing losses when sodium concentration is high in the body, mainly as maintenance fluid

1/5th NS is hardly used clinically

Dextrose in Saline or DNS is used for maintenance and is not isotonic

Colon Volvulus

Q) Regarding colonic volvulus all are true except

a) Sigmoid volvulus without gangrene – colonoscopic decompression is the trt of choice

b) Caecal bascule has high chance of gangrene due to torsion of mesentry

c) Splenic flexure volvulus has better prognosis than transverse colon volvulus

d) Recurrence rate after detorsion of cecal volvulus is 10-20%

Answer for premium members

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.

 

Complications of Surgery of Aortic aneurysm

Q) A 68 year old man undergoes repair of infra renal aortic aneurysm. On 2nd POD he has abdominal pain, bloody diarrhea and tachycardia. BP is 120/70. Abdomen is mildly distended and tender especially in the left lower quadrant.

How will you proceed

a) Send stool for clostridium and spores

b) CT Abdomen

c) Exploratory laparotomy

d) Higher antibiotics

Answer for premium - Discuss the complications of Surgery for aortic aneurysm

HCC Cancer

Q) Which of the following is true about screening in hepatocellular carcinoma (HCC Cancer) 

a) Alpha feto protein should be done 6 monthly

b) Ultrasound abdomen should be done 6 monthly

c) Candidates for liver transplant should be screened every 3 months

d) Nodules more than 2 cm should be followed up  more regularly

Answer b

In a cirrhotic liver, hcc cancer  can develop any time and a stringent screening protocols  have  to be followed for early detection and timely treatment. Earlier ultrasound of liver and alpha feto protein were both used as tumor markers. However in 2009 Marrero et al demonstrated the suboptimal accuracy of AFP and after that it has been removed from the screening protocol and now only ultrasound is being done.

The screening recommendation is not for those patients with severe Read More ...