b) Necrotizing Pancreatitis involves both pancreatic parenchyma and surrounding tissues or sometimes
c) Peripancreatic involvement means severe disease as comapred to pancreatic parenchyma alone
d) Radioloical diagnosis of necrotizing pancreatitis is difficult in the 1st week
Question 2. Which of the following statement is not true for ideal hepaticojejunostomy
a) The anastomosis should be tension free
b) All the suture knoys should be on the outside of bile duct
c) Mucosal contact must exist between the mucosa of the bowel and bile duct
d) Anastomosis done with single layer absorbable sutures
Question 3. Barrett's esophagus is a premalignant condition.
Which of the following statement is false regarding
a) Barrett's mucosa predisposes to Squamous cell carcinoma of esophagus
b) Risk of Cancer is 0.5% per year
c) Prevalence of Barrett's esophagus in general population is 2-7%
d) Intestinal type of mucosa with goblet cells is the most common histopathological finding
Question 4. A 45 year old lady presents to the HepatoBiliary
Clinic with a large 3 cm stone in the neck of gall bladder
eroding into the Common Bile duct (CBD) effacing about
50% of its diameter. Patient has been counselled about
surgery and is willing for the same.What would be the most
appropriate surgery for this patient?
a) Cholecystectomy, removal of stone and primary repair of CBD over a T tube
b) Radical Cholecystectomy
c) Cholecystectomy and use of a flap of Gall Bladder to repair the defect in CBD
d) Cholecystectomy and Roux en Y Hepaticojejunostomy
Question 5. A 50 year old presents with vague persistent abdominal pain. CT Scan of the abdomen reveals a duodenal diverticulum. Which of the
statements is true regarding duodenal diverticulum.
a) The overall incidence of duodenal diverticulum is 7-20% and about 10% of these require surgery.
b) Most of the duodenal diverticula are symtomatic and perforation is the most common complication
c) Surgery should be avoided and carried out only in case of complications like perforation, uncontrooled hemorrahge, persistent biliary or pancreatic symptoms
d) Juxta vaterian diverticulum is the easiest to manage
Pancreatic necrosis occurs in 10-20% of all cases of Acute pancreatitis and commonly involve both pancreatic parenchyma and peri pancreatic tissue.Involvement of pancreatic parenchyma heralds a disease more severe in intensity than involvement of peripancreatic tissue alone.
Ideal Hepaticojejunostomy should be tension free with mucosal approximation and done using single layer absorbale suture
All though it is desired that the suture knot should be outside but absorbale suture are bein used , in the posterior layer knots may be place on the inside of the lumen
Barrett's esophagus is associated with adenocarcinoma and not squmaous cell carcinoma. Metaplasia occurs most commonly because of GERD and the normal esopheal lining is replaced by columnar cells
These columnar cells can be (i) Junctional cells (ii) Gastric cells and (iii) Intestinal Type of cells
Prsence of intestinal type of cells with prsence of goblet cells is the sine quo non of Barrett's esophagus
All other options are true.
This patient has typical feature of Mirizzi's syndrome named after the Pablo Mirizzi.
It is a rare condition in which stone gets impacted in the neck of Gall Bladder. The stone compresses the CBD externally or can lead to fistula formation with the CBD.
Patients generally present with pain abdomen, jaundice and fever.
The Csendes classification of Mirizzi syndrome is
Type 1: external compression of the common bile duct
Type 2: a cholecystobiliary fistula is present involving less than one third the circumference of the bile duct
Type 3: a fistula is present involving up to two thirds the circumference of the bile duct
Type 4: a fistula is present with complete destruction of the wall of the bile duct
Mirizzi Syndrome Treatment
Type 1 - Mirizzi syndrome treatment is fundus first cholecytectomy or partial cholecystectomy
For Type 2 to 4 the best treatment would be cholecystectomy and Roux en Y hepaticojejunostomy. A flap of gall bladder may sometimes be used if it appears healthy.
Ref: Complications of Gallstones: The Mirizzi Syndrome, Gallstone Ileus, Gallstone Pancreatitis, Complications of “Lost” Gallstones
Surgical Clinics of North America - Volume 88, Issue 6
Duodenum Diverticulae are the 2nd most common
diverticulum of small intestine after ileum.Most of these
are asymptomatic and incidentally detected. Only 10%
of the duodenal diverticulae are symptomatic and only 1% require
surgery.Haemorrhage is the most common complication and
perforation is the least common. Surgey is reserved for complicated
disease and where medical therapy has failed. Endoscopic options are
available for bleeding and biliary and pancreatic symptoms.
Juxtavaterian diverticulum ie 2 cm around ampulla are the most difficult to
manage because of proximity to the ampulla
Ref- Yeo: Shackelford's Surgery of the Alimentary Tract, 7th ed.