Q) What is true regarding gastric conduits to be used as esophagus replacement?
a) The right gastric and gastro epiploic arteries can be safely divided to bring stomach to the neck
b) For malignant diseases stomach is the most reliable conduit
c) Stomach has the least incidence of developing reflux esophagitis
d) For benign esophageal strictures stomach is the conduit of choice
a) Ureteral obstruction
b) Entero vesical fistula
d) Recto uretheral fistula
Q) A 37 year old lady with history of oral contraceptives undergoes a CT scan for pain lower abdomen which also revealed a solitary 6 cm lesion in segment VI of liver. Triple phase Ct scan shows a lesion which enhances in the arterial phase more at the margins and in the venous phase it moves towards the center. This lesion is :
a) Focal Nodular Hyperplasia
c) Hepatic Adenoma
d) Hepatocellular carcinoma
Answer is C
Hepatic Adenoma is benign neoplasms of the liver. They are associated with
Androgen containing steroids
Type I and III glycogen storage diseases
They are diagnosed on the basis of CT scans. Diagnostic features of CT Scan for hepatic adenoma are
Non contrast- Heterogenous hypodense mass with areas of hemorrhage and necrosis
Arterial phase shows rapid filling at the periphery then progressing to the center
Hepatocellular carccinoma shows - Rapid arterial filling with wash off in the portal venous phase
Hemangioma- Peripheral nodular enhancement
FNH- Central scar
Rf: Shackelford page 1564
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) 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
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.
a) Paraesophageal hiatus hernia
b) Sliding hiatus hernia
c) Both sliding and paraesophageal hernia
d) Large part of stomach in the mediastinum with pylorus near the esophageal hiatus
Hiatal hernias are protrusion of stomach through a defect in the esophageal hiatus into the mediastinum.
They are of two types
- Sliding - GE junction migrates to the mediastinum and rests superior to the diaphragm.
- Paraesophgaeal - Part of stomach migrates through the esophageal hiatus into the mediastinum with GE junction remaining at its normal position.
- There are IV types of hiatal hernia