Q 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
Q 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
CEA is an oncofetal protein that is normally present during fetal life but can be present in low concentrations in healthy adults. Structurally, it is a glycoprotein with a molecular weight of 200 kDa. It is not useful as a screening test because of its low sensitivity in early-stage disease.
It can be increased in several beningn diseases such as rheumatoid arthritis, cystic diseases of kidneys, COPD, cirrhosis.
It is useful as a follow up investigation after colonic resection because increasing levels correlate with the stage of the disease and similarly preop values correlate with the severity of the disease