Month: September 2017

Foreign body esophagus

Foreign body esophagus

Q) True about foreign body in esophagus

a) Sharp objects should be operated and not retrieved

b) Lead batteries should be removed

c) Most common impacted foreign bodies are dentures

d) Contrast examination of esophagus should be done before endoscopy

 

Answer

b

Sharp objects can be removed over overtubes and not always require surgery. Lead batteries can corrode and decay in the stomach or intestine and should always be removed. Most common impacted foreign bodies are food boluses above a pathological narrowing and require endoscopic break up

Contrast examination is not always required and might complicate things

Bailey page 991

Cholelithiasis with Choledocholithiasis

Cholelithiasis with Choledocholithiasis

Q.  Patients with gallstones and choledocholithiasis in a centre with endoscopy, interventional radiology and tertiary care centre

a.       Single setting lap chole + CBDE better than endoscopy followed by lap chole

b.      In choledocholithiasis endoscopic clearance alone without lap chole can be done without any long term complication

c.       For impacted ampullary stones with CBD dilatation that requires biliary enteric drainage is performed with a preferred open approach

Answer

 

Banff Score

Banff Score

Q) Banff Scoring system is for

a) Acute pyelonephritis

b) Chronic glomerulonephritis

c) Acute Rejection

d) Chronic renal graft rejection

Answer check

Discuss what is banff score

What is the need of banff score

What are the components

What is the significance

Two field esophagectomy

Two field esophagectomy

Q) Which is not included in two field esophagectomy in carcinoma esophagus

a) Supra carinal and cervical

b) Infra carinal and celiac

c) Superior mediastinal

d) d) Posterior mediastinal

Premium members

Discusss the lymph node stations

Japanese and european classifications of esophageal spread

Two field esophagectomy

 

Survival after pancreatic resection in Ca head of Pancreas

Survival after pancreatic resection in Ca head of Pancreas

Q) Median survival after surgery and chemotherapy in Ca Head of Pancreas

a) 12 months

b) 22 months

c) 32 months

d) 44 months

Answer for premium members

This is an interesting question because this is one tumor in which breakthrough has not been achieved in the last 70 years. Pancreatic cancer remains one of the deadliest cancers of the GI tract and whipple's surgery continues to have high morbidity.

We discuss the role and response of chemotherapy also

Dumping Syndrome

Dumping Syndrome

Q) Late dumping syndrome is due to 

a) Excessive release of insulin

b) Food bolus in jejunum

c) Release of serotonin

d) Local enteric reflexes


Answer

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 

  1. Diet - Avoid carbohydrates, frequent small meals of protein and fat and separate liquids from solids
  2. surgery Conversion to Roux en Y

Ref Sabiston 1212


 

Clinical question

Clinical question

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

Premium Answer

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