Billroth 2 surgery

Q) What is true regarding complications of billroth 2 surgery?

a) It has less complications than billroth 1 surgery

b) Recurrent ulceration is more common in the afferent limb as compared to efferent limb.

c) Afferent loop obstruction is more common after billroth 2 surgery

d) Billroth I operation is preferred in scarred duodenum

Answer c -

In billroth 2 surgery, afferent limb obstruction is more common

In surgery for benign gastric ulcers, billroth I reconstruction is the preferred choice. Billroth II surgery has problems of

  1. Retained antrum syndrome
  2. Afferent loop obstruction
  3. Duodenal stump leak (1-3%)

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USMLE Trauma

Q ) A 25 year old male brought to the hospital  after being involved in a road traffic accident that occurred 50 minutes ago. His  initial BP at the scene of accident was  80/40 mm HG with a pulse rate of 120/min.

The paramedics administered 2 litres of normal saline in the ambulance and in the emergency department his BP is 110/70 with a pulse rate of 90/min.

He has tenderness in Left upper quadrant abdomen and USG reveals perisplenic fluid. Next step is to :

a) Take him for exploratory laparotomy

b) Shift him to ICU and observe

c) Do a CT scan of the abdomen

d) Put in a laparoscope and assess

Answer c

This Patient has a splenic injury due to blunt trauma abdomen.The  immediate management  depends on grade of splenic  injury  and response to IV Fluids. This patient is hemodynamically stable after IV fluids  and immediate laparotomy is not needed.

Direct shifting to ICU is also not the right choice because CT is required first and for more severe injuries patient can go to OT

Laparoscopy has no role in splenic injuries

Paget disease of the breast

Q) A 60 year old lady, mother of 2 presents with rash and color change in the left areola of 3 months duration. She is diagnosed with Paget disease of the breast. What is true regarding this condition

a) Cancer is a distant possibility

b) Surgical therapy fails to cure Paget's disease of breast

c) Nipple biopsy is diagnostic

d) It is associated with paget's disease of bone

Answer

c

Paget's disease of the breast is invasive carcinoma which grows along the ducts into nipple and areola. Diagnosis is made by nipple biopsy. The lesion presents with eczematous rash which is persistent.

On histology swollen paget cells are seen. Surgical therapy is curative and this pathology is unrelated to paget's disease of the bone.