Retained antrum syndrome

Q) True about retained antrum syndrome after gastrectomy  are all except

a) It is a persistent hypergastrinemic state

b) It is only seen after Billroth II Gastrectomy

c) Technetium labelled food is not helpful in diagnosing this condition

d) Serum gastrin is usually less than 1000 pg/ml


Answer c

 After billroth II gastrectomy, if a cuff of gastric mucosa remains with duodenum, this entity is called as retained antrum syndrome. This cuff of gastric mucosa is cut off from the proximal stomach and inhibitory effect of hormones such as VIP (Vasoactive Intestinal Peptide)  leading to a persistent hypergastrinemic state. ALso this gastric mucosa is continuously bathed by the alkaline contents of duodenum , which further increases the acid formation.

Both Basal and maximal gastric acid outputs increase but it is not as high as seen in zollinger ellison syndrome. Typically less than 1000 pg/ml

This condition can present as recurrent and persistent ulcerations. Technetium scanning is the diagnostic modality of choice. Treatment is re do surgery and antral excision.

Technetium pertechnate imaging has a sensitivity of 73% and specificity of 100%

More about retained antrum syndrome

Anal canal

 Q  True about anal canal anatomy are all except
a) Columns of morgagni above dentate line
b) Resting anal canal Pressure 5 – 20 mm Hg
c) Muscles are tubular with inner layer supplied by autonomic nerves

d) Contains columnar, transitional and squamous epithelium

Answer

Hepatic blood flow

Q. All are true regarding hepatic blood flow except
A. Liver has dual blood supply from portal vein and hepatic artery
B. 70% of liver oxygen comes from the hepatic artery
C. 70-80% of blood supply to the liver is from portal vein

d) Liver receives 25% of cardiac output

Answer for premium

The explanation discusses how much blood and oxygen goes through portal vein and hepatic artery to the liver

What is hepatic artery buffer response

 

Liver trauma

Q) All are true for blunt hepatic trauma except
A. Grade V liver injuries are associated with vascular avulsion
B. Hepatic packing is an expeditious method to control bleeding in blunt hepatic trauma
C. After damage control Surgery and hepatic packing, abdominal compartment syndrome can
happen in immediate postoperative period
D. Post conservative management, in the 3rd week anemia MC occurs due to subcapsular
hematoma rupture

Answer

anatomy of esophagus

Q Which of the following is true about anatomy of esophagus?
A. Oesophageal hiatus is superior to aortic hiatus
B. Thoracic duct crosses esophagus at T3-T4level at the level of azygos vein arch
C. Laimer triangle is superior to the Killians triangle

D. In the mediastinum right vagus runs anteriorly and left vagus runs posteriorly

Answer

Post op chyle leak

Q 27 Postoperative chyle leak following esophagectomy which is true?
A. Intraoperative prophylactic ligation of thoracic duct reduce leak risks
B. Conservative management - almost all heal by 3 weeks
C. Transthoracic ligation only
D. Conservative treatment includes antibiotics, enteral nutrition only

Answer 

 

Blood supply to rectum

Q) Blood supply to rectum - all are true except
A. Inferior rectal artery pierces the levator ani to supply the distal rectum
B. Middle rectal artery is a branch of hypogastric
C. Arc of riolan is an anastomosis between ascending branch of IMA and Middle Colic Artery
D. Left Colonic Artery arises 3-4 cm distal to the IMA origin

Answer to Q14 

 

Hereditary Pancreatic Cancer

Q. All of the following predisposing syndromes for pancreatic adenocarcinoma are AD except
A. PJS (Peutz Jeghers) 
B. CFTR (Cystic fibrosis) 
C. HNPCC
D. FAMMM

Answer for premium members

Several hereditary cancer syndromes (e.g., Peutz-Jeghers syndrome, familial atypical mole and multiple melanoma syndrome, hereditary breast and ovarian cancer syndrome) are known to be associated with increased risk of pancreatic cancer

Read on Q24

Oropharyngeal dysphagia

 Oropharyngeal dysphagia false is
A. Nasal twang in voice, ptosis
B. Treatment is most often not satisfactory if conservative
C. Associated with myesthenia gravis and Parkinsonism
D. Water brasch and regurgitation presentation

Answer 

CEA

True regarding CEA is 

  1. Low specificity
  2. Falls after 1 week of surgery to baseline
  3. Preoperative high value is good prognostic marker
  4. Follow up, first test of CEA in 8-10 days followed by weekly tests thereafter

Answer after Q 20

Dieulafoy lesion

Diuelafoy lesion which is false? (AIIMS 2018) 
A. Most of the bleed cannot be visualised due to small mucosal defect lies over large arterial
bleed.
B. Large 1-3 mm artery in the submucosa is the source
C. MC in the greater curvature
D. Found within 6 cm from GEJ

Answer 

 

Chronic pancreatitis enzymes

Q . All are true regarding enzyme supplementation in chronic pancreatitis except 

a) Lipase to be given 30000U before or after meal

b) H2 blocker is mandatory with enteric coated tablets

c) Main cause of failure is inadequate dosage

d) In cases of failure of enzyme replacement feeding of medium chain Triglycerides are  helpful


Ans

Indications of enzyme supplementation are -

  1. Weight loss, steatorrhea (15g/day ) or both
  2. Dyspepsia, Diarrhoea, bloating, malabsorption of proteins  and carbohydrates
  3. Pain abdomen

Read on for ans Q 23