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 of Dumping syndrome

  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

 

Carbon Monoxide poisoning

Q. Carbon monoxide poisoning true is

a. It is having 10 times more affinity than oxigen
b. 60 percent is not deadly.
c. Concentration above 10% are dangerous and need observation
d. Concentration above 10% are dangerous and need treatment with pure oxigen
for more than 24 hours

Answer Free 

d

Option A: Affinity of CO for Hb is 200-250 times that of oxygen. It causes a conformational change in Hb molecule and reduces affinity of Hb for O2, shifting the oxyhemoglobin dissociation curve to the left.

Option B: Concentrations less than 10% are usually asymptomatic. Concentrations >60% are fatal. Arterial carboxyhemoglobin level must be obtained because pulse oximetry can be falsely elevated.

Option C: Concentrations above 10 per cent are dangerous and need treatment with pure oxygen for more than 24 hours. Administration of 100% O2 reduces the half-life of CO from 250 minutes in room air to 40 to 60 minutes on 100% oxygen.

Strongest layer of the intestine

Q) Which is the strongest layer of the intestine?

a) Mucosa

b) Submucosa

c) Muscularis propria

d) Muscularis mucosa

Answer:

b) Submucosa is the strongest and most important layer for intestinal anastomosis. It has fibroblasts that will ultimately release collagen and hold the anastomosis together. This layer should be fully incorporated in the anastomosis.

Inverted Vs everted anastomosis of intestine debate has been log going on but now many prefer inverted because mucosa is exposed to mucosa and eventually degrades joining the two submuoca together to cause healing by primary intention.

REF Schakelford: page 923

Borrmann’s classification for ca stomach

Q) According to Borrmann's Classification of Ca stomach Type II is

a) Fungating

b) Polypoid

c) Ulcerative

d) Infiltrative

Answer free

Ans  a

Fungating

Borrmann’s classification is for advanced gastric tumors. 

It is useful to distinguish between advanced and early gastric tumors because in advanced tumors neo adjuvant therapy improves over all survival.

The gross appearance of advanced gastric carcinomas can be divided into

Type I for polypoid growth

Type II for fungating growth,

Type III for ulcerating growth,

Type IV for diffusely infiltrating growth which is also referred to as linitisplastica 

advanced ca stomach
Borrman's classification of ca stomach

Thyroid Questions

Q) Which of the following thyroid cancers do not take up radio active iodine

a) Medullary carcinoma thyroid

b) Papillary  carcinoma

c) Follicular carcinoma

d) Hurthle cell carcinoma

Free Answer

a - Medullary carcinoma

Medullary carcinoma of the thyroid is a tumor that arises from the C cells ie the parafollicular cells and not from cells of thyroid follicles.

These are not TSH dependent and hence do not take up radioactive iodine

Hurthle cell carcinoma is a variation of follicular carcinoma only.

In these tumors lymph node involvement is about 60%

Bailey page 769