Q) A 50 year old male undergoes pancreatectomy for Carcinoma head of pancreas. His pre op Hb was 9.2g% and during surgery he received 5 units of PRBC. In the post op period on the 2nd day he develops ECG changes. Work up is done for Myocardial Ischemia which is negative. What is the most common cause of ECG changes here
Free Answer b, Hyperkalemia
Transfusion of high volume of PRBC especially stored blood leads to hyperkalemia. In the setting of pancreatectomy in an already anemic patient, if massive blood transfusion is given, chances of hyperkalemia are there.
The ECG changes of Hyperkalemia are tall T waves, shortened QT interval and ST segment depression
Q) A 55 year old lady presents with vague pain in right lower abdomen. Physical examination reveals a well defined mass there which is non tender and freely mobile. It is non pulsatile as well. What is the most likely possibility?
a) Appendicular mass
b) Mesenteric cyst
c) Perforated tubo ovarian mass
d) Meckel's diverticulum
Mesenteric cysts are uncommon lesions found in this age group. It typically presents as a freely mobile mass which moves perpendicular to small blwel axis. It is painless as well.
Appendicular mass will have a preceding history of pain abdomen
Similarly perforated tubo ovarian mass will also have a history of pain
Meckel's diverticulum does not present as this kind of mass
Q) True about blood supply of stomach
a) Right gastric artery is the largest artery to the stomach
b) At least three out of four arteries of the stomach can be ligated and blood supply to the stomach may remain preserved.
c) Right gastric artery originates from splenic artery
d) Aberrant left hepatic artery arises from splenic artery
Blood supply of stomach is mostly consistent and there are four named arteries.
Left gastric artery is the largest artery to the stomach and in 15-20% cases, there is an aberrant left hepatic artery which arises from it.
At least three arteries of the stomach can be safely ligated if the arcades on the greater and lesser curvatures are preserved and vascularity of whole of stomach may be preserved.
Right gastric artery is the branch of common hepatic artery or Gastro duodenal artery
Aberrant left hepatic artery is the branch of Left gastric artery. It is seen in 15-20% cases.
Right gastro epiploic artery is the branch of Gastro duodenal artery and left gastro epiploic from splenic artery
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
- Retained antrum syndrome
- Afferent loop obstruction
- Duodenal stump leak (1-3%)
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