Q) Which of the following is true about giant gastric ulcer?
a) 70-80% of these ulcers are malignant
b) By definition giant gastric ulcer is more than 1.5 cm in size
c) Medical therapy can heal 80% of such ulcers
d) They are more common on the greater curvature and invade surrounding organs like spleen, liver etc
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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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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