HCC Cancer

Q) Which of the following is true about screening in hepatocellular carcinoma (HCC Cancer) 

a) Alpha feto protein should be done 6 monthly

b) Ultrasound abdomen should be done 6 monthly

c) Candidates for liver transplant should be screened every 3 months

d) Nodules more than 2 cm should be followed up  more regularly

Answer b

In a cirrhotic liver, hcc cancer  can develop any time and a stringent screening protocols  have  to be followed for early detection and timely treatment. Earlier ultrasound of liver and alpha feto protein were both used as tumor markers. However in 2009 Marrero et al demonstrated the suboptimal accuracy of AFP and after that it has been removed from the screening protocol and now only ultrasound is being done.

The screening recommendation is not for those patients with severe Read More ...

Cholecystostomy

Q.    Regarding percutaneous cholecystostomy A/E

a.       Technical success in 90 – 98 % of cases

b.      Indicated in Grade II cholecystitis with significant pericholecystic inflammation & GOO

c.       Indicated in Gr III cholecystitis with significant comorbidity

d.      In Grade III cholecystitis with biliary peritonitis, PCC results in significant improvement

Answer 

Modified Nissen’s fundoplication

Q ) Modified Nissen's Fundoplication

a) 2700 anterior wrap around esophagus

b) 2400 wrap

c) 3600 wrap over > 52 Fr for 1 – 2 cm

d) 600 wrap over 42 Fr for 4 cm

Answer

c

Nissen fundoplication is complete 360 degree but has high incidence of gas bloat. To counter this modification done to wrap over 52 F tube for 1-2 cm

Belsey - Left thoracotomy, mobilization of distal esophagus and stomach, hiatus opened from above,  fundus is brought 270 degrees around distal esophagus. Then the whole assembly is brought down and crura is repaired.

Hill procedure - No fundoplication is done

Toupet is anterior fundoplication either 240 degree or 270 degree.

 

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

Duodenal atresia

Question on Duodenal atresia was asked in AIIMS 2017 in April

Q) An infant presents with duodenal atresia. Which of the following is true about this condition?

a) It is the most common GI atresia

b) It presents soon after birth with non bilious vomiting

c) Pre natal detection of duodenal atresia is common

d) Gastro jejunostomy is the procedure of choice to bypass the obstruction

Answer (free) 

C-

Commonly detected in the pre natal ultrasound

Duodenal atresia is seen in 1:5000 live births and most common atresia is jejunoileal (1in 2000). It is associated with lot of other congenital malformations like Down's,  prematurity, biliary atresia etc.

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