Complications of duodenal diverticulum

Q) True statement regarding complications of duodenal diverticulum is

a) Perforation is the commonest complication

b) Obstruction is caused by extra luminal duodenal diverticulum

c) Bleeding is the most common complication of duodenal diverticulum.

d) Diverticulitis is common and easily diagnosed.

Answer

c

Complications of duodenal diverticulum are rare with a reported incidence of 5-10% in those with duodenal  diverticulum. Operative intervention is required in about 1% cases

Perforation is the rarest but the most severe complication of duodenum diverticulum. The most common cause of perforated duodenal diverticulum is diverticulitis. They perforate in the retroperitoneum, adding to diagnostic uncertainty. Ct Scans are most diagnostic to help in this diagnosis. Read More ...

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

 

Compartment syndrome of limb

Q) All are true about compartment syndrome of limb except?

a) Diagnoses is unlikely if pulse is felt distally

b) There is pain on passive stretching of the limb

c) Pain is out of proportion to the signs

d) Muscles of calf and forearm are commonly involved

Answer 

As a result of trauma, pressure within limbs increase,..

Read on

Q Which of the following is not a criteria for diagnosing Sphincter of Oddi Dysfunction

a) Common Bile Duct  diameter more than 12 mm on USG

b) Decrease in Common Bile Duct  pressure after infusion of Cholecystokinin

c) Ampullary pressure more than 40 mm Hg

d) Delayed emptying of contrast from Common Bile Duct after ERCP

Answer Premium members