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Q61. which of the following statements regarding arterial blood supply of the colon is incorrect?
a) Marginal artery of Drummond is a collateral vessel that connects SMA with IMA
b) Arc of Riolon or meandering mesenteric artery connects proximal SMA with proximal IMA
c) Right colic artery is the most constant branch of Ileo colic artery
d) Splenic flexure is the area of watershed
Q2. Growth factor for adaptive response is
a) Gastrin b) Secretin
c) Neurotensin d) VIP
Q3. Schilling test is not used in
a) Steatorrhoea b) Blind loop syndrome
c) Pernicious Anemia
Q4. Most important investigation for Dysphagia in 60 year old is
a) Upper GI Endoscopy b) CT Thorax
c) Barium Swallow d) MRI
Q5. Maximum potassium concentration is seen in
a) Saliva b) Gastric Secretion
c) Jejunum d) Colon
Answers
Ilio colic artery is the most constant branch of Superior mesenteric artery (SMA). Right colic artery is absent in 2-18% and middle colic artery is absent in 4-20% cases.
Sabiston 17th edition page 1406
2. C
SHORT BOWEL SYNDROME is a clinical condition characterized by rapid intestinal transit and malabsorption in individuals who have a congenital or acquired lesion leading to intestinal resection .
Surgical outcome in a given individual depends on the extent and location of resection and how well the residual intestine adapts to the reintroduction of oral nutrition.
All layers of the bowel wall have been shown to participate in a hyperplastic adaptive response to intestinal resection
In addition to a marked increment in the diameter and some increase in the length of the residual intestine there are structural, functional, and cytokinetic adaptations of the mucosa, with augmentation of the intestinal mucosal surface area. In both animal and human studies, the adaptive increase in intestinal mucosal mass is associated with gradual functional compensation that is characterized by diminishing fecal losses and increased transit time associated with increased segmental absorption of water, electrolytes, and nutrients
The mediators of intestinal adaptive response are multifactorial, and the literature supports three categories of factors:
Intestinal luminal nutrients such assoluble fiber, fatty acids, triglycerides, glutamine, polyamines, and lectins,
pancreaticobiliary secretions of small intetine
Intestinal hormonal and/or systemic factors [growth hormone, epidermal growth factor, transforming growth factor-, enteroglucagon, insulin-like growth factors I and II, keratinocyte growth factor, GLP-2, peptide YY, neurotensin, bombesin, and cytokines including interleukin (IL)-3, IL-5, and IL-11]
Gastrin can also have an effect
Ref. http://ajpgi.physiology.org/cgi/content/full/275/5/G911
3. A
The Schilling test is used to determine whether the body absorbs Vitamin B12 normally
Abnormal Stage I and II Schilling tests may indicate:
Biliary disease
Intestinal celiac disease (sprue)
Hypothyroidism
Liver disease
Lower-than-normal amounts of Vitamin B12 absorption may indicate:
biliary disease, resulting in intestinal malabsorption (inadequate absorption of nutrients from the intestinal tract)
intestinal malabsorption (for example, related to sprue or celiac disease)
liver disease (causing malabsorption)
pernicious anemia
Additional conditions under which the test may be performed:
anemia of B-12 deficiency
blind loop syndrome
megaloblastic anemia
Steatorrhea is intestinal fat malabsorbtion
4. A
To rule out esophageal carcinoma in a 60 year old manis the 1st concern in this case. Endoscopy of the esophaguswould aid in direct visualisation as well as biopsy.
although barium would provide a road map for endoscopy most important remains a.
5. A
we are checking for references
