16. Boundaries of gastrinoma triangle are all except
a) Cystic duct & CBD junction
b) Gall Bladder& cystic duct junction
c) Junction of Neck of pancreas & Head of Pancreas
d) 2nd and 3rd part of duodenum
Q17. One of the follwing is not the surgery for duodenal ulcer disease
a) Taylor
b) Hill Baker
c) HSV
d) Lewis Tanner
Q18) Duodenal obstruction is caused by all except
a) Duodenal Diverticulum
b) Annular Pancreas
c) SMA syndrome
d) Malrotation of duodenum
Q19) Duodenal atresia is associated with all except
a) Malrotation of gut
b) Tracheo esophageal fistula
c) Imperforate anus
d) Down syndrome
e) All are seen
Q20) Crohn's disease True Statement is
A. Is caused by Mycobacterium paratuberculosis.
B. Is more common in Asians than in Jews.
C. Tends to occur in families.
D. Is less frequent in temperate climates than in tropical ones.
E. Is improved by smoking.
16) b
The upper part of the triangle is at the porta hepatis ie the junction of cystic duct and CBD. Medially is the junction of head and neck of duodenum and laterally is the junction of 2nd and 3rd part of duodenum
It is the site for 70-80% of gastrinomas with duodenum being the most common site.
17) d
Lewis is for radical three field esophagectomy
Taylor procedure is laparoscopic posterior vagotomy with anterior seromyotomy
Hill Bake procedurer is laproscopic posterior vagotomy and anterior highly selective vagotomy.
18) a
Duodenal diverticulum is asymptomatic.
It is a true diverticulum at posteromedial apect of second portion of duodenum
Emergency surgery in duodenal obstruction is required for perforation or haemorrhage.(5-10%)
All other conditions cause duodenal obstruction.
Schakelford page 27
19) e
Duodenal atresia can be associated with other GI and biliary tract abnormalities (malrotation, esophageal atresia, ectopic anus, annular pancreas, gallbladder or biliary atresia, vertebral anomalies).
In addition, duodenal atresia can be associated with a duodenal diaphragm as well as congenital abnormalities in other systems. Examples include vertebral defects, anal atresia, tracheoesophageal fistula with esophageal atresia, and radial and renal anomalies (VATER) association and vertebral, anal, cardiac, tracheal, esophageal, renal, and limb (VACTERL) association. Anomalies of the kidneys can occur in VATER association.
These are usually aplasia, dysplasia, hydronephrosis, ectopia, persistent urachus, vesicoureteral reflux, ureteropelvic obstruction, and other conditions.
Down's syndrome is the commonest anomaly.
20) c
The cause of Crohn's disease is unknown. No specific microorganism has been identified as a pathogen, and no clear-cut environmental factor, such as smoking, has been implicated, even though many patients with Crohn's disease are heavy smokers. The disease does tend to occur in families. It is more common among Jews than Asians and among people who live in temperate climates than those in tropical ones.
