Q3.Helicobacter Pylori (H.Pylori) is a known cause of peptic ulcer disease.
It was discovered in Australia in 1987.
Which of the following statements is not true regarding it
a) Its infectivity is highest in developed world.
b) Person to person transmission is common
c) It is seen in populations with low socio economic status
d)H. Pylori is a gram negative microaerophilic bacteria
Q4. Which of the following hormones are not released in duodenum?
a) Gastrin
b) Motilin
c) Somatostatin
d) Pancreatic YY
Q5. Treatment for bleeding duodenal diverticulum is
a) Diverticulectomy
b) Diverticulopexy
c) Diverticulization
d) Subtotal diverticulectomy
Answers
1. b
A type I hernia is known as a sliding Hiatus Hernia and is characterized by upward displacement of the GE junction into the posterior mediastinum. The stomach remains in its usual longitudanal postion.
Type II—a “true” paraesophageal hernia PEH—is defined by a normally positioned intraabdominal GE junction with upward herniation of the stomach alongside it. A type III hernia is known as a “mixed” hernia and is characterized by displacement of both the GE junction and a large portion of the stomach cephalad into the posterior mediastinum.
The difference between a type I or sliding HH and a type III or mixed PEH is that with a type III hernia, a portion of the stomach lies cephalad to the GE junction.
In a type IV hernia, the esophageal hiatus has dilated to such an extent that the hernia sac also contains other organs such as the spleen, colon, or small bowel .
PEHs initially develop on the left anterior aspect of the esophageal hiatus
Yeo: Shackelford's Surgery of the Alimentary Tract, 6th ed.
2. d
Not all patients are good candidates for laparoscopic PEH repair. Those who have previously undergone open HH repair or laparoscopic PEH repair and obese patients are poor candidates for the laparoscopic approach. This group of patients is probably best approached transthoracically.
In such cases the advantages include complete mobilization of the the esophagus with dissection of the sac.
3. a
H. Pylori was discovered by Warren and Marshall in 1987. It is a disease associated with poor sanitation, over crowding and under developed countries. Peptic ulcer associated with H. Pylori is rarely seen in the developed countries.
Sabiston 18th page 1236
4. d
Peptide YY is released from ileum.
Gastrin - G cells stomach
Motilin- M cells from duodenum and jejunum
Somatostatin - D cells in pancreas, stomach and duodenum
5. a
Treatment of choice in such cases is diverticulectomy. Subtotal diverticulectomy is done if the diverticulum is very close to ampulla of vater to safeguard the bilio- pancreatic ducts
