Q13 Which of the following is not true about the mechanism of duodenal injuries?
a) Most of the duodenal injuries are penetrating in nature
b) Blunt abdominal injuries are equally distributed in incidence in the four parts of duodenum
c) 2nd part of duodenum is the most common site of injury in all the types of injury
d) Motor vehicle accidents are the most common form of blunt abdominal injuries
Q14. In patients with short bowel syndrome most common cause of death is
a) Underlying disease for which surgery was done
b) Supervening disease
c) Complications of TPN (Total Parenteral Nutrition)
d) All have equal incidence
Q15. All of the following help prevent liver disease in patients on chronic TPN
a) Prevent over administration of calories
b) Control Sepsis
c) Frequent line changes
d) Prevent bacterial overgrowth
Answers
11. d
NSAID-induced ulcers occur more commonly in the ileum, with single or multiple ulcerations noted. Complications necessitating operative intervention include bleeding, perforation, and obstruction. In addition to ulcerations, NSAIDs are known to induce an enteropathy characterized by increased intestinal permeability leading to protein loss and hypoalbuminemia, malabsorption, and anemia.
Other causes of small bowel ulceration
Infections--- Tuberculosis, syphilis, cytomegalovirus, typhoid, parasites, Strongyloides hyperinfection, Campylobacter, Yersiniosis
Inflammatory ---Crohn’s disease, systemic lupus erythematosus, celiac disease, ulcerative enteritis
Ischemia --Mesenteric insufficiency
Idiopathic ---Primary ulcer, Behçet’s syndrome
Drug induced ---Potassium, indomethacin, phenylbutazone, salicylates, antimetabolites
Radiation---- Therapeutic, accidental
Vascular----- Vasculitis, giant cell arteritis, amyloidosis (ischemit lesion), angiocentric lymphoma
Metabolic---- Uremia
Hyperacidity ---Zollinger-Ellison syndrome, Meckel’s diverticulum, stomal ulceration
Neoplastic---- Lymphoma, adenocarcinoma, melanoma
Toxic ---Acute jejunitis (ß-toxin-producing Clostridium perfringens), arsenic
Mucosal lesions---- Lymphocytic enterocolitis
Ref Book- Sabiston text book Surgery
12) a
Formerly, malnutrition and electrolyte imbalance were the causes of death in the majority of patients with small bowel fistula. In
the present era of fistula treatment, mortality is largely attributable to uncontrolled sepsis and sepsis-associated malnutrition.
Ref Book: Shackelford's Surgery of Alimentary canal 6th edition Chapter 73
13. b
Blunt trauma leads to injuries mostly in the 2nd and 3rd part of duodenum and penetrating injuries are evenly distributed.
Blunt duodenal injuries are caused by a complex series of forces that may crush, burst, or shear the duodenum. Crush injuries are due to a blow to the anterior abdominal wall, which then crushes the duodenum against the underlying vertebral column.
Xray Abdomen
Air around the right kidney, right psoas, or cecum
Obliteration of the right psoas shadow
Scoliosis of the spine to the left.
Free air is seen in less than 10% of patients with duodenal rupture
14. b
50% of the deaths occur due to supervening diseases especially sepsis. 1/3rd occur due to the underlying disease and 20% to complications of TPN
15.c
Frequent line changes is not advised unless the line becomes infected
