Cholecystostomy

Q.    Regarding percutaneous cholecystostomy A/E

a.       Technical success in 90 – 98 % of cases

b.      Indicated in Grade II cholecystitis with significant pericholecystic inflammation & GOO

c.       Indicated in Gr III cholecystitis with significant comorbidity

d.      In Grade III cholecystitis with biliary peritonitis, PCC results in significant improvement

Answer 

Modified Nissen’s fundoplication

Q ) Modified Nissen's Fundoplication

a) 2700 anterior wrap around esophagus

b) 2400 wrap

c) 3600 wrap over > 52 Fr for 1 – 2 cm

d) 600 wrap over 42 Fr for 4 cm

Answer

c

Nissen fundoplication is complete 360 degree but has high incidence of gas bloat. To counter this modification done to wrap over 52 F tube for 1-2 cm

Belsey - Left thoracotomy, mobilization of distal esophagus and stomach, hiatus opened from above,  fundus is brought 270 degrees around distal esophagus. Then the whole assembly is brought down and crura is repaired.

Hill procedure - No fundoplication is done

Toupet is anterior fundoplication either 240 degree or 270 degree.

 

Foreign body esophagus

Q) True about foreign body in esophagus

a) Sharp objects should be operated and not retrieved

b) Lead batteries should be removed

c) Most common impacted foreign bodies are dentures

d) Contrast examination of esophagus should be done before endoscopy

 

Answer

b

Sharp objects can be removed over overtubes and not always require surgery. Lead batteries can corrode and decay in the stomach or intestine and should always be removed. Most common impacted foreign bodies are food boluses above a pathological narrowing and require endoscopic break up

Contrast examination is not always required and might complicate things

Bailey page 991

Cholelithiasis with Choledocholithiasis

Q.  Patients with gallstones and choledocholithiasis in a centre with endoscopy, interventional radiology and tertiary care centre

a.       Single setting lap chole + CBDE better than endoscopy followed by lap chole

b.      In choledocholithiasis endoscopic clearance alone without lap chole can be done without any long term complication

c.       For impacted ampullary stones with CBD dilatation that requires biliary enteric drainage is performed with a preferred open approach

Answer

 

Survival after pancreatic resection in Ca head of Pancreas

Q) Median survival after surgery and chemotherapy in Ca Head of Pancreas

a) 12 months

b) 22 months

c) 32 months

d) 44 months

Answer for premium members

This is an interesting question because this is one tumor in which breakthrough has not been achieved in the last 70 years. Pancreatic cancer remains one of the deadliest cancers of the GI tract and whipple's surgery continues to have high morbidity.

We discuss the role and response of chemotherapy also