Weight loss surgery

Q) Which  of the following statement about Roux en Y gastric bypass is not true?

a) After weight loss it resolves symptoms of venous ulcers due to stasis

b) Symptoms of pseudo tumor cerebri are resolved

c) Heartburn is alleviated immediately

d) Protein malnutrition is a very common problem

 

Answer 

d Protein malnutrition is common in Biliopancreatic division and duodenal switch.

Essential components of successful Roux en Y gastric bypass are 

  1. Small Gastric pouch (15-20ml) made from cardia of stomach
  2. Keep the length of roux limb at around 75 cm
  3. Division of gastric pouch from distal end of stomach

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Mass in Right lower quadrant

Q) A 55 year old lady presents with vague pain in right lower abdomen. Physical examination reveals a well defined mass there which is non tender and freely mobile. It is non pulsatile as well. What is the most likely possibility?

a) Appendicular mass

b) Mesenteric cyst

c) Perforated tubo ovarian mass

d) Meckel's diverticulum

Answer

b

Mesenteric cysts are uncommon lesions found in this age group. It typically presents as a freely mobile mass  which moves perpendicular to small blwel axis. It is painless as well.

Appendicular mass will have a preceding history of pain abdomen

Similarly perforated  tubo ovarian mass will also have a history of pain 

Meckel's diverticulum does not present as this kind of mass

  • gastricbypass.surgery
  • Dumping Syndrome

    Q) Which of the following is true about dumping syndrome

    a) Somatostatin analogues are effective in controlling symptoms

    b) Symptoms always include flushing and tachycardia 

    c) Diarrhea is always part of dumping syndrome

    d) Part of treatment includes combining solids with liquids in frequent small meals

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    Contraindication of liver transplantation

    Q) Which is an absolute contraindication for liver transplantation

    a) Previous breast cancer

    b) Portal vein thrombosis

    c) Active tuberculosis

    d) Active substance abuse

    Answer

    d

    Previous history of breast cancer if completely treated is not an contraindication of liver transplant. Portal vein thrombosis was earlier considered a relative contraindication but almost all series have shown similar results in patients with PVT than patients without PVT.

    Active tuberculosis can be managed after transplant but any kind of active substance abuse alcohl. drugs etc are absolute contraindications for liver transplant.

    Nutrient Absorption

    Q) What is true regarding absorption of nutrients from small intestine?

    a) Bile salt is required for absorption of Vitamin B12

    b) Parathyroid hormone increases calcium absorption

    c) Triglycerides are synthesized by intestinal epithelial cells before being released in portal circulation

    d)  Iron deficient individual can absorb 80% of dietary iron

    Answer

    b

    Calcium absorption is due to Vitamin D and Parathyroid hormone. Bile salt is required for absorption of fat soluble vitamins like Vitamin A, D, E& K

    Vitamin B12 requires intrinsic factor. Triglyceride absorption occurs in the form of Free fatty acids and monoglycerides.

    Only 20% iron is absorbed by iron deficient individuals

     

    Nutcracker esophagus

    Q) Which of the following is the least common symptom of nutcracker esophagus?

    a) Pain in chest

    b) Dysphagia

    c) Odynophagia

    d) Regurgitation

    Answer d

     Nutcracker esophagus is a hyper contractile disorder of the  esophagus in which there is excessive contractility of the esophagus. There are high amplitude peristaltic contractions in the body of esophagus.

    It is the most common motility disorder of the esophagus.

    It can occur in all age groups and is of equal distribution in both sex.

    Nutcracker esophagus symptoms

    1. Chest pain
    2. Dysphagia
    3. Painful deglutition (Odynophagia)

    Acording to the Chicago classification 

     There is  subjective complaint of chest pain with at least one swallow showing a distal contractile integral greater than 8000 mm  Hg with single or multi­peaked contractions on HRM. The LES pressure is normal, and relaxation occurs with each wet swallow

    Manometry shows

    1. High amplitude peristaltic contractions in distal 10 cm of esophagus
    2. After ten 5 ml swallows average amplitude is more than 220 mmHg

    Management

    1. Avoid trigger inducing foods such as caffeine
    2. Calcium channel blockers, Nitrates, Antispasmodics
    3. Esophageal dilatation in some cases

     

    GI Bleed

    Q )  A 59 year old male alcoholic male presents with history of upper GI bleed of 1 day duration. During the day he has had three episodes of bleeding each time about 150 ml. Blood is fresh and not associated with retching. He has a history of long standing alcohol intake. What will be the most likely cause of GI bleed

    a) Mallory weiss tear

    b) Esophageal varices

    c) Gastric ulcer

    d) Esophagitis

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