Association of WDHA syndrome

Q. WDHA syndrome is associated with 
A. VIPoma
B. Somatostatinoma
C. Glucagonoma
D. Gastrinoma

Answer 

 

Retained antrum syndrome

Q) True about retained antrum syndrome after gastrectomy  are all except

a) It is a persistent hypergastrinemic state

b) It is only seen after Billroth II Gastrectomy

c) Technetium labelled food is not helpful in diagnosing this condition

d) Serum gastrin is usually less than 1000 pg/ml


Answer c

 After billroth II gastrectomy, if a cuff of gastric mucosa remains with duodenum, this entity is called as retained antrum syndrome. This cuff of gastric mucosa is cut off from the proximal stomach and inhibitory effect of hormones such as VIP (Vasoactive Intestinal Peptide)  leading to a persistent hypergastrinemic state. ALso this gastric mucosa is continuously bathed by the alkaline contents of duodenum , which further increases the acid formation.

Both Basal and maximal gastric acid outputs increase but it is not as high as seen in zollinger ellison syndrome. Typically less than 1000 pg/ml

This condition can present as recurrent and persistent ulcerations. Technetium scanning is the diagnostic modality of choice. Treatment is re do surgery and antral excision.

Technetium pertechnate imaging has a sensitivity of 73% and specificity of 100%

More about retained antrum syndrome

NOTES

Q) Regarding minimal access cholecystectomy all are true except?

a) NOTES can be done transvaginally and transgastrically

b) Transgastric route is preferred

c) SILS is done through single port with multiple instruments avoiding multiple ports

d) SILS has difficulty with triangulation and retraction


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Answer is B

Natural  orifice  transluminal  endoscopic  surgery (NOTES),  which  uses  natural  orifices  (transgastric, colonic,  urethral,  vagina)  to  introduce  an  endoscope,  has been  reported  since  early  2000  as  a  less  invasive  approach to  laparoscopy.  The  first  human  NOTES  transvaginal  cholecystectomy  was  reported  in  2007,  and  later  the  report  of a  hybrid  combination  of  flexible  scope  by  a  transvaginal approach  in  combination  with  an  umbilical  needle  or port  for  laparoscopic  instruments  for  retraction,  dissection,  or  clips  application.  This  hybrid  technique  allowed for  a  quicker  and  safer  procedure;  the  present  deficiency is  in  the  proper  endoscopic  instrumentation. For  the  trans vaginal  approach,  a  Foley  catheter is  placed,  a  dissection  is  performed  in  the  posterior vaginal  cul-de-sac  to  allow  a  port  placement,  and  when the  case  is  over,  the  closure  is  easier  than  a  transgastric or  transcolonic  approach,  which  continues  to  be  an  issue.

Shackelford

Anal canal

 Q  True about anal canal anatomy are all except
a) Columns of morgagni above dentate line
b) Resting anal canal Pressure 5 – 20 mm Hg
c) Muscles are tubular with inner layer supplied by autonomic nerves

d) Contains columnar, transitional and squamous epithelium

Answer