Stomach 16-20

 Stomach 1-5       Questions 6-10             Questions 11-15                       Questions 21-  25                    Bariatric Surgery

Q16. Which of the following is not true for Dieulfoy's lesion of the stomach?

 A) Wedge Resection of the stomach is a treatment modality
B) Endoscopy can diagnose all cases
C) Lesser curvature of the stomach is involved
D) It can cause massive bleeding

Q17. What is not included in the triad of zollinger ellison syndrome (ZES)
 A) Hyperacidity
B) Intractable duodenal ulcer disease
C) Liver secondaries
D) Non beta islet cell tumor of pancreas

Q18. Which is not a metabolic abnormality after gastrectomy
a) Weight loss
b) Hypokalemia
c) Anemia
d) Osteoporosis

 Q19 ) True about gastric volvulus

a) Organoaxial rotation is less common than mesenteroaxial 

b) Organoaxial rotation is associated with diaphragmatic defect

c) Symptoms are gradual and chronic

d) Most of the cases require resection of compromised stomach

Q20) 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

Dieulfoy's lesion is a submucosal arterial bleeding in the stomach. Endoscopy can not diagnose all the cases because the arterial bleed is submucosal. Endoscopic treatment is tried initially with sclerotherapy. Other modalities are angiographic and surgcial wedge excicsion.
17) c
Zollinger Ellison syndrome is a non beta islet cell tumor of the pancreas.
Although all of these may occur but hypokalemia is the least common.
These are more common after antrectomy/gastrectomy than vagotomy. Also more chances of these problems after Billroth II gastrectomy. Iron absorbtion from the proximal jejunum requires an acidid environment which is lost after gastrectomy leading to iron deficiency anemia.
B12 deficiency anemia also develops after gastrectomy.
These patients require cyanocobalalmine injections every 3-4 months.
Fat malabsorbtion leading to osteoporosis is common after gastrectomy. Hypocalecemia is another metabolic problem.
19) b

Gastric volvulus  is a rare emergency in stomach

Organoaxial is more common than mesenteroaxial roatation and is associated with diaphragmatic defect

In adults the diaphragmatic defects are traumatic or paraesophageal hernias and in children they are congenital

Symptoms are often sudden and acute and treatment requires reduction of stomach and fixation with closure of diaphragmatic defect.

In 5-28% some form of  gastric resection is required.

20) a

Dumping Syndrome is caused when the pyloric sphincter is bypassed or removed occurring in 20% of cases after distal gastrectomy.

MOA- Rapid emptying of gastric contents (high in carbohydrates) in the duodenum. This leads to net fluid retention and release of VIP and serotonin.

Symptoms are GI related and neurological. GI symptoms are nausea vomiting diarrhea and cramps

Neurological symptoms are diaphoresis, flushing and palpitations.


  1. Small frequent meals with separation of solids and liquids
  2. Octreotide effective in almost all cases
  3. Surgery is the last resort

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