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Q1. Ideal treatment of alkaline reflux gastritis after after Billroth I and Billroth II gastrectmy is
a) Conversion of Billroth I gastrectomy to Billroth II gastrectomy
b) Roux en Y gastrojejunostomy
c) Total gastrectomy
d) Conservative management
Q2.Surgical Treatment of bleeding Type I gastric ulcer is
a) Wedge resection of the gastric ulcer
b) Oversewing the vessel at the ulcer base
c) Distal gastrectomy
d) Distal gastrectomy along with truncal vagotomy
Q3.Helicobacter Pylori (H.Pylori) is a known cause of peptic ulcer disease. It was discovered in Australia in 1987.
Which of the following statements is not true regarding it
a) Its infectivity is highest in developed world.
b) Person to person transmission is common
c) It is seen in populations with low socio economic status
d)H. Pylori is a gram negative microaerophilic bacteria
Q4. Which of the following hormones are not released in duodenum?
d) Pancreatic YY
Q5. Treatment for bleeding duodenal diverticulum is
d) Subtotal diverticulectomy
Once a diagnosis of alkaline reflux gastritis is made, treatment is directed at the relief of symptoms. Medical or conservative treatment is not very helpful and do not show consistent benefit.
Surgery is recommended for those who have intractable symptoms. The surgical procedure of choice is conversion of Billroth II to Roux-en Y Gastrojejunostomy in which is the Roux loop is lengthened to about 45 cm
Sabiston text book of surgery 18th edition page 125
Treatment of choice for a bleeding gastric ulcer Type I is distal gastrectomy followed with a Billroth I gastrojejunostomy. For type II and type III ulcers vagotomy is added.
If the patient is too moribund to undergo gastrectomy then other options available are wedge excision of the ulcer or just under running of the bleeding vessel and biopsies of the ulcer.
Sabiston textbook of surgery 18 page 1249
H. Pylori was discovered by Warren and Marshall in 1987. It is a disease associated with poor sanitation, over crowding and under developed countries. Peptic ulcer associated with H. Pylori is rarely seen in the developed countries.
Sabiston 18th page 1236
Peptide YY is released from ileum.
Gastrin - G cells stomach
Motilin- M cells from duodenum and jejunum
Somatostatin - D cells in pancreas, stomach and duodenum
Treatment of choice in such cases is diverticulectomy. Subtotal diverticulectomy is done if the diverticulum is very close to ampulla of vater to safeguard the bilio- pancreatic ducts
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