Stomach Surgery

Stomach Ulcer surgery

These are questions in stomach surgery asked in MCH, MRCS and USMLE exams. Stomach is a vast topic and questions can range from anatomy, physiology, benign diseases such as GAVE, menetrier's disease and malignancy.

I have included a separate page for GI bleed

There are 5 questions on this page followed by answers and explanations.

 Q1. Ideal treatment of alkaline reflux gastritis after Billroth I and Billroth II gastrectomy is-

 a) Conversion of Billroth I gastrectomy  to Billroth 2 surgery
b) Roux en Y gastrojejunostomy
c) Total gastrectomy
d) Conservative management
 Q2.Surgical Treatment of bleeding Type I stomach 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?
a) Gastrin
b) Motilin
c) Somatostatin
d) Pancreatic YY
Q5. Treatment for bleeding duodenal diverticulum is
a) Diverticulectomy
b) Diverticulopexy
c) Diverticulization
d) Subtotal diverticulectomy


Answers to questions on Stomach Surgery

 1. b
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 the Roux limb is lengthened to 45 cm
2. c
Treatment of choice for a bleeding gastric ulcer Type I is distal gastrectomy followed with a Billroth I gastrojejunostomy.Types of Gastric Ulcers
For type II and type III ulcers vagotomy is added.
If the patient is too moribund to undergo gastrectomy,  other options  include wedge excision of the ulcer or just under running of the bleeding vessel and biopsy of the ulcer.
Sabiston textbook of surgery 18 page 1249
3. a
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
4. d
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
5. a
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.
Links to other exam questions (premium pages)  in gastric surgery are......
Questions 6-10                      Questions 11-15                                   Duodenum Questions