Preparartion Stomach SURGERY Questions

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

Answers

16)b

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.

18)b

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.

Notes

Criteria for Unresectability in Carcinoma Stomach

1. Distant metastasis

2. Loco regional spread

a) Level 3 or 4 lymph nodes on imaging or biopsy

b) Invasion or encasement of major vascular structures

In Metastatic Ca stomach

If Karnofsky Performance status is more than 60% or ECOG performance score is less than 2 then chemotherapy otherwise best suppportive care