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
Q10. Which of the following is not an indication of re exploration of a patient after CABG
a Mediastinal drain output more than 500 ml in the 1st hour
b Drain output of 200 ml in 2 hours.
c Pericardial tamponade
d Large hemothorax
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.
10) b
2-3% of patients require reexploration for bleeding after CABG .
The increased risk is due to hepatinization, hypothermia, CPB (coronary pulmonary bypass) and protamine.
Persistent blood loss of 200 ml / 4 hrs is an indication for surgery.
All the above statements except (b) are true.
Also CPB (coronary pulmonary bypass) machine use is associated with increased risk of bleeding, neuro cognitive dysfunction, thromboembolism, fluid retention and reversible organ dysfunction. The levels of neutrophil elastase, interleukin 8, C3a and C5 a are also increased in CPB leading to higher rates of infection.
Advantages of OPCAB (off pump coronary artery Bypass)
1. Less blood loss
2. Less ICU and Hospital stay
3. Less neurocognitive dysfuncti
Notes
Newer advances in Coronary Revascular techniques
1. Robotic Intervention
Da Vinci surgical robots for harvesting Internal thoracic artery and CABG
2. Transmyocardial LASER Revascularization
