Indication Surgery crohn disease

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Q. Most common indication of surgery in Crohn's disease (#AIIMS GI )    (# Jejunum MCQS) 
a) Fistula
b) intractability
c) abscess
d) obstruction

Ans d Obstruction

Confusion between failure of medical therapy or obstruction as the ans. I have checked Bailey sabiston and Shackelford

2 books mention obstruction on top whereas one mentions failure of medical therapy. However with the improvement of medical management in the past decade, obstruction can be the ans

Crohn’s disease will require surgery at some time durin the course of their illness. Approximately 70% of patients will
require surgical resection within 15 years after diagnosis.

Indications for surgery include failure of medical treatment, bowel obstruction, and fistula or abscess formation. Most patients can
be treated with elective surgery,

Bleeding in Ulcerative colitis

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Q) 30 yr old female with severe rectal bleed known case of UC , on admission not responding to steroids and medical treatment  .. next line of treatment ?
a) Subtotal colectomy with Ilerorectal anastomosis
b) Subtotal colectomy with ileostomy

c) Total Proctocolectomy TPC with ipaa
d) Tpc with end iliostomy

 

CDH 1 gene

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Q) CDH 1 gene is associated with which cancer

a) Breast

b) Colon

c) Prostate

d) Renal

ANs a CDH 1 is with gastric and lobular breast cancer

Germline mutation in the CDH1 gene encoding E-cadherin was shown to be associated with hereditary diffuse gastric cancer. Prophylactic total gastrectomy should be considered in patients with these mutations

Renal mainly associated with VHL

Amylase in pancreatitis

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Q) In  acute pancreatitis all are true except :

1) Amylase is more sensitive for first 5 days than lipase

2) S. lipase remains elevated for a longer time

3) Amylase levels not included in definitive diagnostic criteria of acute pancreatitis

4) Amylase levels may not be elevated in 19 % of patients

 

Colon Lymphoma

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Q) True about lymphoma of the colon

a) MOre common in females

b) Most common in 3rd and 4th decade

c) Most common site is caecum

d) T cells are most commonly involved

Ans c

Lymphoma is uncommon in the colon/rectum occurring in 0.4% of patients; intestinal lymphoma and can present anywhere between the
second and eighth decades of life.

Most of these lesions are intermediate to high-grade B-cell lymphomas.

Affected men outnumber women about 1.5:1 

The majority of colorectal lymphomas are found in the cecum or ascending colon. More than 70% of colorectal lymphomas are proximal to the hepatic flexure. 

 

Xeloda Regimen

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Q) Xeloda Regimen is 

a) Continuous 5 fU infusion

b) Folfox

c) Folfiri

d) fluropyradmidine and Capecitabine