MCH Preparation in GI, Onco & General Surgery

3500 Surgery SuperSpeciality MCQS .

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Gold Standard Investigations in GI Surgery and Onco Surgery

Esophagus

Ambulatory pH monitoring is the gold standard for the diagnosis of GER. ( SKF 61)

Esophageal high-resolution manometry (HRM) is currently the gold standard for the evaluation of esophageal motility ( SKF 11)

The current gold standard for the operative treatment of GERD is the laparoscopic Nissen fundoplication. ( SKF 234)

The gold standard of bariatric surgery is still the laparoscopic Roux en-Y gastric bypass. ( SKF chapter 24)

Barium esophagram as the gold standard for evaluating PEH ( SKF 286)

Endoscopic therapy as the gold standard in patients with high-grade dysplasia in Barrett esophagus. ( SKF 350)

 Stomach

  1. Solid phase gastric emptying test is the current gold standard for the diagnosis of gastroparesis
  2.  Gold standard for diagnosis of H. pylori is mucosal biopsy performed during upper endoscopy

Endocrine

  1. Gold standard in breast reconstruction with autogenous tissue is the transverse rectus abdominis ( saby 868) 
  2. Bilateral neck exploration (BNE) has long been the gold standard operation for PHPT ( Saby 931) 
  3. The gold standard for diagnosis of insulinoma is the 72-hour monitored fast  ( Saby 952) 

Miscellaneous

  1. Use of the urinary bladder catheter has been the gold standard and is the indirect method used to measure IAP  ( Saby 308) 

Gastrinoma diagnosis

Q) Gastrinoma false is (AIIMS GI 2020) 
a) Fasting sG 1000 g/ml
b) Duodenotomy should be done in all cases
c) Diarrhoea most common symptom
d) SRS can localize 80% cases

Ans  )  c -

Duodenotomy detects 25% to 30% of tumors not seen on preoperative imaging.

Gastrin  levels higher than 1000 pg/mL are strongly suggestive of gastrinoma, provided that the patient demonstrated increased gastric acid  secretion ( gastric secretion ph should be less than 2) 

Most common is abdominal pain ( 75%) In 10% to 20% of patients, diarrhea is the only symptom ( Saby page 954) 

SRS should be performed because almost all gastrinomas express somatostatin receptors.

2nd primary tumors

Q) In buccal mucosa cancer after surgery and CRT, after 2 year patient developed cancer at base of tongue with N3 nodes positive. Best line of management
A .Palliative RT
B. CTRT
c. Rehabilitation
D.  Surgery followed CTRT

There are two parts to this questions 

a) Second Primary tumor (SPM)

b) Management of Base of tongue tumors with N3

Both are discussed here ---

 

Caustic Injuries of Esophagus

Q . Caustic injury of esophagus pick up the  false statement
a) Steroid is used 
b) Carcinoma risk  is 30%
c) Contrast study has false negative of 25%
d Esophageal stent reduce leaks by 75%

Ans ) a

Points of esophagus caustic injuries

There is no proven benefit of starting steroids in early or intermediate phase of injury as there is no evidence to support prevention of stricture

  1. Endoscopy should be performed after initial stabilization
  2. Complete esophagus can be examined now with flexible endoscopes
  3. Available studies show no benefit of steroid use ( skf PAGE 521) 
  4. Cancer risk is 30% in injured and non injured portions

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